Comparison of Short-term Outcomes of Laparoscopic-Assisted Colon Cancer Surgery Using a Joystick-Guided Endoscope Holder (Soloassist II) or a Human Assistant

PURPOSE: This study aimed to compare the short-term outcomes of laparoscopic-assisted colon cancer surgery in the Soloassist II-assisted (SA) group and in the human-assisted (HA) group. METHODS: A total of 76 patients with colon cancer who underwent laparoscopic-assisted right hemicolectomy and anterior resection performed by a single surgeon between January 2017 and May 2018 were recruited from the consecutively enrolled registry and retrospectively analyzed. RESULTS: Of 76 patients, 43 underwent surgery with human assistance and 33 underwent surgery using the Soloassist II system. The clinicopathologic characteristics were not statistically different between the 2 groups. In both HA and SA groups, no statistical difference was observed between operation time (220.23 ± 47.83 minutes vs. 218.03 ± 38.22 minutes, P = 0.829), total number of harvested lymph nodes (20.42 ± 10.86 vs. 20.24 ± 8.21, P = 0.938), and other parameters of short-term outcomes (length of hospital stay, blood loss, open conversion, time to flatus, time to soft diet, and complication events). Subgroup analyses did not show statistical differences. CONCLUSION: Soloassist II can reduce the participation of a human assistant during surgery and is not inferior to human assistance in laparoscopic-assisted colon cancer surgery. Thus, it is a feasible instrument in laparoscopic-assisted colon cancer surgery that can provide positive short-term outcomes.

Primary Undifferentiated Pleomorphic Sarcoma of the Colon Mesentery

An undifferentiated pleomorphic sarcoma (UPS), also known as a malignant fibrous histiocytoma in the past, commonly involves the soft tissue of the extremities and the retroperitoneum. However, a primary UPS of the colon mesentery is very rare. A 69-year-old male patient visited our outpatient department for treatment of an enlarged, palpable mass in the right lower quadrant (RLQ). Computed tomography showed a 15-cm multilobulated, heterogeneous, enhanced mass in the RLQ, which we suspected originated from the colon. He underwent a right hemicolectomy, and the pathologic result was a colon mesenteric UPS. We report a rare case of a primary UPS of the colon mesentery and discuss the characteristics of this neoplasm in reference to the literature.

Efficacy and Safety of Laparoscopic Hartmann Colostomy Reversal

PURPOSE: Hartmann operation is widely recognized as a useful procedure, especially in emergencies involving the rectosigmoid colon. One of the surgeon’s foremost concerns after Hartmann operation is future colostomy reversal, as colostomy reversal after a Hartmann procedure is associated with relatively high morbidity and mortality. Laparoscopic surgical techniques continue to prove useful for an ever-increasing variety of indications. We analyzed the outcomes of laparoscopic Hartmann colostomy reversals at our center. METHODS: We retrospectively analyzed the hospital records of 170 patients who had undergone Hartmann operation between January 2010 and June 2017 at Wonkwang University Hospital. Among 68 Hartmann colostomy reversals, we evaluated and compared the outcomes of 3 groups of patients: 29 patients in the open colostomy reversal group (OG) who had undergone laparotomies for Hartmann reversals, 19 patients in the conversion group (CG) whose laparoscopic procedures had required conversion to a laparotomy, and 20 patients in the laparoscopy group (LG). RESULTS: The overall reversal rate for Hartmann colostomies was 40.5% during this time period. The duration of hospital stay was significantly shorter among LG patients (10.15 ± 2.94 days) than among OG patients (16 ± 9.5 days). The overall complication rate among OG patients was higher than that among LG patients (adjusted odds ratio, 8.78; P = 0.01). The most common complication was postoperative ileus (19.1%). CONCLUSION: If no contraindications to laparoscopy exist, surgeons should favor a laparoscopic reversal of Hartmann operation over an open reversal.

Serine/arginine-rich splicing factors 2 (SRSF2) and SRSF4 expression patterns in Korean with colon cancer

PURPOSE: Splicing factors play important roles in tumorigenesis. Serine/arginine-rich splicing factors 2 (SRSF2) and SRSF4 proteins, the members of SR family proteins, are dysregulated in various cancers. However, their protein expression levels and diagnostic values are unclear in colorectal cancer.METHODS: We quantified the protein levels of SRSF2, SRSF4, and previously known colon cancer markers (heterogeneous nuclear ribonucleoprotein A1 [HNRNPA1] and carcinoembryonic antigen [CEA]) in tumor compared with adjacent normal-looking areas (non-tumor) of the colon in Korean patients with colon cancer using immunoblot analysis.RESULTS: The protein levels of HNRNPA1 and CEA were remarkably increased in tumor compared to non-tumor tissue and up-regulated in all of the tumor samples. However, the protein levels of SRSF2 and SRSF4 in tumor tissue were reduced in contrast with those of non-tumor tissue.CONCLUSION: None of the SRSF proteins were significantly different between the low (≤II) and high (>II) stages.

Necrotizing Fasciitis Arising From an Enterocutaneous Fistula in a Case of an Appendiceal Mucocele

An appendiceal mucocele (AM) is a rare tumorous condition of the appendix. Many patients with AM are admitted to the hospital with abdominal pain or discomfort, and many cases are found incidentally. Although the rate of complications in patients with AM is very low, if left untreated, a mucocele may rupture and produce a potentially fatal entity known as pseudomyxoma peritonei. In this paper, we report a case of an 80-year-old man with necrotizing fasciitis arising from an enterocutaneous fistula caused by AM.

Association between genetic polymorphisms in cortactin and susceptibility to gastric cancer

PURPOSE: Overexpression of cortactin (CTTN) in human tumors has been proposed to result in increased cell migration and metastatic potential. Here, we determined the frequencies of CTTN g.-9101C>T, g.-8748C>T, and g.72C>T polymorphisms in apparently healthy subjects and gastric cancer patients, respectively, and the influence of the CTTN polymorphisms on gastric cancer susceptibility. METHODS: Blood samples were collected from 267 patients and 533 controls. CTTN g.-8748C>T and g.-9101C>T polymorphisms were determined using polymerase chain reaction-restriction fragment length polymorphism; the g.72C>T polymorphism was determined using the TaqMan method. RESULTS: Genotype frequencies of the CTTN g.-9101C>T polymorphism were 97.5% (TT), 2.5% (TC), and 0% (CC) in the patient group, and 98.6% (TT), 1.4% (TC), and 0% (CC) in the control group. Genotype frequencies of the CTTN g.-8748C>T polymorphism were 93.3% (TT), 6.8% (TC), and 0% (CC) in the patient group, and 94.2% (TT), 5.8% (TC), and 0% (CC) in the control group. Genotype frequencies of the CTTN g.72C>T polymorphism were 82.4% (CC), 17.2% (CT), and 0.4% (TT) in the patient group, and 78.0% (CC), 20.1% (CT), and 1.9% (TT) in the control group. Genotype and allele frequencies of the CTTN g.-9101C>T polymorphism differed significantly between the advanced gastric cancer and control groups. Patients with advanced gastric cancer, possessing the TC genotype, had a significantly poorer prognosis than the group with the TT genotype. CONCLUSION: The CTTN g.-9101C>T polymorphism might influence advanced gastric cancer susceptibility. However, the role of the CTTN g.-9101C>T, g.-8748C>T, and g.72C>T polymorphisms requires careful interpretation and confirmation through larger studies.

Appendiceal Neuroendocrine Tumor with Lymph Node Metastasis in a Teenager / 대한소화기학회지

Neuroendocrine tumor (NET) is a cancer-like tumor that occurs mostly in the gastrointestinal system. Within the gastrointestinal tract, NET most commonly occurs in the rectum whereas appendix is very rarely involved. In most cases of appendiceal NET, it is found at a relatively early stage compared to other NETs because appendiceal NET frequently presents with acute appendicitis because appendiceal NET frequently presents with acute appendicitis even when the size is smaller than 1 cm. Therefore, it is very rare for lymph node metastasis to occur in a young adult. Herein, we report a rare case of grade 1 appendiceal NET with lymph node metastasis which developed in a teenage male.

A Case of Appendiceal Perforation Caused by Fishbone

On rare occasions, ingested foreign bodies make their way into the appendix, which can cause an inflammatory reaction with or without perforation. In addition, perforation of the appendix by a foreign body is relatively rare, however, it should be considered in atypical cases of peritonitis, intra-abdominal abscess, or mass, and intestinal obstruction. We experienced a case of appendiceal perforation caused by a fishbone, which presented as chronic abdominal pain and intra-abdominal abscess. A 57-year-old man presented with ambiguous lower right-side abdominal pain with fever for approximately one week. Abdominal computed tomography showed a foreign body in the appendix with abscess formation. Subsequently, a laparoscopic appendectomy was performed and histopathological examination confirmed perforated appendicitis with severe inflammation secondary to a foreign body.

Clinical Implications of Methylenetetrahydrofolate Reductase Mutations and Plasma Homocysteine Levels in Patients with Thromboembolic Occlusion

PURPOSE: Hyperhomocysteinemia has been identified as an independent risk factor in arterial and venous thrombosis. Mutations in genes encoding methylenetetrahydrofolate reductase (MTHFR), involved in the metabolism of homocysteine, may account for reduced enzyme activity and elevated plasma homocysteine levels. In this study, we investigated the interrelation of MTHFR C677T genotype and level of homocysteine in patients with arterial and venous thrombosis. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 146 patients who were diagnosed as having arterial and venous thrombosis. We excluded patients diagnosed with atrial fibrillation. We examined routinely the plasma concentration of total homocysteine level and MTHFR C677T polymorphism for evaluation of thrombotic tendency in all patients. Screening processes of MTHFR C677T polymorphism were performed by real-time polymerase chain reaction. RESULTS: Investigated groups consisted of thrombotic arterial occlusion in 48 patients and venous occlusion in 63 patients. The distribution of the three genotypes was as follows: homozygous normal (CC) genotype in 29 (26.1%), heterozygous (CT) genotype in 57 (51.4%), and homozygous mutant (TT) genotype in 25 (22.5%) patients. There were no significant differences among individuals between each genotype group for baseline characteristics. Plasma concentration of homocysteine in patients with the TT genotype was significantly increased compared to the CC genotype (P<0.05). CONCLUSION: We observed a significant interaction between TT genotypes and homocysteine levels in our results. The results might reflect the complex interaction between candidate genes and external factors responsible for thrombosis.

Chronic gastric anisakiasis provoking a bleeding gastric ulcer

Gastric anisakiasis is a parasitic disease caused by the gastric mucosal penetration of the Anisakis larvae ingested with raw fish. Acute gastric anisakiasis is diagnosed by the endoscopic visualization of Anisakis larvae along with mucosal edema, erythema, hemorrhage, and/or an ulcer, whereas chronic anisakiasis is often observed as a localized tumor commonly occurring in the submucosal layer, and is characterized by eosinophilic granuloma with edema and embedded Anisakis larvae on pathological examination of surgical specimens. We report here a case of chronic gastric anisakiasis provoking a bleeding gastric ulcer, which is a rare clinical manifestation of this condition.

Postoperative Pain Relief Using Wound Infiltration With 0.5% Bupivacaine in Single-Incision Laparoscopic Surgery for an Appendectomy

PURPOSE: Recently, single-incision laparoscopic surgery (SILS) has been popular for minimally invasive surgery and cosmetic improvement. However, some papers have reported that SILS for an appendectomy (SILS-A) has had the more postoperative complaints of pain. We investigated postoperative pain relief using wound infiltration with 0.5% bupivacaine in SILS-A and compared the result with that for conventional SILS-A. METHODS: Between July 2010 and September 2012, 75 patients who underwent SILS-A were enrolled in this study. The patients were randomly assigned to two groups: conventional SILS-A group (C-SILS-A) or wound infiltrated with 0.5% bupivacaine in SILS-A group (W-SILS-A). Forty-five patients were in the C-SILS-A, and 30 patients were in the W-SILS-A. Patients with perforated appendicitis were excluded. The clinical outcomes were compared between the groups by using the verbal numerical rating scale (VNRS). RESULTS: Clinical outcomes were similar in both study groups except for the pain score. The W-SILS-A group showed significantly lower numbers of additional pain killers and lower VNRS scores 1, 6, and 12 hours after surgery than the C-SILS-A group. CONCLUSION: W-SILS-A is a technically simple and effective method of reducing early postoperative pain. It may be applicable in SILS-A for pain control system.

Application of single incision laparoscopic surgery for appendectomy in children / 대한외과학회지

PURPOSE: Recently, single incision laparoscopic surgery (SILS) has been popular in use with its progress studied for more minimally invasive surgery and cosmetic improvement. We investigated the feasibility and efficacy of SILS for appendectomy (SILS-A) in children and compare it with conventional laparoscopic appendectomy (C-LA). METHODS: We studied, retrospectively, adolescent patients who underwent C-LA or SILS-A. There were 25 patients in the C-LA group and 30 patients in the SILS-A group. The clinical outcomes were compared between the groups. RESULTS: The SILS-A procedures were performed successfully in adolescent patients . There were no significant difference between the C-LA and SILS-A group with respect to demographic data and post-operative outcomes. There was one complication (4%) in the C-LA group and two complications (6.6%) in the SILS-A group, but there was no significant difference. CONCLUSION: SILS-A was technically feasible and safe in children. Considering little postoperative scar and no difference in post-operative outcomes compared to C-LA, SILA could be applicable in adolescent patients. Larger studies and further technical implements will be necessary to assess the true benefit of this approach.

Association of CTTN polymorphisms with the risk of colorectal cancer / 대한외과학회지

PURPOSE: Various studies searching for biomarkers to predict tumor metastasis or prognosis in both esophageal squamous cell carcinoma (ESCC) and head and neck squamous cell carcinoma (HNSCC) are currently underway. However, few data have been reported on its association with colorectal cancer (CRC). Single nucleotide polymorphisms (SNPs) are the most common known form of human genetic variation and may contribute to an increased susceptibility to cancer including CRC. The present study aimed to investigate whether the polymorphisms in the CTTN gene are associated with susceptibility to CRC in the Korean population. METHODS: A case-control study was performed to examine the relationship between the CTTN g.-9101C>T, g.-8748C>T, and g.72C>T polymorphisms and the risk of CRC. Polymerase chain reaction-restriction fragment length polymorphism analysis of g.-8748C>T, g.-9101C>T and Taqman analysis of g.72C>T were performed on blood samples from 218 patients with CRC and 533 control individuals. The g.-9101C>T, g.-8748C>T, and g.72C>T SNPs in CTTN and their haplotypes were analyzed. RESULTS: The genotype and allele frequencies of g.-9101C>T, g.-8748C>T, and g.72C>T did not differ between the patient group and the control group. Further, the haplotype of CTTN g.-9101C>T, g.-8748C>T, and g.72C>T did not differ between patient group and the control group. However, the genotype and allele frequencies of CTTN g.-9101C>T were significantly increased in the lymph node positive CRC group compared to the control group. CONCLUSION: The CTTN g.-9101C>T polymorphism may influence lymph node positive CRC.

Laparoscopic Treatment of Adult Sigmoidorectal Intussusception Caused by a Mucinous Adenocarcinoma of the Sigmoid Colon: A Case Report

Intussusception is a rare cause of intestinal obstruction in adult patients, but is common in children. In fact, it accounts for an estimated 1% of all cases of bowel obstruction in adults, although adult intussusception of the large intestine is rare. Sigmoidorectal intussusception, however, is a rare variety with few cases reported in the literature. A mucinous adenocarcinoma, a subtype of adenocarcinoma, is characterized by extracellular mucin production and accounts for between 5% and 15% of the neoplasms of the colon and rectum. Despite the general consensus supporting surgical resections for adult intussuceptions, controversy remains over whether intussuceptions should be reduced before resection. Most cases of colon intussusception should not be reduced before resection because they most likely represent a primary adenocarcinoma. However, prior reduction followed by a resection can be considered for the sigmoidorectal intussusception to avoid inadvertent low rectal cancer sugery. We experienced one case of sigmoidorectal intussusception caused by a mucinous adenocarcinoma of the sigmoid colon in a 79-year-old woman. Abdominal computed tomography demonstrated a sigmoidorectal intussusception. After the end-to-end anastomosis-dilator-assisted reduction, the patient underwent a laparoscopic oncological anterior resection under the impression that a sigmoidorectal intussusception existed. We report a successful laparoscopic anterior resection in a patient with an intussusception caused by a sigmoid malignant tumor.

Primary adenosquamous carcinoma of the colon / 대한외과학회지

Adenosquamous cell carcinoma (Ad-SCC) of the colon is rare. The pathogenesis of Ad-SCC is unclear, however, several hypotheses have been suggested. The clinical presentation and gross findings of Ad-SCC of the colon are similar to those of adenocarcinoma of the colon, but Ad-SCC has a more aggressive clinical course and a poorer prognosis. We report on two cases of Ad-SCC of the colon with obstruction; a collision-type Ad-SCC that has not only obstruction but also numerous hepatic metastases, and a composite-type Ad-SCC treated with left hemicolectomy followed by an adjuvant chemotherapy.

Retrograde Jejunojejunal Intussusception Presenting as Hematemesis

Retrograde jejunal intussusception is a rare complication following gastric surgery. Unless this complication is suspected, diagnosis is very difficult. Early diagnosis is very important in preventing avoidable morbidity and mortality. Awareness of this rare complication would help in early diagnosis and appropriate management. We present a case of an 84-year-old woman who visited the emergency department with hematemesis. Endoscopy and a computed tomography scan revealed a retrograde jejunojejunal intussusception, which was treated by surgical manual reduction.

A Case of Angiosarcoma in Rectum

Angiosarcoma is a malignant vascular neoplasm that usually involves the skin or soft tissues. A primary rectal angiosarcoma is exceedingly rare. A 77-year-old female was admitted to the hospital for evaluation of constipation and hematochezia. The patient had a history of uterine cervix carcinoma which was treated with surgery and radiation therapy. A colonoscopy revealed a friable, ulceroinfiltrative tumor with multiple hyperemic mucosae in the rectum. Microscopically, the tumor exhibited vasoformative growth with nuclear atypism and numerous mitoses. The tumor cells were strongly positive for CD31, CD34, and Factor VIII. We report a case of rectal angiosarcoma that developed after radiation therapy.

A Case of Angiosarcoma in Rectum

Angiosarcoma is a malignant vascular neoplasm that usually involves the skin or soft tissues. A primary rectal angiosarcoma is exceedingly rare. A 77-year-old female was admitted to the hospital for evaluation of constipation and hematochezia. The patient had a history of uterine cervix carcinoma which was treated with surgery and radiation therapy. A colonoscopy revealed a friable, ulceroinfiltrative tumor with multiple hyperemic mucosae in the rectum. Microscopically, the tumor exhibited vasoformative growth with nuclear atypism and numerous mitoses. The tumor cells were strongly positive for CD31, CD34, and Factor VIII. We report a case of rectal angiosarcoma that developed after radiation therapy.

Synchronous granular cell tumors in the perianus and chest wall / 대한외과학회지

Granular cell tumor (GCT) is a rare tumor that originates from the Schwann cells in the skin, soft tissues, and internal organs. Usually, GCTs are clinically benign, although malignant and multifocal forms are very rarely known to occur. Cases of GCT of the perianus are rare, and thus far, no study has reported synchronous GCTs of the perianus and the chest wall. We report a case of a 31-year-old woman with synchronous GCTs of the perianus and the chest wall to have a mind of consideration of the possibility of GCT in the differential diagnosis of perianal tumor.

Small Bowel Obstruction Caused by Acute Invasive Enteric Anisakiasis / 대한소화기학회지

Anisakiasis usually occurs in the stomach and can easily be diagnosed by digestive tract endoscopy as opposed to enteric anisakiasis which is very rare and difficult to be diagnosed definitively. The most important and useful tool in diagnosing enteric anisakiasis is obtaining an accurate patient history of having eaten raw fish before the onset of symptoms. We report a case of small bowel obstruction caused by acute invasive enteric anisakiasis. A 60-year-old woman visited the emergency room suffering from sudden abdominal pain. She had eaten raw fish 1 day before the onset of symptom. Radiologic studies showed small bowel obstruction. However, no definitive cause could be found. An emergency laparotomy revealed edematous and dilated proximal jejunum and a focal stenosis of the distal jejunum. Segmental resection of the jejunum was performed, and histopathological examination revealed enteric anisakiasis. The patient was discharged on the 7th day after surgery following an uneventful course of recovery.