Clinical Significance of Serial Serum Carcinoembryonic Antigen Values for Treating Rectal Cancer with Preoperative Chemoradiotherapy

PURPOSE: Preoperative chemoradiotherapy is now widely accepted to treat rectal cancer; however, the prognosis for rectal cancer patients during and after chemoradiotherapy must be determined. The aim of this study was to evaluate the serial serum carcinoembryonic antigen (s-CEA) samples in patients with rectal cancer who underwent radical surgery after concurrent chemoradiotherapy (CRT). METHODS: This study evaluated 236 patients with rectal cancer who received preoperative CRT followed by curative surgery between June 2005 and June 2010. We measured the patient's s-CEA levels pre-CRT, post-CRT and post-surgery. Patients were classified into four groups according to their s-CEA concentrations (group 1, high, high, high; group 2, high, high, normal; group 3, high, normal, normal; group 4, normal, normal, normal). We analyzed the clinicopathologic factors and the outcomes among these groups. RESULTS: Of the 236 patients, 12 were in group 1, 31 were in group 2, 67 were in group 3, and 126 were in group 4. The 3-year disease-free survival rate in group 1 was poorer than those in group 3 (P = 0.007) and group 4 (P < 0.001). In a univariate analysis, type of surgery, clinical N stage, pathologic T or N stage, lymphovascular invasion, perineural invasion, and CEA group were prognostic factors. A multivariate analysis revealed that type of surgery, pathologic T stage, and lymphovascular invasion were independent prognostic factors; however, no statistical significance was associated with the CEA group. CONCLUSION: High pre-CRT, post-CRT, and post-surgery s-CEA levels in patients with rectal cancer were associated with high rates of systemic recurrence and poor survival. Therefore, patients with sustained high s-CEA levels during CRT require careful monitoring after surgery.

Multivisceral resection for locally advanced rectal cancer: adequate length of distal resection margin / 대한외과학회지

PURPOSE: Locally advanced rectal cancer may require an intraoperative decision regarding curative multivisceral resection (MVR) of adjacent organs. In bulky tumor cases, ensuring sufficient distal resection margin (DRM) for achievement of oncologic safety is very difficult. This study is designed to evaluate the adequate length of DRM in multiviscerally resected rectal cancer. METHODS: A total of 324 patients who underwent curative low anterior resection for primary pT3-4 rectal cancer between 1995 and 2004 were identified from a prospectively collected colorectal database. RESULTS: Short lengths of DRM ( or =2 cm) showed 72.4% and 60.2% (P = 0.03, 0.044). In multivariate analysis of MVR, poorly differentiated histology, ulceroinfiltrative growth of tumor, and short DRM (<2 cm) were significant factors for prediction of poor survival outcome, although short DRM was not significantly related to local and systemic recurrence. CONCLUSION: In locally advanced rectal cancer of pT3-4, a short length of DRM (< or =1 cm) did not compromise essentially poor oncologic outcome. In rectal cancers invading adjacent organs and requiring MVR, a shorter DRM (<2 cm) was found to be related to poor survival outcome.

Recurring gastrointestinal stromal tumor with splenic metastasis / 대한외과학회지

Malignant gastrointestinal stromal tumors (GISTs) are rare non-epithelial, mesenchymal neoplasms of the gastrointestinal tract that metastasize or recur in 30% of patients who undergo surgical resection with curative intent. A 59-year-old man visited our hospital for an examination of a palpable mass in the left abdomen. Fourteen months prior to his visit, the patient underwent gastric wedge resection to remove a GIST of the gastric cardia. At the time of surgery, no evidence of metastatic disease was observed and the pathological interpretation was a high-risk GIST. A follow-up computed tomography scan of the abdomen revealed a partially necrotic solid mass (9.8 x 7.6 cm) and enhancing mass in the spleen (2.3 cm). On exploration, multiple masses were found in the liver, greater omentum, and mesentery. Here, we report a case of recurring GIST of the stomach that metastasized to the spleen. To the best of our knowledge, few reports of metastasis to the spleen exist.

Clinicopathologic characteristics of serosa-positive gastric carcinoma in elderly patients / 대한외과학회지

PURPOSE: The relationship between the prognosis and the age of patients with gastric carcinoma is controversial. This study examined the clinicopathologic features of elderly gastric carcinoma patients with serosal invasion. METHODS: We reviewed the hospital records of 136 elderly gastric carcinoma patients with serosal invasion retrospectively to compare the clinicopathologic findings in the elderly (aged > 70 years) and young (aged < 36 years). RESULTS: The 5-year survival rates of elderly and young patients with curative resection did not differ statistically (33.9% vs. 43.3%; P = 0.318). Multivariate analysis showed that two factors were independent, statistically significant parameters associated with survival: histologic type (risk ratio, 1.805; 95% confidence interval [CI], 1.041 to 3.132; P < 0.05) and operative curability (risk ratio, 2.506; 95% CI, 1.371 to 4.581; P < 0.01). CONCLUSION: This study demonstrated that elderly gastric carcinoma patients with serosal invasion do not have a worse prognosis than young patients. The important prognostic factor was whether the patients underwent curative resection.

Intraperitoneal Bronchogenic Cyst Misidentified as Gastric Submucosal Tumor

Most bronchogenic cysts originate in the mediastinum, while 15% to 20% occur in the lung parenchyma. According to the literature, most intrapulmonary cysts occur in the lower lobes. But, they are rarely located in an extrathoracic site, such as subdiaphragmatic retroperitoneal area. We describe a paraesophageal intra-abdominal bronchogenic cyst, first considered as gastric submucosal tumor. Resection was successfully realized by laparoscopy. A 20-year-old female was admitted to our hospital with incidentally detected gastric submucosal tumor. At operation, there was a 2.5x2 cm sized cystic tumor that was isolated from the gastric wall. We performed tumor resection laparoscopically. The postoperative course was uneventful and the patient was discharged on the second postoperative day. Histological examination reported a bronchogenic cyst. We, herein, report this case.

Discrepant Bowel Perforation from a Primary Lesion after Chemotherapy of Diffuse Large B Cell Lymphoma

Diffuse large B cell lymphoma is the most common type of non-Hodgkin's lymphoma, representing approximately one-third of all cases and involving the gastrointestinal tract in about 18%. With the development of modern chemotherapeutic regimens and advances in medical care, the prognosis for malignant lymphoma can be excellent. However, because of the aggressive adjuvant therapy required, complications such as bowel perforation may be fatal. In cases of chemotherapy for malignant lymphoma, we should keep in mind the possibility of perforation of the bowel after chemotherapy. Early detection is important to save patients.

Clincal Features and Surgical Treatment of Solid Pseudopapillary Tumor of Pancreas

PURPOSE: A solid pseudopapillary tumor (SPT) is a rare pancreatic neoplasm, with low malignant potential, which tends to occur predominantly in younger females. Most patients are diagnosed due to the abdominal pain or the large palpable abdominal mass. The treatment is surgical resection, using either enucleation or more radical procedures. Only a few cases of SPT have been reported; therefore, the purpose of this study was to evaluate the clinicopathological characteristics and prognosis after surgical resection of this rare type of tumor. METHODS: In this paper, twelve cases of SPT, treated at the Department of Surgery, Chonnam National University Hospital, between 1994 and 2003, are presented. RESULTS: 10 females, with a mean age of 32.2 years, ranging from 14 to 48, and 2 males, aged 15 and 32, were diagnosed. The tumors were large, with a mean resected diameter of 7 cm, had cystic degene rations between the solid areas, and were distributed in the head (7 cases) and the body-tail (5 cases) of the pancreas. Immunohistochemical studies were performed in 7 patients, which revealed the majority of the cases to be a-1 antitrypsin and neuron specific enolase (NSE) positive. The surgical managements of the tumors included enucleation (6 cases) or more radical procedures, such as a distal pancreatectomy (5 cases) and pancreaticoduodenectomy (1 case). There was no recurrence after the complete surgical resection. CONCLUSION: The mainstay of treatment in patient with a SPT is surgical resection, after which the prognosis was favorable.

Observation of Compression Plate for Treatment of the Femoral Shaft Fractures / 대한정형외과학회잡지

The effectiveneas of compression plate fixation in promoting fracture healing could be due to a specific stimulus of compression on bone formation or to enhanced immobilization. ASI type heavy plate fixation for fracture of the femoral shaft was examined on occasions in three patient in the period 1971–1973. We believe that the major effect of the compression as applied through a compression plate is that of enhanced stabilization.

Traumatic Bilateiral Anteror and Posterior Dislocation of Hip: Report of Two Case / 대한정형외과학회잡지

Two cases of traumatic bilateral anterior and posterior dislocation of hip are reported. Dislocations were developed by a traffic accident as a passenger injury in truck. In both cases, the fractued femoral heads appeared posteriorly dislocated on x-ray examination and one of them was removed through posterior approach. Primary arthroplasty for operated hip was not attempted because the patient was young and the defect seemed to be unrelated to weight bearing surface. Extreme rarity of its incidence and curious uncertain mechanism of injury urge to report these cases.