Is Laparoscopic Multivisceral Resection Applicable to Colorectal Cancer Adherent to Adjacent Organs? / 대한내시경복강경외과학회지

PURPOSE: The aim of this study was to assess the feasibility and safety of laparoscopic multivisceral resection of colorectal cancer adherent to adjacent organs. METHODS: We reviewed retrospectively 32 patients undergoing elective laparoscopic multivisceral resection for colorectal cancer adherent to adjacent organs between June 2003 and May 2009. Survival curves were generated by Kaplan-Meier method. RESULTS: The median age of 32 patients was 73 years. In 10 of 17 rectal cancer patients (59%), neoadjuvant chemoradiation was performed. All the surgeries were completed laparoscopically. The postoperative complications occurred in 21.9% and there was no operative mortality. The median length of hospital stay was 15.5 days. In 23 of 32 patients (72%), the resection was considered curative. Median follow-up period of all patients and curatively resected patients was 22 (range, 2~65) months, 34 (range, 4~65) months respectively. Local recurrence rate, the 3-year overall survival rate and the 3-year disease free survival rate of 23 curatively resected patients was 4.3%, 92.9% and 84.4%, respectively. CONCLUSION: Laparoscopic multivisceral resection is feasible and safe in highly selected patients with colorectal cancer adherent to adjacent organs. Further validation is needed.

Laparoscopic Colorectal Resection for Aged Patients

PURPOSE: The purpose of this study is to assess the periopertive morbidity and mortality rates in relation to the principal variables in aged patients who undergo laparoscopic colorectal resection. METHODS: From March 2001 to March 2006, the prospective laparoscopic colorectal resection database was used to identify 233 patients. Among them, 132 were 70 years of age or older and they were classified as the aged group. 101 were younger than 70 years of age and they were classified as the younger group. RESULTS: Comorbidity was more common in the aged group than in the younger group (67.4% and 53.5%, respectively) (P=0.030). There were higher ASA scores in the aged group (I: 2.3% II: 68.2% III: 29.5%) than in the younger group (I: 27.7% II: 56.4% III: 15.8%) (P<0.0001). There was a higher postoperative complication rate for the aged group than for the younger group (25.0% and 8.9%, respectively) (P=0.002). Only one case of mortality (0.8%) was found in the aged group. The period of the postoperative hospital stay was longer for the aged group than that for the younger group (21.9+/-3/416.3 days and 16.3+/-3/48.1days, respectively) (P= 0.002). For the aged group, univariate analysis revealed that the operative procedure, disease, the T stage and the operation time were significant variables for the postoperative complications, and multivariate analysis identified the operation time as an independent variable faor the postoperative complications. CONCLUSION: More prudent care is needed to prevent postoperative complications for the aged patients who undergo laparoscopic colorectal resection, and particularly for those who can be expected to have a longer operation time.

Risk Factors for Anastomotic Leakage after Laparoscopic Rectal Resection in Rectal Cancer: Does Laparoscopic Rectal Resection Increase Anastomotic Leakage Rate?

PURPOSE: The purpose of this study is to evaluate the risk factors for clinical anastomotic leakage after laparoscopic resection for rectal cancer. METHODS: From March 2001 and February 2006 in Seoul Veterans' Hospital, the prospective laparoscopic colorectal resection database identified 101 patients who a had laparoscopic rectal resection with colorectal or coloanal anastomosis. The associations between clinical anastomotic leakage and patient-, tumor-, surgery- and laparoscopic-related variables were studied. RESULTS: The rate of clinical anastomotic leakage was 4 percent (4 of 101). The patient-related variable significantly associated with clinical anastomotic leakage was preoperative radiotherapy. The surgery-related factor that turned out to be significant was anastomosis situated less than 5 cm from the anal verge. No tumor- or laparoscopic-related variables were significantly associated with clinical anastomotic leakage. CONSLUSIONS: A protective ileostomy should be considered after a laparoscopic rectal resection for an rectal cancer for anastomosis situated less than 5 cm from the anal verge, particularly when preoperative radiotherapy is being used.

Staged Surgery for Chronic Primary Aortoduodenal Fistula in a Septic Patient

Aortoenteric fistula is one of the most challenging problems that confront the vascular surgeons. Controversy remains over the optimal treatment because of the continued publication of series with high mortality, amputation, and aortic disruption rates. A positive preoperative blood culture is the best predictor of mortality with increased amputation rates due to infection of the extra-anatomic bypass. Therefore, in selected cases with sepsis, a prudent management protocol is required. We report a 68-yr-old male presenting with a chronic primary aortoduodenal fistula extensively involving the duodenum and Gram-negative sepsis. We planned a staged operation. Initially, an emergency laparotomy and control of the aorta allowed stabilization of the patient, identification of the fistula, and direct in situ placement of the prosthetic graft followed by an en bloc resection of the aneurysm and the surrounding structures. After he recovered from sepsis and had been stabilized, a staged extra-anatomic bypass followed by transabdominal removal of the temporarily placed graft was done. This management plan will allow the highest success rate and may be a prudent management protocol for these difficult cases.

Analysis for Influencing Factor of the Organ Procurement Rate in Brain Dead Donors / 대한이식학회지

PURPOSE: The number of patients waiting for organ transplantation continues to grow as technical and pharmacological advances increase the success rate of transplantation procedures, while organs are donated by few of the thousands of potential donors who die every year. The organ transplantation continues to be the best treatment for many end-stage diseases of the heart, liver, kidneys, and other organs. Many organ procurement failures have been attributed to a failure to identify patients with nonsurvivable central nervous system injury or disease as potential organ donors or failure to maintain a hemodynamic stability or failure to request consent for donation from next to kin. This study has been done for investigating the factors that influence the organ procurement rate in brain dead donors. METHODS: Of the 259 brain dead donors in the Asan Medical Center, from January 1991 to April 2003, 189 brain dead donors donated solid organs excluding conea. We retrospectively reviewed the medical records and the data of the transplantation center. A hemodynamic stability is defined as systolic blood pressure more than 90~100 mmHg with the use of low-dose vasopressor (dopamine less than 10microgram/ kg/min). RESULTS: From January 1991 to April 2003, the procurement rates of liver, heart, kidney and pancreas were 39% (n=75), 40% (n=76), 97% (n=184) and 17% (n=33), respectively. The procurement rates according to age were 26% in 50 years (n=11). The major. causes of death among potential organ donors were traffic accident (59%) and cerebrovascular events (33%). In traffic accident, the procurement rates of liver, heart, kidney and pancreas were 42% (n=47), 37% (n=41), 98% (n=109) and 16% (n=18), and in cerebrovascular events, 33% (n=21), 38% (n=24), 97% (n=61) and 19% (n=12). Multiple organs were donated in the hemodynamically stable donors. CONCLUSION: Aggressive resuscitation and hemodynamically stabilization of all brain dead donors are important factors that may increase procurement rates.