Comparison of clinical result between early laparoscopic cholecystectomy and delayed laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for patients with complicated acute cholecystitis

BACKGROUNDS/AIMS: In the treatment of complicated cholecystitis, laparoscopic cholecystectomy (LC) has limited efficacy due to its substantial post-operative complications. In addition, the clinical characteristics of complicated cholecystitis (CC) patients were suspected as advanced age with highly risky comorbidity. Percutaneous transhepatic gall bladder (PTGBD) drainage could be an alternative option for successful LC. Hence, this study evaluated the outcome of PTGBD for CC within and after 5 days. METHODS: The medical records of 109 consecutive CC patients who had undergone an LC between January 2007 and December 2011 were retrospectively reviewed and compared with the medical records of CC patients who had undergone an LC within 72 hours of (group I, n=63) or 5 days after PTGBD (group II, n=40). In addition, group I was divided into group Ia (n=46) and group Ib (n=17), according to the patients' development of open-conversion or post-operative complications. The clinical outcomes of the four groups were analyzed. RESULTS: There was a significantly higher reference to age, the ASA score grading, and predominant comorbidities in group II than in group I. The peri-operative results of group II showed lower blood loss and relatively shorter operating times than those of group I. In the cases of early LC within 72 hours (group Ia vs. group Ib), the difference was statistically insignificant. CONCLUSIONS: The delayed LC after PTGBD for complicated cholecystitis with high clinical risk had better results in this study, although it prolonged the patient's hospital stay.

Laparoscopic Totally Extraperitoneal Hernia Repair for Inguinal Hernia Patients: Results of 92 Cases / 대한내시경복강경외과학회지

PURPOSE: Laparoscopic totally extraperitoneal herniorrhaphy (TEP) was developed as an alternative treatment of inguinal hernias to open hernia repair. This study evaluated 92 cases of laparoscopic surgery to determine the effectiveness and safety of laparoscopic TEP. METHODS: Laparoscopic TEP was performed on 92 patients with inguinal hernias from January 2008 to December 2010. Through a retrospective study of these patients, information om TEP repair was collected including the patients' characteristics, operation time, hospital stay, analgesic use and related complications. RESULTS: Laparoscopic herniorrhaphy were performed on a total of 92 patients (85 men and 7 women, age ranging from 16 to 83 years, with a mean of 56 years). The mean operation time for a unilateral inguinal hernia and bilateral inguinal hernia was 58.7 and 84.2 min, respectively. The mean postoperative hospital stay was 4.0 days (range, 2~9 days). Thirty nine patients were discharged without an analgesic injection, whereas 36 patients were injected with analgesic on the day of surgery. Of these 92 procedures, 10 complications were recorded; one granuloma complication, two patients with operation site discomfort, five with urinary retention issues, one patient with a scrotal seroma, and one patient with scrotal edema. CONCLUSION: TEP repairs have minimal morbidity and are more effective with less pain than the open procedure. TEP repair can be considered a favorable procedure for patients who request minimally invasive procedures for inguinal hernia repairs.

Clinical Features of Gastric Cancer Patients with a Second Primary Cancer

PURPOSE: The aim of this study was to clarify the risk factors and clinicopathologic features of gastric cancer patients with a second primary cancer (SPC). METHODS: The data on 2455 patients with gastric cancer was analyzed retrospectively with respect to the clinicopathologic features of the pathologically proven SPC. RESULTS: Of the 2,455 patients, there were 90 (3.7%) gastric cancer patients with SPC. Among them, 31 patients had synchronous cancers and 59 had metachronous cancers. Of the 59 metachronous cancers, 21 were found before the gastric surgery and 38 were found after the gastric surgery. The most prevalent SPC was colorectal cancer (28 cases) and followed by cancer in the liver (13 cases) kidney and pancreas (6 cases each, respectively). Among the 61 patients with SPC found after gastric cancer surgery, 31 cases (50%) were diagnosed within 2 years. On comparison of the clinicopathologic features, the patients with SPC tended to be older, more prone to have early gastric carcinoma and to have multiple gastric lesions. The survival rate of the patients with SPC and gastric cancer alone was not different; however, there was a significantly difference for the patients with early gastric cancer (61.7% vs. 91.3%, respectively, P < 0.05). CONCLUSION: For the patients who were older, had multiple primary lesions or they had early gastric cancer, evaluation for SPC, and especially in the colon and liver, should be considered during routine follow up.

Expression of Survivin and HSP90 in Colorectal Cancer and its Relationship with Clinicopathologic Factors

PURPOSE: Survivin is an inhibitor of apoptosis protein and it is overexpressed in most human cancers. Recent data demonstrated that survivin-HSP90 complex regulate apoptosis. We assessed expression of survivin and HSP90 by using immunohistochemistry with colorectal cancer tissue and correlate it with clinicopathologic prognostic parameters. METHODS: Using immunohistochemistry, survivin and HSP90 expression were evaluated on paraffin sections of fifty-six colorectal carcinomas. Various clinicopathologic parameters including histologic differentiation grade, T-stage, nodal metastasis, stage were obtained from pathologic records. RESULTS: Survivin expression were observed in 30 cases (53.6%). The expression of survivin showed no statistically significant correlation with histologic differentiation grade, T-stage, nodal metastasis, stage. HSP90 expression were observed in 31 cases (55.4%). The expression of HSP90 showed a statistically significant correlation with histologic differentiation grade (P=0.035) and stage (P=0.017). There were a significant correlation between survivin expression and HSP90 expression (P=0.018). CONCLUSION: Survivin and HSP90 was expressed in colorectal cancer. The expression of HSP90 correlates with histologic differentiation grade, stage. The above results suggest that HSP90 could be a prognostic marker of poor outcome in colorectal carcinoma.

Clinicopathologic Characteristics of and Prognosis for Patients with a Borrmann Type IV Gastric Carcinoma

PURPOSE: The prognosis for patients with a Borrmann type IV gastric cancer is extremely poor despite an aggressive surgical approach. We evaluated the clinicopathological features for Borrmann type IV cancers to find treatment strategy. MATERIALS AND METHODS: The 1098 patients with advanced gastric cancer who underwent surgical resection between 1990 and 2001 were analyzed. These patients were divided into two groups: 81 patients with a Borrmann type IV carcinoma, and 1017 patients with all other types of gastric carcinomas. RESULTS: Patients with a Borrmann type IV carcinoma were younger than those with other types, and female was prevalent (p=0.000). Of the patients with a Borrmann type IV gastric carcinoma, 68 patients (84%) were classified as stage III or IV at the initial diagnosis. The histologic type was commonly undifferentiated and serosal infiltration; nodal involvement and lymphatic invasion were more frequent in patients with a Borrmann type IV than in those with other types of cancer. Multivariate analysis confirmed that the extent of lymph node metastasis was a negative prognostic factor for Borrmann type IV gastric carcinomas. The curability for a Borrmann type IV carcinoma was only 53.1%, and peritoneal dissemination rate was 25.9%. The predominant pattern of recurrence for a Borrmann type IV gastric carcinoma was peritoneal dissemination, and it was significantly different with other types (93.1% vs 55.8%, P<0.05). The 5-year survival rate of patients with a Borrmann type IV gastric carcinoma was significantly lower than those of patients with other types of cancer, even though a curative resection had been accomplished (26% vs 63%, p<0.005). The 5-year survival rates of patients with a Borrmann type IV carcinoma following a curative resection were 44.9%, 24%, and 0% for stages II, III and IV, respectively (p<0.05). CONCLUSION: Because the prognosis for patients of a Borrmann type IV gastric cancer is extremely poor despite a curative resection, preoperative and/or intraperitoneal chemotherapy should be considered. And diagnostic laparoscopy and peritoneal cytology may be used to play an important role in accurate staging workup.