Outcomes of selective surgery in patients with suspected small bowel injury from blunt trauma

PURPOSE: The role of initial conservative therapy with selective surgery for patients with suspected blunt bowel injury by radiologic evaluation is less clear. The aim of the study is to assess the outcomes of patients who received initial conservative therapy with selective delayed surgery, compared to emergency surgery. METHODS: During this 8-year study, a total of 77 patients who were hemodynamically stable were enrolled, in which computed tomography verified suspected bowel injury from blunt trauma (mesenteric hematoma, mesenteric fat infiltration, bowel wall thickening, and free fluid without solid organ injury) was managed with either initial conservative therapy with selective delayed surgery (group A; n = 42) or emergency surgery (group B; n = 35). The clinical outcomes including the rate of negative or nontherapeutic exploration and postoperative complications, between the groups were compared. RESULTS: The enrolled patients had a mean age of 41 years including 51 men and 26 women. No difference in the clinical characteristics was found between the groups. In group A, 18 patients underwent delayed surgery and 24 recovered without surgery. Among patients who underwent surgery, 3 (17%) underwent negative or nontherapeutic explorations. In group B, 13 (37%) underwent negative or nontherapeutic explorations. Postoperative complications occurred in 21 patients and there was no difference between the groups. CONCLUSION: Initial conservative therapy with selective delayed surgery did not increased severe postoperative complications and had a low rate of negative or nontherapeutic surgical explorations in hemodynamically stable patients with suspected blunt bowel injury.

Relationship between Preoperative 18F-Fluorodeoxyglucose Uptake and Epidermal Growth Factor Receptor Status in Primary Colorectal Cancer

PURPOSE: Both 18F-fluorodeoxyglucose (18F-FDG) uptake and epidermal growth factor receptor (EGFR) status are prognostic variables of colorectal cancer (CRC). The aim of this study was to investigate a possible association between 18F-FDG uptake on preoperative positron emission tomography/computed tomography (PET/CT) and EGFR status in primary CRC. MATERIALS AND METHODS: Records of 132 patients (66 men and 66 women; mean age=67.1+/-11.1 years) who underwent 18F-FDG PET/CT for CRC staging and subsequent bowel resection were reviewed. In primary lesions, 18F-FDG uptake was semiquantitatively evaluated in terms of maximum standardized uptake value (SUVmax), and EGFR status was determined by immunohistochemistry. Associations of clinicopathological parameters and EGFR status were analyzed by Pearson's chi-square test, multiple logistic regression, and receiver operating characteristic curves. RESULTS: Eighty-six patients (65.2%) showed EGFR expression. SUVmax was significantly lower in EGFR-negative tumors than in EGFR-expressing tumors (10.0+/-4.2 vs. 12.1+/-2.1; p=0.012). It was the only significant parameter correlated with EGFR expression (odds ratio=2.457; relative risk=2.013; p=0.038). At the SUVmax threshold of 7.5, the sensitivity and specificity for predicting EGFR expression were 84.9% and 40.4%, respectively (area under the curve=0.624; p=0.019). CONCLUSION: Preoperative 18F-FDG uptake is slightly correlated with EGFR status in primary CRC. Preoperative SUVmax of 18F-FDG may have a limited role in predicting EGFR expression in such tumors because of its poor specificity.

Exposure to Cigarette Smoke Contributes to the Risk of Developing a Colorectal Adenoma, Doesn't It? Are Repeated Exposures to Such Smoke Dangerous?

No abstract available.

Diffuse Ganglioneuromatosis of the Colon Presenting as a Large Subepithelial Tumor in Adults: Report of Two Cases / 대한소화기학회지

Colonic diffuse ganglioneuromatosis is a benign neoplastic condition characterized by disseminated, intramural, or transmural proliferation of neural elements involving the enteric plexuses, sometimes associated with von Recklinghausen's disease and other multiple tumor syndromes. Colonic diffuse ganglioneuromatosis is usually large, ranging from 1 to 17 cm, and thus can distort the surrounding tissue architecture as well as infiltrate the adjacent bowel wall. However, colonic diffuse ganglioneuromatosis is an exceptional finding in adults and only individual cases are reported in the literature. Herein, we report two unusual cases of adult patients with colonic diffuse transmural ganglioneuromatosis presenting as a large subepithelial tumor.

Reply on "Characteristics and Survival of Korean Anal Cancer From the Korea Central Cancer Registry Data"

No abstract available.

Reply on "Data on the Characteristics and the Survival of Korean Patients With Colorectal Cancer From the Korea Central Cancer Registry"

No abstract available.

Functional New Sphincter Ani Reconstruction by Using Neurovascualr Antropylorus Transposition After an Anorectal Excision

No abstract available.

Characteristics and Survival of Korean Anal Cancer From the Korea Central Cancer Registry Data

PURPOSE: In Korea, anal cancer is rare disease entity with specific clinical characteristics. Therefore, no survival analysis with a sufficient patient population has been performed. The aim of this study was to evaluate the characteristics of Korean anal cancer, focusing on the survival according to tumor histologies, sex, and a specific age group, using the nationwide cancer registry. METHODS: Using the Korea Central Cancer Registry, we analyzed a total of 2,552 cases from 1993 to 2010. We assessed the 5-year relative survival by using tumor histology. In addition, survival differences of Surveillance Epidemiology and End Results (SEER) stage were analyzed for both sexes and for young-age cancer (younger than 40 years) and advanced-age cancer (older than 70 years). RESULTS: The 5-year relative survival among anal cancer patients increased from 38.9% for the period 1993-1995 to 65.6% for the period 2006-2010. The anal squamous cell carcinoma was the most common histology and showed better survival than other types of cancer. Females demonstrated better survival than males in all SEER stages. The 5-year survivals for patients in whom anal cancer developed before the age of 40 and at or after the age of 40 were 62.4% and 51.6%, respectively. The 5-year survival for patients in whom cancer developed at or after the age of 70 was much worse than that for patients in whom the cancer had developed prior to that age. CONCLUSION: Korean anal cancer has certain distinctive characteristics of survival according to tumor histology, sex, and age. Despite limitations on available data, this study used the nationwide database to provide important information on the survival of Korean patients with anal cancer.

Characteristics and Survival of Korean Anal Cancer From the Korea Central Cancer Registry Data

PURPOSE: In Korea, anal cancer is rare disease entity with specific clinical characteristics. Therefore, no survival analysis with a sufficient patient population has been performed. The aim of this study was to evaluate the characteristics of Korean anal cancer, focusing on the survival according to tumor histologies, sex, and a specific age group, using the nationwide cancer registry. METHODS: Using the Korea Central Cancer Registry, we analyzed a total of 2,552 cases from 1993 to 2010. We assessed the 5-year relative survival by using tumor histology. In addition, survival differences of Surveillance Epidemiology and End Results (SEER) stage were analyzed for both sexes and for young-age cancer (younger than 40 years) and advanced-age cancer (older than 70 years). RESULTS: The 5-year relative survival among anal cancer patients increased from 38.9% for the period 1993-1995 to 65.6% for the period 2006-2010. The anal squamous cell carcinoma was the most common histology and showed better survival than other types of cancer. Females demonstrated better survival than males in all SEER stages. The 5-year survivals for patients in whom anal cancer developed before the age of 40 and at or after the age of 40 were 62.4% and 51.6%, respectively. The 5-year survival for patients in whom cancer developed at or after the age of 70 was much worse than that for patients in whom the cancer had developed prior to that age. CONCLUSION: Korean anal cancer has certain distinctive characteristics of survival according to tumor histology, sex, and age. Despite limitations on available data, this study used the nationwide database to provide important information on the survival of Korean patients with anal cancer.

Data on the Characteristics and the Survival of Korean Patients With Colorectal Cancer From the Korea Central Cancer Registry

PURPOSE: The incidence rates of colorectal cancer (CRC) in Korea have been increasing during the past decade. Therefore, it is important to understand the characteristics, including survival, of Korean CRC patients. The aim of this study was to use the nationwide cancer registry to evaluate the characteristics of Korean CRC, focusing on the survival, according to tumor location, sex, and specific age groups. METHODS: Using the Korea Central Cancer Registry (KCCR), we analyzed a total of 226,352 CRC cases diagnosed from 1993 to 2010. The five-year relative survivals were compared for the proximal colon, the distal colon, and the rectum. Survival rates were compared between men and women and between patients of young age (less than 40 years old) and patients of advanced age (70 years old or older). RESULTS: The 5-year survival rates were improved in all subsites between 1993 and 2010. Distal colon cancer showed favorable survival compared to proximal colon or rectal cancer. Females demonstrated worse survival for local or regional cancers, and this difference was significant in for patients in their seventies. Young patients ( or =40 years old), but advanced age patients (> or =70 years old) had worse survivals for all tumor subsites compared to their younger counterparts (<70 years old). These trends were similar in distant CRC. CONCLUSION: Korean CRC has certain distinct characteristics of survival according to tumor location, sex, and age. Despite the limitations of available data, this study contributes to a better understanding of survival differences in Korean CRC.

Safe Distal Resection Margin in Patients With T3 Mid and Distal Rectal Cancer Who Underwent a Sphincter-Saving Resection Without Preoperative Radiotherapy

No abstract available.

Laparoscopic colectomy of colonic intussusceptions in adults / 대한외과학회지

Adult intussusception is a rare entity. Most adult intussusceptions require surgical intervention because they have a high rate of pathologic leading point. Mandatory laparotomy and en bloc resection is recommended in colonic intussusceptions due to the possibility of malignancy. We report herein 3 cases of adult colonic intussusceptions. The intussusceptions were located in the sigmoid and rectum, which were managed by laparoscopic colectomy. Case 1 was managed by laparoscopic anterior resection and diverting ileostomy combined with perineal reduction. Perineal approach facilitated laparoscopic reduction. In case 2, intraoperative colonoscopy was performed to determine the distal resection margin. Intraoperative colonoscopy showed edematous bowel mucosa as well as leading point after reduction of intussusceptions. Case 3 showed asymptomatic transient rectorectal colonic intussusceptions.

Risk factors for the development of Clostridium difficile colitis in a surgical ward / 대한외과학회지

PURPOSE: Clostridium difficile colitis (CDC) is a nosocomial infection. We attempted to discover the risk factors for the development of CDC in patients admitted to our surgical ward. METHODS: We conducted a retrospective chart review of all patients admitted to our surgical ward between January 2010 and July 2011. CDC was confirmed when toxin A/B or toxin B polymerase chain reaction was detected in the stool and clinical symptoms, such as diarrhea, were present. We divided patients into the CDC and non-CDC groups, and compared the clinical features between the two groups. RESULTS: The rate of CDC occurrence was 0.4% (19/4,720 patients). Univariate analysis showed that colectomy (P < 0.001), hospital stays longer than 10 days (P < 0.001), aged over 55 years (P < 0.001) and transfer from medical ward (P = 0.009) were significant parameters for CDC. Multivariate analysis showed that colectomy (P < 0.001; odds ratio [OR], 8.405; 95% confidence interval [CI], 2.927 to 24.132) and hospital stays longer than 10 days (P = 0.035; OR, 10.253; 95% CI, 1.176 to 89.392) were high risk factors for CDC occurrence in the surgical ward. CONCLUSION: The risk factors for CDC in a surgical ward could be colectomy and a long duration of hospitalization. Therefore, clinicians should consider the possibility of CDC when patients undergo colectomy, are admitted for a long time, and have postoperative diarrhea.

Abdominal compartment syndrome caused by a bulimic attack in a bulimia nervosa patient / 대한외과학회지

We present a rare case of abdominal compartment syndrome due to a bulimic attack in a 19-year-old female patient with bulimia nervosa. She was admitted to our emergency room with complaints of progressive abdominal pain following bulimia. Computed tomography showed dilated stomach with food and air pressed other visceral organs and major abdominal vessels. Decompression using nasogastric tube or gastric lavage tube failed. At laparotomy, we performed gastrotomy and decompression was performed. After decompression, she fell into hypovolemic shock due to bleeding in the intra-gastric and peritoneal cavity. Twelve hours after the operation, the patient died due to refractory hypovolemic shock from uncontrolled bleeding following decompression of abdominal compartment. It should keep in mind that binge-eating habits in patients with bulimic nervosa could cause abdominal compartment syndrome due to gastric distension and this may be a potentially fatal condition.

How to Treat Retrorectal Cysts or Tumors in Adult

No abstract available.

Trans-Sacral Local Resection as a Posterior Approach

PURPOSE: Surgical removal for a mass in the pre-sacral space or mid rectum through a posterior approach is not frequent. We would like to present the technique of trans-sacral local resection as a posterior approach. We analyzed the follow up of patients who underwent surgery using the proposed technique. METHODS: A total of 21 patients who had undergone a trans-sacral local resection with lower sacrectomy between January 1997 and December 2006 were enrolled in this study. The diagnoses were large epidermal cyst, gastrointestinal stromal tumor, high grade adenoma, and early cancers in the mid rectum. We analyzed the surgical complications and disease recurrences. The mean follow up for tumors of the rectum was 53+/-35 mo. RESULTS: Epidural anesthesia was appropriate for all whole procedures. Among the 21 cases, there was one case of a rectocutaneous fistula as a postoperative complication (4.9%). In one case among the submucosal cancers, there was a systemic metastasis at 24 mo without local recurrence. CONCLUSION: In our experience, a trans-sacral resection with a lower sacrectomy is a good option and provides a wide and direct surgical exposure for the removal of a pre-sacral or a mid-rectal mass. Good bowel preparation is mandatory.

Intersphincteric Resection versus Stapled Coloanal Anastomosis for Low Rectal Cancer

PURPOSE: Local control and functional results of an intersphincteric resection are controversial in Asian, low BMI patients, even though it might a provide a chance to avoid a permanent colostomy. We tried to evaluate the potential risk of an intersphincteric resection, compared with a stapled coloanal anastomosis, in patients with low rectal cancer. METHODS: Patients with low rectal cancer, who underwent a intersphincteric resection with a hand-sewn anastomosis (ISR) or a coloanal anstomosis with staples (stapled CAA), were analyzed. RESULTS: From 1999 to 2006, 85 patients were enrolled. The distance between the anal verge and the lower margin of the tumor was 3.4+/-0.8 cm (range: 2~5 cm) in the ISR group and 4.9+/-0.8 cm (range: 3~7 cm) in the stapled CAA. The mean body mass index was 23 (range: 18~32). The patients complained postoperatively of intolerable anal incontinence (Kirwan's class > 2) in 35% of the ISR group and in 9% as the stapled CAA group, (P<0.02). The local recurrence rate was greater in the ISR group (15%) than in the stapled CAA group (2%, P<0.04). There was no significant difference in distant metastasis between the two groups. The disease-free survival rates were 80.8% and 91.2% at three years in the ISR group and the stapled CAA group, respectively. Complications, such as urinary incontinence and sexual dysfunction in male patients, were not significantly different between the two groups. CONCLUSIONS: An intersphincteric resection with hand-sewn anastomosis could be worse than a stapled coloanal anastomosis in function and local recurrence. This may indicate that careful selection is required for a intersphincteric resection even when a stapled anastomosis cannot be applied due to a narrow margin.

Laparoscopic Assisted Distal Rectal Cancer Resection with Preoperative Concurrent Chemoradiotherapy / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Anatomy of deep pelvis, narrow distal margin and tumor invasion into neighbor organ are obstacles for curative radical resection for advanced cancer of distal rectum. Technically, laparoscopic application after downstaging the tumor with preoperative concurrent chemotherapy (CCRT) may give a solution to overcome the anatomical difficulties. We compared the results of laparoscopic surgery in the patients who received CCRT with those of patients who had conventional surgery. MATERIALS AND METHODS: A continuous infusion of 5FU plus leucovorin and radiotherapy (50.4 Gy) in 28 fractions was given each patient as CCRT. They underwent D2 radical resection with TME and ANP for the rectal cancer in 4 weeks. RESULTS: Thirty three patients had laparoscopic resection such as LAR, colo-anal anastomosis and APR. The results were compared with 12 cases of the conventional resections. As a result of preoperative CCRT, the cancer was down-staged in 71%. Two year disease free survival was 75% and 74% in the group of conventional and laparoscopic resection, respectively (p=0.427). Ileus, voiding difficulty and leakage after surgery were not different between two groups. Weakness of ejaculation was noted in 9~11% of both groups. The DFS of the preoperative CCRT followed by radical resection in the groups with a response was more favorable than that in the group with progressive or stable disease. CONCLUSION: Radical resection of advanced distal rectal cancer could be done with performing a laparoscopic assisted operation after CCRT induced down-staging. We may suggest that laparoscopic assisted resection is a good treatment option as it doesn't increase the complications and it has a compatible survival rate to conventional surgery.

Evaluation of the Appendix Base Location in Acute Appendicitis Using Sonography and its Clinical Significance

PURPOSE: The purpose of this study is to investigate the location of appendiceal base using sonography in acute appendicitis and the usefulness of the appendiceal base marking in deciding the incision site of appendectomy. MATERIALS AND METHODS: We performed appendix sonography in 813 patients and 381 patients were diagnosed as acute appendicitis. During sonography, we marked the base of the appendix on the skin of the patients' abdomen. After appendiceal base marking, we measured the distance from McBurney's point to the appendiceal base. The marking was used as the guide for incision site for appendectomy by the surgeon. Among 381 patients, we excluded 78 patients due to nonvisualization of the cecoappendiceal junction (n = 6), pregnancy appendicitis (n = 2), false positive appendicitis (n = 3) and no reply from the surgeon (n = 67). So we investigated 303 patients prospectively. After operation, we asked the surgeon whether the appendiceal base marking was helpful for appendectomy or not. RESULTS: The base of the appendix at McBurney's point were 31%, lying within 2 cm from McBurney's point were 20%, within 5 cm were 28%, more than 5 cm were 21%. For the usefulness of appendiceal base marking, 95% showed good correlation with marking and surgical incision, and 5% revealed poor correlation. CONCLUSION: The base of the appendix was located in diverse areas of the abdomen, although most frequent in the McBurney's point and within 2 cm from the McBurney's point. Appendiceal base marking on the skin of the abdomen after diagnosis of acute appendicitis could be an useful method to guide the surgeon for decision of surgical incision site.

Safety of 'Isolated IVb (Inferior) Resection of the Liver' by Cadaver Dissection

PURPOSE: Healey divided segment IV of the live as the 'superior portion (IVa) ' and the 'inferior portion (IVb) '. On the contrary, Couinaud suggested that there was no useful purpose in dividing segment IV because of several reasons. Our goal is to evaluate the safety of the 'isolated IVb (inferior) resection of the liver' via performing the dissection of cadavers. METHODS: There were ten total cadavers. Cadaver dissection proceeded with respect to the Glissonian pedicle, the portal vein and the bile duct, respectively. The total number of Glissonian pedicles at segment IV was measured. The distance between the origins of the IVa and IVb branches was measured. Additional pedicles that were known to exist at segment IVa were also evaluated. RESULTS: The mean number of Glissonian pedicles in segment IV, IVa, and IVb was 5 (+/-1.3), 1.6 (+/-7), and 3.4 (+/-0.9), respectively. The mean distance between the origins of the IVa and IVb branches was 5.6 mm (+/-3.9 mm). Two of 10 cases had a very short distance between the origins that were considered as having common origin. Additional pedicles were identified at the Lt. main Glissonian pedicle in all the cases (8 cases: 1 each, 2 cases: 2 each). CONCLUSION: Considering the possible existence of a common origin of segment IVa and IVb Glissonian pedicles, there is the risk that the segment IVa will be injured during 'iso lated IVb resection'. Inevitable ligation of the additional pedicle of segment IVa from the Lt. main Glissonian pedicle can be made during the 'isolated IVb resection'. Therefore, we think that 'isolated IVb resection of the liver' can be safe only when the surgeon divides the branches of segment IVb with meticulous preservation of the IVa branches.