Influence of old age on the postoperative outcomes of obstructive colorectal cancer surgery after the insertion of a stent

PURPOSE: In some patients more than 70 years of age with obstructive colorectal cancer, their concerns about the postoperative complications lead them to refuse surgery after the insertion of a stent. This study aimed to compare the postoperative outcomes between obstructive colorectal cancer patients aged less than 70 years and those aged 70 years and more who underwent surgery after the insertion of a colonoscopic stent. METHODS: Patients with obstructive colorectal cancer who underwent surgery after the insertion of a colonoscopic stent between March 2004 and March 2014 were reviewed retrospectively by using medical records. The patients were divided into two groups: 22 patients were aged less than 70 years (group A) and 30 patients were aged more than 70 years (group B). RESULTS: Although no significant difference in comorbidity was noted between the two groups, the American Society of Anesthesiologists (ASA) score was higher in group B. There was no significant difference in cancer location, stage, or the time from the insertion of the stent to operation. The perioperative results including operation time, blood loss, and length of stay were not significantly different between the groups. The postoperative complications were also not significantly different. CONCLUSION: The surgical outcomes of elderly patients were similar to those of younger patients, despite higher ASA scores. These results indicate that surgery can be performed safely in elderly patients with obstructive colorectal cancer after the insertion of a stent.

Additional Chemotherapy During Resting Periods After Preoperative Chemoradiotherapy in Patients With Rectal Cancer

No abstract available.

Risk Factors for the Development of Clostridium difficile-associated Colitis after Colorectal Cancer Surgery

PURPOSE: Clostridium difficile (C. difficile)-associated colitis, a known complication of colon and rectal surgery, can increase perioperative morbidity and mortality, leading to increased hospital stay and costs. Several contributing factors, including advanced age, mechanical bowel preparation, and antibiotics, have been implicated in this condition. The purpose of this study was to determine the clinical features of and factors responsible for C. difficile-associated colitis after colorectal cancer surgery. METHODS: The medical records of patients who had undergone elective resection for colorectal cancer from January 2008 to April 2010 were reviewed. Cases that involved procedures such as transanal excision, stoma creation, or emergency operation were excluded from the analysis. RESULTS: Resection with primary anastomosis was performed in 219 patients with colorectal cancer. The rate of postoperative C. difficile-associated colitis was 6.8% in the entire study population. Preoperative metallic stent insertion (P = 0.017) and aged sixty and older (> or = 60, P = 0.025) were identified as risk factors for postoperative C. difficile-associated colitis. There were no significant differences in variables such as preoperative oral non-absorbable antibiotics, site of operation, operation procedure, and duration of prophylactic antibiotics. CONCLUSION: Among the potential causative factors of postoperative C. difficile-associated colitis, preoperative metallic stent insertion and aged sixty and older were identified as risk factors on the basis of our data. Strategies to prevent C. difficile infection should be carried out in patients who have undergone preoperative insertion of a metallic stent and are aged sixty and older years.

Feasibility of York-Mason Operation for Selective Advanced Rectal Cancer

PURPOSE: The York-Mason operation has been used as local therapy for benign rectal tumors not easily excised with a conventional transanal excision and for T1 rectal cancers having a low risk of lymph-node metastasis. This study evaluated whether a York-Mason operation could be an alternative therapy for selected patients with T2 or T3 rectal cancers. METHODS: From February 2004 to March 2008, 11 patients with T2 or T3 rectal cancer, who refused rectal excision due to fear of abdominal surgery itself and perioperative side effects or unwillingness to have a permanent stoma, underwent a York-Mason operation. The data on the patients were analyzed retrospectively. RESULTS: The distance from the anal verge to the tumor was 5 cm (median, 2-8 cm), and the tumor size was 3 cm (median, 1.5-4 cm). Histological examination revealed a pathological tumor (pT) stage 2 in eight patients, stage pT3 in one patient, and stage pTx in two patients. The distance from the resection margin to the tumor was 0.3 cm (median, 0.1-0.5 cm). Six patients (55%) had incomplete tumor excision. Radiotherapy was performed in one patient preoperatively and in eight postoperatively. Postoperative morbidity occurred in four patients (36%). During a median of 38.2 months, two patients (18%) developed local recurrence and liver metastasis. Postoperative mortality, which was not related to the procedure, occurred in one patient (9%). CONCLUSION: The York-Mason operation could be considered as an alternative therapy for selected T2 or T3 rectal cancer patients who refuse rectal excision.

Treatment of Colon Perforation Associated with Colonoscopy

PURPOSE: Recently, non-operative conservative management or laparoscopic repair has been reported for the management of colonic perforation during colonoscopy. However, the preferred management strategy remains controversial. The purpose of the present study is to identify an appropriate strategy for the treatment of colon perforation during colonoscopy. METHODS: The medical records of patients who developed colon perforation during colonoscopy between May 2003 and November 2007 were retrospectively reviewed. The mechanism and site of perforation, the treatment administered, complications, and clinical outcomes were analyzed. RESULTS: In total, 16 perforations were evaluated. Of these, 11 developed during diagnostic colonoscopy and 5 during therapeutic colonoscopy. The most frequent perforation site was the sigmoid colon (12), followed by the transverse colon (2), the rectum (1), and unknown site (1). Six patients underwent surgery due to signs of diffuse peritonitis 10 were initially treated conservatively. Among the patients who underwent surgery, four underwent laparoscopic repair and two underwent open repair. Among the patients initially treated conservatively two patients required surgery due to clinical deterioration of peritonitis and rectovaginal fistula. These 2 patients underwent repair with proximal diverting stomas. CONCLUSIONS: Colon perforation associated with colonoscopy is a rare event, but raises serious complications. Selected patients with colonoscopic perforation may be treated conservatively, but if these patients fail to respond to such treatments, extensive surgical procedures may be warranted.

Abdominal Compartment Syndrome after Stent Insertion for Obstructed Colon Cancer

Colonic stenting has been suggested as an acceptable therapeutic option for the palliation of malignant colorectal obstruction or to achieve bowel decompression and preparation. It is effective as a bridge to surgery that is useful as an option to avoid emergency colostomy. However, it is associated with complications such as intestinal perforation, stent migration, bleeding, and failure of bowel decompression. Of all the complications, intestinal perforation and failure of bowel decompression are most serious and require surgical treatment. Here we report a case of abdominal compartment syndrome after stent insertion for obstructive colon cancer. The main causative factors for abdominal compartment syndrome were bowel distension associated with endoscopic gas inflation and failure to achieve bowel decompression.

Lumbar Hernia Combined with Descending Colon Incarceration

Lumbar hernia is a relatively rare clinical phenomenon. They may be classified according to their anatomic location and they can be either congenital or acquired. These patients usually present with a protruding bulge in the posterolateral abdominal wall. Portions of the small and large intestine may be found in the sac. This may be asymptomatic or it can become incarcerated and strangulated. We report here on a rare case of secondary lumbar hernia combined with descending colon incarceration. The diagnosis of lumbar hernia was made by CT scan and barium enema. Excision of the sac was performed and the hernial defect in the fascia was repaired with polypropylene mesh reinforcement.

Comparison between Responder and Non- responder of Oxaliplatin Chemotherapy for Metastatic Colorectal Cancer

PURPOSE: The purpose of this study was to evaluate the clinicopathological significance of responders with metastatic colorectal cancer treated with oxaliplatin chemotherapy. METHODS: A total of 52 patients with unresectable metastatic colorectal cancer were enrolled for treatment between March 2000 and August 2005. Patients received first line chemotherapy consisted of oxaliplatin 85 mg/m2 or 130 mg/m2 as a 2-hour infusion on day 1, concurrently with leucovorin (LV) 20 mg/m2 as a bolus infusion on day 1~5, followed by continuous infusion of 5-fluorouracil (5-FU) 425 mg/m2 on day 1~5. This treatment was repeated in 2 or 3 week intervals. All responses were assessed after 4 cycles of therapy by independent radiologic experts and categorized into two groups: responder (major reduction of tumor) and non-responder group (no change or progression of the tumor. RESULTS: The response rate was 51.9 percent (27/52 patients). There were no significant differences in clinicopathologic parameters between two groups. The decrease of CEA value after chemotherapy was significantly more frequent in the responder group than in the non-responder group. CONCLUSIONS: We could not find any clinical differences between the two groups, but these results suggest that oxaliplatin chemotherapy has a beneficial effect on tumor shrinkage and serum CEA value can be an indicator for tumor response of oxaliplatin in advanced colorectal cancer.

Complete Rectal Prolapse Combined with Rectal Cancer: A Case Report

Colorectal cancer and rectal prolapse occur more frequently in elderly patients. Although the relationship between complete rectal prolapse and colorectal cancer has not yet been clarified, when both diseases develop simultaneously in a patient, it may be due to just coincidence or to a promotion of prolapse due to accelerated constipation caused by cancer. Thus, patients with a sudden onset of rectal prolapse should be screened for colorectal cancer. We report a case of complete rectal prolapse combined with early rectal cancer in a 75 year-old woman who was successfully treated with a perineal rectosigmoidectomy.

CEA Study on the Effect of the No-touch Isolation Technique for Preventing Tumor Metastasis in Patients with Colorectal Cancer

PURPOSE: Although the 'No-touch' isolation technique was introduced by Turnbull et al. in 1967, the controversy over whether or not it reduces the risk of metastasis during surgery exists even today. The aim of this study was to evaluate the effect of the 'No-touch' isolation technique in primary colorectal cancer surgery. METHODS: The evaluation was done by comparing the levels of CEA and CEA m-RNA expression from the same draining vein before and after tumor mobilization. Blood samples from 25 patients with primary colorectal cancer were collected for analysis. At the time of surgery, the main draining vein from the tumor was isolated and ligated at the proximal end. The 1st blood samples were collected just prior to tumor mobilization, and the 2nd samples right after. Both samples were analyzed for serum CEA level and CEA mRNA expression by using reverse transcriptase polymerase chain reaction (RT-PCR). RESULTS: The mean CEA value from draining veins after tumor mobilization (8.08+/-8.98 ng/ml) was significantly higher than it was before mobilization (4.17+/-4.98 ng/ml). CEA mRNA was detected in 16% (4/25) of the blood specimens post-mobilization, whereas it was detected in only 4% (1/25) of the pre-mobilization samples. CONCLUSIONS: The results suggest the validity of using the 'No-touch' isolation technique to reduce the risk of metastasis into the draining vein during mobilization.

CEA Expressions in Colorectal Tumor

PURPOSE: The purpose of this research is to investigate the clinical usefulness of carcinoembryonic antigen (CEA) expression in colorectal cancer tissue. METHODS: We performed immunohistochemical staining of CEA on 64 surgically resected colorectal cancer tissues obtained during the period from May 2000 to May 2001. CEA expression was detected by immunohistochemistry using a CEA monoclonal antibody. The degrees of CEA expression in the tumor cell cytoplasm and the luminal secretion of the tumor gland were grouped into positive (strongly positive) and negative groups (weakly positive) by using the Sinicrobe method and were compared with clinicopathological variables. RESULTS: The expression rates were positive in 38 cases (59.4%) and negative in 26 cases (40.6%). The preoperative CEA level showed a higher trend in the positive group (8.23+/-13.7) than it did in the negative group (17.89+/-38.7 ng/ml), but the difference was not statistically significant. The relationships between the CEA expressions of the two groups and the clinicopathologic factors were not statistically significant. We observed CEA expression in the luminal secretion of the tumor gland in 41 cases. The expression rates in the luminal secretion were positive in 21 cases (51.2%) and negative in 20 cases (48.8%). No significant clinical difference were noted between the two groups. CONCLUSIONS: The results suggest that CEA expression may not play a role as a prognostic factor for colorectal cancer.

Cases of Postoperative Mesenteric Panniculitis

Mesenteric panniculitis is a rare inflammatory condition of mesenteric adipose tissue in which the mesentery is replaced with fibrosis. The frequent symptoms of mesenteric panniculitis are palpable mass, abdominal pain and gastrointestinal obstructive symptoms. In the majority of cases, its course is self-limiting and the prognosis is favorable. 3 cases of mesenteric panniculitis are described that presented with obstructive symptoms of gastrointestinal tract, which occurred in 2 weeks following colectomy of colonic tumors. And reviewed the symptomatology, pathology, treatment, and outcome of this disorder.

The Effect of Tumor Manipulation on Serum Carcinoembryonic Antigen Levels in Colorectal Cancer Patients

PURPOSE:Tumor cells can be shed into a venous blood stream by manipulation of tumor during surgery, resulting metastasis to distant organs from the primary tumor. In order to elucidate the effect of early lymphovascular dissection prior to tumor mobilization, we studied the difference in carcinoembryonic antigen (CEA) values of tumor draining veins before and after tumor mobilization. METHODS:Blood samples were taken from the tumor draining veins of sixteen patients during operations. The lymphovascular dissection was performed before the tumor mobilization, and the main draining vein from the tumor was isolated and the proximal end was ligated and blood samples were taken, then the tumor mobilization was made. Just before the removal of the tumor, we took the second sets of blood samples from the same sites. RESULTS:There were no significant differences in CEA values between peripheral blood (1.8+/-1.2 ng/mL) and tumor draining veins before the tumor mobilization. The mean CEA value of draining veins after the tumor mobilization (14.3+/-11.9 ng/mL) was significantly higher than that of draining veins before the mobilization (2.2+/-2.1 ng/mL)(P<0.001). CONCLUSIONS:Theses results suggest that early lymphovascular dissection procedures before tumor mobilization can reduce the opportunity of tumor cell dissemination into draining vein.

Modified Anal Cushion Preserving Hemorrhoidectomy

PURPOSE: The ligation and excision method of hemorrhoids is a simple and rapid procedure, but it has a drawback of possible damage to the anal cushion. To solve this problem, we tried to preserve the anal cushion with superficial ligation and excision method of anorectal mucosa including removal of the hemorrhoidal tissues from the anal cushion after submucosal dissection. However, it was difficult to remove hemorrhoidal vessels with this procedure and it was time consuming. To minimize these problems, we originally tried a new cushion preserving procedure in 15 patients during 1 year. METHODS: R> After mobilization of the anorectal mucosa, hemorrhoidal tissues and anal cushion from the anal sphincter muscles, the anorectal mucosa was first dissected from the anal cushion, then the hemorrhoidal vessels were removed and the remaining anal cushion was reattached to the anal sphincter muscles. RESULTS: The results of this surgery have been satisfactory with only one postoperative bleeding and two anal skin tags. CONCLUSIONS: This method is simple and convenient for preservation of anal cushion with minimal complications when compared with the conventional method of anal cushion preservation.

The significance of CD44 variants expression in colorectal cancer and its regional lymph nodes

CD44 is a cell adhesion molecule with numerous isoforms created by mRNA alternative splicing. Expression of CD44 variants has been suggested to play a potential role in tumor progression and metastasis. We designed primers CD44V, CD44V6/7, CD44R1 and CD44V6-10 to analyze and compare the roles of each CD44 variants. Expressions of CD44 variants were investigated in normal colonic mucosa, the lymph nodes which was histopathologically free of cancer cell, and cancer tissues of 44 human colorectal cancer patients by RT-PCR method. The expression of CD44V was observed in 28 out of 39 (71.8%) tumors and 7 out of 11 (63.6%) N1 normal regional lymph nodes, and CD44V6/7 was observed in 28 out of 39 (71.8%) tumors and 9 out of 11 (81.8%) N1 normal regional lymph nodes. The expressions of CD44V and CD44V6/7 were most frequently observed compared with any other CD44 variants. In normal colonic mucosa, the expression of CD44 variants are low but in cancer tissue and its regional lymph node, the expression of CD44V and CD44V6/7 were significantly higher and more frequent than any other CD44 variants (p<0.05). These results suggest that CD44V and CD44V6/7 can be a molecular marker for colorectal cancer and its micrometastasis to the regional normal lymph node.

The Significance of CD44v Expression in the Pelvic LateralLymph Node in Distal Rectal Cancer

PURPOSE: The CD44 has been known a lymph node homing receptor on circulating lymphocytes. CD44 spliced variants have been found to be overexpressed in human cancers and metastatic cancers. The variant CD44v 6-7 in particular has been suggested to have a potential role in tumor metastasis. It has been reported that histopathological examination could occaisionally miss lymph node micrometastasis. PURPOSE: The aim of this study was to investigate the role of CD44v in metastasis of rectal carcinoma to the pelvic lateral lymph nodes around the obturator nerve, obturator vessel and superior vesical artery. METHODS: Thirty pelvic lateral lymph nodes reported normal histopathologically from 22 patients with rectal carcinomas, 22 rectal carcinomas and their corresponding colonic mucosas. We have used RT-PCR for the detection of CD44 gene products (CD44v and CD44 v6-7) in samples. RESULTS: The expression rates of CD44v were 2/22 (9%) for normal colonic mucosa, 20/22 (90%) for cancer tissues, and 4/30 (13.3%) for pelvic lateral lymph nodes. The rates of CD44v6-7 were also 2/22 (9%) for normal colonic mucosa 20/22 (90%) for cancer tissues, but 7/30 (23.3%) for pelvic lateral lymph nodes. CONCLUSIONS: The analysis of CD44v might be useful for determination of pelvic lateral lymph nodes metastasis, but it should not be used as a metastatic marker in general for rectal cancer patients.

A Retrospective Study Comparing Clinical Characteristics between

PURPOSE: This study was undertaken to obtain better clinical insights and therapeutic approaches to the diverticular diseases of the colon by identifying the clinical characteristics of the right and left colonic diverticular diseases. METHODS: A retrospective analysis was made of 68 colonic diverticular patients treated between August of 1986 and July of 1997. Right colonic diverticular disease was present in 55 patients, left side disease in eight patients, and bilateral disease in five patients. According to the location of the colonic diverticular disease, various clinical parameters such as the nature of the diverticula, age and sex, diagnostic accuracy, and methods of treatment were assessed. RESULTS: The average age of 68 patients in this study was 50.94 years. Fifty two patients were male and sixteen were female. The disease was far more common in the right colon (80.9%) than the left colon (11.7%) and the right colonic diverticular disease was the most common source of confusion in diagnosis from acute appendicitis. Conservative management was tried in 30 of 35 patients above age 50 and obtained a good result without any complication. CONCLUSIONS: There has been a tendency toward increased incidence of annual colonic diverticular diseases in this study. The right colonic diverticular disease was far more common than the left side disease and the disease was more common in the male. In patients above age 50, initial conservative management is a reasonable approach, although early surgical exploration might be better in younger patients. Acute appendicitis should be ruled out before any treatment decision was made.

Effectiveness of Partial Autonomic Nerve Preservation Surgery for Sexual Function in the Male in the Advanced Rectal Cancers

BACKGROUND: During the past eight years, we have been performing partial autonomic nerve preservation surgery (PANP) for the treaolent of advanced rectal cancer in order to reduce the postoperative male sexual dysfunctions. METHODS: This is a prospective study of 25 rectal cancer patients who underwent PANP from 1990 to 1997. All patient were in Duke C stage and their ages were between 30 and 55. Patients were divided into four types: 1) Partial sacrifice of inferior mesenteric plexus (PSIP). 2) Partial sacrifice of preaortic nerve (PSPN). 3) Complete sacrifice of preaortic nerve with complete pelvic nerve preservation (CSPN). 4) Unilateral sacrifice of pelvic autonomic nerve (USPN). RESULTS: The percentage of ejaculation and erection difficulties at each surgery was as follows: PSIP 0/5 (0%) for ejaculation vs. 0/5 (0%) for erection, respectively, PSPN 5/7 (71.4%) vs. 2/7 (28.6%), CSPN 6/7 (85.7%) vs. 0/7 (0%) and USPN 6/6 (100%) vs. 5/6 (83.3%). Summary: PANP is possible for the treatment of advanced rectal cancer.

Expression of Tumor Metastasis Related Genes in Korean Colorectal Cancers and Cell lines

We studied the expressions of E-cadherin, MMP-7 and CD44V in colorectal cancer and their corresponding normal mucosa using RT-PCR. From the 26 patients whom a com parative study of clinical and histopathological data is available, MMP-7 and CD44V were significantly enhanced in cancer and their metastatic tissues, compared with their normal mucosa. E-cadherin did not reveal any difference between cancer and normal mucosa. The relashionship between these genes and colorectal cancer development can not be confirmed by this study, however CD44v and MMP-7 may be associated with metastasis of colorectal cancer.

Identification of CD44 splice variant in Korean colorectal cancers and cell lines

CD44 is a glycoprotein expressed in a wide variety of cell types. Recently expression of some alternatively-spliced variants of CD44 transcripts (CD44v) has been suggested to play a potential role in tumor metastasis and the detection of CD44v containing exon 6 to 11 may be helpful for the diagnosis of cancers. Expressions of CD44v containing exon 6 to 11 were investigated in 20 human colorectal cancer samples, peripheral blood leukocytes isolated from colorectal cancer patients, and 4 colorectal cancer cell lines using reverse transcription-polymerase chain reaction and Southern blot analysis. The standard form of CD44 transcripts was expressed in all samples tested. CD44v containing exon 6 to 11 was expressed in 18 cases of colorectal cancers (sensitivity = 90%), 3 out of 4 cell lines, and one normal tissue (specificity = 95%). These results suggest that the expression of CD44v containing exon 6 to 11 can be regarded as tumor specific and that this marker may be helpful for the early diagnosis of colon cancers, if specimens from the early stage are available.