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1.
Journal of Pathology and Translational Medicine ; : 60-66, 2023.
Article in English | WPRIM | ID: wpr-967636

ABSTRACT

Fibrosis is characterized by a proliferation of fibroblasts and excessive extracellular matrix following chronic inflammation, and this replacement of organ tissue with fibrotic tissue causes a loss of function. Inflammatory bowel disease (IBD) is a chronic inflammation of the gastrointestinal tract, and intestinal fibrosis is common in IBD patients, resulting in several complications that require surgery, such as a stricture or penetration. This review describes the pathogenesis and various factors involved in intestinal fibrosis in IBD, including cytokines, growth factors, epithelial-mesenchymal and endothelial-mesenchymal transitions, and gut microbiota. Furthermore, histopathologic findings and scoring systems used for stenosis in IBD are discussed, and differences in the fibrosis patterns of ulcerative colitis and Crohn’s disease are compared. Biomarkers and therapeutic agents targeting intestinal fibrosis are briefly mentioned at the end.

2.
Annals of Surgical Treatment and Research ; : 156-163, 2023.
Article in English | WPRIM | ID: wpr-966309

ABSTRACT

Purpose@#Laparoscopic right colectomy (LRC) with extracorporeal anastomosis (ECA) remains the most widely adopted technique despite mounting evidence that intracorporeal anastomosis (ICA) offers several advantages. This study aimed to compare the postoperative outcomes of ICA and ECA and to investigate the effect of ICA on postoperative ileus after LRC. @*Methods@#This retrospective study included 45 patients who underwent ICA and 63 who underwent ECA in LRC for rightsided colonic diseases between January 2015 and December 2019. @*Results@#There were no significant differences in total operation time, blood loss, total length of incisions, tolerance of diet, postoperative pain score on postoperative days 1 and 2, or length of hospital stays between the 2 groups. However, the ICA group had a significantly shorter time to first flatus passage (3.0 ± 0.9 days vs. 3.8 ± 1.9 days, P = 0.013). The rate of postoperative ileus was significantly higher in the ECA group (2.2% vs. 14.3%, P = 0.033); however, there was no significant difference in the overall morbidity within 30 days after surgery. Multivariate logistic regression analysis showed that the ECA technique (odds ratio [OR], 0.098; 95% confidence interval [CI]; 0.011–0.883, P = 0.038) and previous abdominal operation (OR, 5.269; 95% CI, 1.193–23.262; P = 0.028) were independent risk factors for postoperative ileus. @*Conclusion@#The postoperative outcomes of patients who underwent LRC with ICA or ECA were comparable, and ICA could reduce the incidence of postoperative ileus after LRC compared with ECA.

3.
Journal of Minimally Invasive Surgery ; : 55-63, 2023.
Article in English | WPRIM | ID: wpr-1001353

ABSTRACT

Purpose@#This study aimed to compare the postoperative outcomes and patient-surveyed scar assessments of single-port laparoscopic appendectomy (SPLA) with the outcomes of multiport laparoscopic appendectomy (MPLA). @*Methods@#Between August 2014 and November 2017, the prospective randomized study comprised 98 patients diagnosed with acute appendicitis and indicated for surgery. Fifty-one patients had MPLA and 47 patients received SPLA. The primary endpoint was the total score of Patient Scar Assessment Questionnaire (PSAQ) administered to patients 6 weeks after surgery. @*Results@#SPLA involved a shorter median operative time than MPLA (47.5 minutes vs. 60.0 minutes, p = 0.02). There were no apparent differences in the time before diet tolerance, length of hospital stay, and postoperative complication. SPLA patients had shorter total incision length (2.0 cm vs. 2.5 cm, p < 0.01) and required fewer analgesics on the day of surgery than MPLA patients (p = 0.011). The PSAQ favored the SPLA approach, revealing significant differences in total score (48 vs. 55, p = 0.026), appearance (15 vs. 18, p = 0.002), and consciousness (8 vs. 10, p = 0.005), while satisfaction with appearance and symptoms scale did not (p = 0.162 and p = 0.690, respectively). @*Conclusion@#The postoperative scar evaluated by the patient was better with SPLA than with MPLA, and patient satisfaction with the scar was comparable between the two techniques.

4.
Journal of Korean Medical Science ; : e200-2023.
Article in English | WPRIM | ID: wpr-1001092

ABSTRACT

Background@#The nuclear factor erythroid 2-related factor 2/Kelch-like ECH-associated protein 1 (Nrf2/Keap1) signaling pathway is involved in the regulation of cellular responses to oxidative stress. Nrf2 acts as a cell protector from inflammation, cellular damage, and tumorigenesis, whereas Keap1 is a negative regulator of Nrf2. Dysregulation of the Nrf2/ Keap1 pathway results in tumorigenesis and the active metabolism of tumor cells, leading to high resistance to radiotherapy. This study aimed to evaluate the predictive role of Nrf2 and Keap1 in the radiosensitivity and prognosis of locally advanced rectal cancer (LARC). @*Methods@#In total, 90 patients with LARC underwent surgery after preoperative chemoradiotherapy (CRT). Endoscopic biopsies from the tumors were obtained before radiation, and the Nrf2 and Keap1 expressions were assessed by immunohistochemistry. The response to therapy was evaluated after surgery following CRT according to the pathologic tumor regression grade. The disease-free survival (DFS) and overall survival rates were also documented. The association between the Nrf2 and Keap1 immunoreactivity and the clinicopathological parameters was analyzed. @*Results@#The overexpression of the nuclear Nrf2 before CRT showed a significant correlation with better DFS. The cytoplasmic Nrf2 expression was associated with more residual tumors after radiotherapy and a more unfavorable DFS, indicating lower radiosensitivity. @*Conclusion@#CRT is an important issue in LARC and is a major aspect of treatment. Thus, the Nrf2/Keap1 expression may be a potential predictor of preoperative therapeutic resistance.The Nrf2-Keap1 modulators that interact with each other may also be effectively applicable to CRT effect in LARC.

5.
Journal of Pathology and Translational Medicine ; : 40-47, 2022.
Article in English | WPRIM | ID: wpr-915804

ABSTRACT

Background@#Polo-like kinase 4 (PLK4) is a serine/threonine protein kinase located in the centriole of the chromosome during the cell cycle. PLK4 overexpression has been described in a variety of many common human epithelial tumors. Conversely, PLK4 acts as a haploinsufficient tumor suppressor in some situations, highlighting the importance of strict regulation of PLK4 expression, activity, and function. Meanwhile, the importance of chemoradiation resistance in rectal cancer is being emphasized more than ever. We aimed to analyze PLK4 expression and the tumor regression grade (TRG) in patients with rectal cancer, treated with chemoradiotherapy (CRT). @*Methods@#A retrospective study was conducted on 102 patients with rectal cancer who received preoperative CRT. Immunohistochemistry for PLK4 in paraffin-embedded tissue was performed from the biopsy and surgical specimens. @*Results@#We found significant association between high expression of PLK4 and poor response to neoadjuvant CRT (according to both Mandard and The Korean Society of Pathologists TRG systems) in the pre-CRT specimens. Other clinicopathologic parameters did not reveal any correlation with PLK4 expression. @*Conclusions@#This study revealed an association between high expression of PLK4 in the pre-CRT specimens and TRG. Our results indicated that PLK4 could potentially be a new predictor for CRT effect in patients with rectal cancer.

6.
Korean Journal of Clinical Oncology ; (2): 47-55, 2022.
Article in English | WPRIM | ID: wpr-938469

ABSTRACT

Purpose@#Endoscopic treatment and laparoscopic surgery are minimally invasive options for early treatment of colorectal cancer, however, more evidence of the long-term outcomes between the two procedures is needed to guide clinical decisions. Therefore, this study aimed to compare the oncologic outcomes between endoscopic and laparoscopic treatment for early colorectal cancer. @*Methods@#The study group included 60 patients who underwent endoscopic treatment and 38 patients who underwent laparoscopic surgery for early colorectal adenocarcinoma between January 2010 and December 2013 at a single study site. @*Results@#Histopathological diagnoses showed that 43 (78.3%) carcinomas in the endoscopic submucosal dissection group were mucosal to sm1, 13 (21.7%) were sm2 or deeper, and 17 high-risk cases (28.3%) in the endoscopic group underwent additional surgery. The median operation time, time to sips of water, and length of hospital stay were significantly shorter in the endoscopic group than in the laparoscopic group. The overall survival rates of patients in the endoscopic group and laparoscopic groups were 91.5% and 87.4%, respectively (P=0.391), and the disease-free survival rates were 90.4% and 87.4% (P=0.614), respectively. Systemic recurrences occurred in two patients (1.6%) in the endoscopic group and one patient (2.0%) in the laparoscopic group. Local recurrence combined with systemic recurrence in one patient (0.8%) in the endoscopic group. @*Conclusion@#Endoscopic resection for early colorectal cancer can be performed safely with better short-term outcomes and comparable longterm oncological outcomes compared to laparoscopic surgery.

7.
Korean Journal of Clinical Oncology ; (2): 82-89, 2021.
Article in English | WPRIM | ID: wpr-917548

ABSTRACT

Purpose@#This study aimed to evaluate and compare the quality of total mesorectal excision (TME) and disease-free and overall survival rates between robotic and laparoscopic surgeries for rectal cancer. @*Methods@#From January 2015 to December 2018, 234 patients underwent curative robotic or laparoscopic surgery for rectal cancer at two centers. Ultimately, 201 patients were enrolled. To control for different demographic factors in the two groups, propensity score matching was used at a 1:1 ratio. Propensity scores were generated with the baseline characteristics, including age, sex, body mass index, American Society of Anesthesiologists score, previous abdominal surgery, tumor location, preoperative chemotherapy, and preoperative radiation. Finally, 134 patients were matched with 67 patients in the robotic surgery group and 67 patients in the laparoscopic surgery group. @*Results@#There was no significant difference in the pathologic stages between the robotic and laparoscopic surgery groups. Distal margin involvement was only observed in the robotic surgery group (1/67, 1.5%). Circumferential resection margin involvement was not different between the robotic surgery and laparoscopic surgery groups (3/67 [4.5%] and 4/67 [6.0%], respectively, P = 1.000). The quality of TME (complete, nearly complete, and incomplete) was similar between the robotic surgery and laparoscopic surgery groups (88.0%, 6.0%, 6.0% and 79.1%, 9.0%, 11.9%, respectively, P = 0.358). The disease-free and overall survival rates were not significantly different between the groups. @*Conclusion@#The quality of TME and disease-free and overall survival rates between the two surgeries were similar. There was no oncologic advantage of robotic surgery for rectal cancer compared to laparoscopic surgery.

8.
Annals of Coloproctology ; : 125-128, 2021.
Article in English | WPRIM | ID: wpr-913390

ABSTRACT

Actinomycosis is an inflammatory disease with various clinical presentations including inflammation and formation of masses. There are several reports suggesting the infiltrative mass-like nature of actinomycosis that is misunderstood as a tumor. A 39-year-old male clinically presented with a fungating mass-like lesion during colonoscopy for healthcare screening. Biopsy was performed for the lesion, and chronic inflammation was diagnosed. Abdominal computed tomography (CT) suggested severe edematous changes in the appendix with an appendicolith, suspected chronic inflammation, and wall thickening of the cecal base, but malignancy could not be definitively ruled out. The patient underwent a laparoscopic single-port cecectomy based on the possibility of cecal cancer. The final biopsy was diagnosed as actinomycosis, and the patient was prescribed antibiotics and showed no recurrence in the follow-up CT scan. We present this rare case of mass-like appendiceal actinomycosis treated with the single-port laparoscopic method.

9.
Journal of Minimally Invasive Surgery ; : 123-125, 2021.
Article in English | WPRIM | ID: wpr-900346

ABSTRACT

Although obstructive colon cancer can often be treated with first-stage resection with primary anastomosis, the results of the oncological outcome of using stenting as a bridge of surgery in the literature are still controversial. Stent insertion for obstructed cancer provides an opportunity for bowel preparation and makes preoperative work-up and clinical staging possible. However, although stenting is becoming a more frequent treatment modality, studies with a significant number of patients acting as a bridge between surgery are still lacking. In this issue of Journal of Minimally Invasive Surgery, the study by Kim et al.highlights the efficacy of stent insertion as the initial treatment and analyzed the prognostic factors in symptomatic obstructive colon cancer. The study demonstrated that emergent surgery, vascular invasion, and omitting adjuvant chemotherapy were independent poor prognostic factors in long-term oncologic outcomes suggested that stent insertion should be considered an initial treatment for symptomatic obstructive colon cancer.

10.
Journal of Clinical Nutrition ; : 17-23, 2021.
Article in English | WPRIM | ID: wpr-899178

ABSTRACT

Purpose@#This study investigated the relationship between the visceral fat area (VFA) and clinico-pathological outcomes in patients with colorectal cancer (CRC). @*Methods@#This retrospective study included 204 patients who underwent anthropometric measurement by bioelectrical impedance analysis (BIA) before surgical treatment for CRC between January 2016 and June 2020. @*Results@#According to the average value of the visceral fat area, 119 (58.3%) patients had a low visceral fat area, and 85 (59.1%) patients had a high visceral fat area. Patients with visceral obesity showed a higher BMI compared to patients without visceral obesity, (21.8±1.9 vs. 25.7±2.5, P<0.001). There was no significant difference in the overall perioperative outcomes including total operation time, time to gas out, sips of water, soft diet, hospital stay, and morbidity between patients in the low and high VFA groups. We divided patients into two subgroups according to the degree of cancer progression and more advanced cases with low VFA showed significantly more total and positive retrieved lymph nodes (LNs) (20.9±10.3 vs. 16.1±7.1, P=0.021 and 3.3±2.9 vs. 2.2±2.3, P=0.019, respectively) and a higher proportion of more than 12 retrieved LNs compared to patients with a high VFA (95.1% vs. 90.0%, P=0.047). Body composition analysis showed that phase angle, muscle composition, and body fluid composition were not statistically different between the two groups. However, body fat mass was statistically higher in the high VFA group (22.0±4.6 vs. 12.8±3.1, P<0.001). @*Conclusion@#Visceral obesity measured by BIA showed lower total and positive retrieved LNs and was not associated with adverse peri-operative outcomes, inflammatory and nutritional, and pathologic outcomes for CRC.

11.
Journal of Minimally Invasive Surgery ; : 123-125, 2021.
Article in English | WPRIM | ID: wpr-892642

ABSTRACT

Although obstructive colon cancer can often be treated with first-stage resection with primary anastomosis, the results of the oncological outcome of using stenting as a bridge of surgery in the literature are still controversial. Stent insertion for obstructed cancer provides an opportunity for bowel preparation and makes preoperative work-up and clinical staging possible. However, although stenting is becoming a more frequent treatment modality, studies with a significant number of patients acting as a bridge between surgery are still lacking. In this issue of Journal of Minimally Invasive Surgery, the study by Kim et al.highlights the efficacy of stent insertion as the initial treatment and analyzed the prognostic factors in symptomatic obstructive colon cancer. The study demonstrated that emergent surgery, vascular invasion, and omitting adjuvant chemotherapy were independent poor prognostic factors in long-term oncologic outcomes suggested that stent insertion should be considered an initial treatment for symptomatic obstructive colon cancer.

12.
Journal of Clinical Nutrition ; : 17-23, 2021.
Article in English | WPRIM | ID: wpr-891474

ABSTRACT

Purpose@#This study investigated the relationship between the visceral fat area (VFA) and clinico-pathological outcomes in patients with colorectal cancer (CRC). @*Methods@#This retrospective study included 204 patients who underwent anthropometric measurement by bioelectrical impedance analysis (BIA) before surgical treatment for CRC between January 2016 and June 2020. @*Results@#According to the average value of the visceral fat area, 119 (58.3%) patients had a low visceral fat area, and 85 (59.1%) patients had a high visceral fat area. Patients with visceral obesity showed a higher BMI compared to patients without visceral obesity, (21.8±1.9 vs. 25.7±2.5, P<0.001). There was no significant difference in the overall perioperative outcomes including total operation time, time to gas out, sips of water, soft diet, hospital stay, and morbidity between patients in the low and high VFA groups. We divided patients into two subgroups according to the degree of cancer progression and more advanced cases with low VFA showed significantly more total and positive retrieved lymph nodes (LNs) (20.9±10.3 vs. 16.1±7.1, P=0.021 and 3.3±2.9 vs. 2.2±2.3, P=0.019, respectively) and a higher proportion of more than 12 retrieved LNs compared to patients with a high VFA (95.1% vs. 90.0%, P=0.047). Body composition analysis showed that phase angle, muscle composition, and body fluid composition were not statistically different between the two groups. However, body fat mass was statistically higher in the high VFA group (22.0±4.6 vs. 12.8±3.1, P<0.001). @*Conclusion@#Visceral obesity measured by BIA showed lower total and positive retrieved LNs and was not associated with adverse peri-operative outcomes, inflammatory and nutritional, and pathologic outcomes for CRC.

13.
Korean Journal of Clinical Oncology ; (2): 9-17, 2020.
Article | WPRIM | ID: wpr-836502

ABSTRACT

Purpose@#Early initiation of adjuvant chemotherapy after colon cancer surgery has shown better oncologic outcomes in previous studies. However, the clinical impact of robotic and laparoscopic surgeries on the initiation of adjuvant chemotherapy has not been widely evaluated. Hence, the study’s aim was to compare the influence of both surgical approaches on the initiation of adjuvant chemotherapy after colon cancer surgery. @*Methods@#From June 2011 to September 2017, 289 patients underwent curative robotic or laparoscopic surgery followed by adjuvant chemotherapy for stage II and III colon cancer. To control for different demographic factors in the two groups, propensity score case matching was used at a 1:4 ratio. Finally, 190 patients were matched with 38 patients of the robotic surgery group and 152 patients of the laparoscopic surgery group. @*Results@#The operation time was longer in the robotic surgery group (297 minutes vs. 170 minutes, respectively; P<0.001). However, conversion rate, number of retrieved lymph nodes, first flatus, first soft diet, length of stay, postoperative complication rate, and Clavien-Dindo grade were not significantly different between the two groups. Additionally, there was no difference in the time to initiation of adjuvant chemotherapy between the two groups (31.5 days vs. 29.0 days, respectively; P=0.226). Disease-free and overall survival rates were also not significantly different. @*Conclusion@#Robotic and laparoscopic surgeries showed no different impact on the initiation of adjuvant chemotherapy. This finding suggests that the two surgical approaches offer similar postoperative outcomes.

14.
Korean Journal of Clinical Oncology ; (2): 135-140, 2019.
Article in English | WPRIM | ID: wpr-788053

ABSTRACT

Colorectal carcinoma invading the submucosa but not the muscularis propria (pT1) represents the earliest form of clinically relevant colorectal cancer in most patients. T1 colorectal cancer with synchronous liver metastasis is considered to be rare. We report a rare case of T1 colon cancer with synchronous liver metastasis not detected by preoperative imaging study. A 54-year-old male patient presented to our department for treatment of sigmoid colon cancer following an endoscopic submucosal dissection. Histopathological examination revealed the pedunculated mass was moderately differentiated adenocarcinoma without lymphovascular invasion and the depth of submucosal invasion was 2,000 µm, the resection margin was not involved. We performed a laparoscopic anterior resection with lymph node dissection. After the 3 months, the patient's carcinoembryonic antigen level elevated from 1.4 to 7.26 ng/mL (normal level: <1.5 ng/mL) and the abdominal computed tomography and FDG-PET/CT (positron emission tomography-computed tomography) showed multiple hepatic metastases in both hepatic lobes (SUVmax: 5.6) without evidence of local recurrence or lymphadenopathy. We strongly suspected a synchronous liver metastasis not detected by imaging study as opposed to a systemic recurrence. Therefore, evaluation and follow-up protocol of T1 colorectal cancer should be changed for discovery and prediction of synchronous liver metastasis; because we cannot exclude the possibility of synchronous liver metastasis.


Subject(s)
Humans , Male , Middle Aged , Adenocarcinoma , Carcinoembryonic Antigen , Colon , Colonic Neoplasms , Colorectal Neoplasms , Follow-Up Studies , Liver , Lymph Node Excision , Lymphatic Diseases , Neoplasm Metastasis , Recurrence , Sigmoid Neoplasms
15.
Korean Journal of Clinical Oncology ; (2): 7-14, 2019.
Article in English | WPRIM | ID: wpr-788050

ABSTRACT

PURPOSE: This study investigated the relationship between body composition and platelet-to-lymphocyte ratio (PLR) in patients with colorectal cancer (CRC).METHODS: This retrospective study included 110 patients who underwent anthropometric measurement by bioelectrical impedance analysis before surgical treatment for CRC between May 2015 and June 2018.RESULTS: According to PLR, 45 patients (40.9%) had low PLR (PLR<150), and 65 patients (59.1%) had high PLR (PLR≥150). Serum hemoglobin (P<0.001) and albumin levels (P=0.021) were significantly lower in high PLR group. Tumor mass diameter was significantly larger in high PLR group (P=0.048) and the proportion of poorly differentiated or mucinous tumors was significantly higher in high PLR group (P=0.037). All indices related to fat (body fat mass, percent body fat, body fat mass of trunk, visceral fat area, fat mass index, measured fat thickness of abdomen) and two indices related to muscle (arm muscle circumference, measured muscle circumference of abdomen) were significantly lower in high PLR group (P<0.05). According to subgroup analysis based on the sex, all indices significantly differed between PLR groups; however, in females no index was significantly different between PLR groups.CONCLUSION: Body composition indices including fat and muscle indices measured by InBody 770 were related to PLR in CRC, especially in male patients. These results suggest that low muscle and fat indices may be related to poor prognosis of CRC.


Subject(s)
Female , Humans , Male , Adipose Tissue , Body Composition , Colorectal Neoplasms , Electric Impedance , Intra-Abdominal Fat , Mucins , Nutrition Assessment , Prognosis , Retrospective Studies
16.
Journal of Bacteriology and Virology ; : 162-175, 2019.
Article in Korean | WPRIM | ID: wpr-785902

ABSTRACT

PURPOSE: Dysbiosis of gut microbiota has been reported to participate in the pathogenesis of colorectal cancer, but changes in microbiota due to radiotherapy have not been studied. In this study, we tried to elucidate the changes in the microbiome in rectal cancer after chemoradiotherapy using RNA sequencing analysis.MATERIALS AND METHODS: We included 11 pairs of human rectal cancer tissues before and after irradiation between August 2016 and December 2017 and performed RNA sequencing analysis. Mapped reads to human reference genomes were used for pair-wise transcriptome comparisons, and unmapped (non-human) reads were then mapped to bacterial marker genes using PathSeq.RESULTS: At microbiome level, interindividual variability of mucosal microbiota was greater than the change in microbial composition during radiotherapy. This indicates that rapid homeostatic recovery of the mucosal microbial composition takes place short after radiotherapy. At single microbe level, Prevotella and Fusobacterium, which were identified as important causative microbes of the initiation and progression of rectal cancer were decreased by radiotherapy. Moreover, changes in Prevotella were associated with changes in the human transcriptome of rectal cancer. We also found that there was a gene cluster that increased and decreased in association with changes in microbial composition by chemoradiation.CONCLUSION: This study revealed changes in tumor-associated microbial community by irradiation in rectal cancer. These findings can be used to develop a new treatment strategy of neoadjuvant therapy for locally advanced rectal cancer by overcoming radio-resistance or facilitating radio-sensitivity.


Subject(s)
Humans , Chemoradiotherapy , Colorectal Neoplasms , Dysbiosis , Fusobacterium , Gastrointestinal Microbiome , Genes, vif , Genome , Microbiota , Neoadjuvant Therapy , Prevotella , Radiotherapy , Rectal Neoplasms , Sequence Analysis, RNA , Transcriptome
17.
Cancer Research and Treatment ; : 712-719, 2018.
Article in English | WPRIM | ID: wpr-715834

ABSTRACT

PURPOSE: The prognosis of patientswith colon cancer and para-aortic lymph node metastasis (PALNM) is poor. We analyzed the prognostic factors of extramesenteric lymphadenectomy for colon cancer patients with isolated PALNM. MATERIALS AND METHODS: We retrospectively reviewed 49 patients with PALNM who underwent curative resection between October 1988 and December 2009. RESULTS: In univariate analyses, the 5-year overall survival (OS) and disease-free survival (DFS) rates were higher in patients with ≤ 7 positive para-aortic lymph node (PALN) (36.5% and 27.5%) than in those with > 7 PALN (14.3% and 14.3%; p=0.010 and p=0.027, respectively), and preoperative carcinoembryonic antigen (CEA) level > 5 was also correlated with a lower 5-year OS and DFS rate of 21.5% and 11.7% compared with those with CEA ≤ 5 (46.3% and 41.4%; p=0.122 and 0.039, respectively). Multivariate analysis found that the number of positive PALN (hazard ratio [HR], 3.291; 95% confidence interval [CI], 1.309 to 8.275; p=0.011) was an independent prognostic factor for OS and the number of positive PALN (HR, 2.484; 95% CI, 0.993 to 6.211; p=0.052) and preoperative CEA level (HR, 1.953; 95% CI, 0.940 to 4.057; p=0.073) were marginally independent prognostic factors for DFS. According to our prognostic model, the 5-year OS and DFS rate increased to 59.3% and 53.3%, respectively, in patients with ≤ 7 positive PALN and CEA level ≤ 5. CONCLUSION: PALN dissection might be beneficial in carefully selected patients with a low CEA level and less extensive PALNM.


Subject(s)
Humans , Carcinoembryonic Antigen , Colon , Colonic Neoplasms , Disease-Free Survival , Lymph Node Excision , Lymph Nodes , Lymphatic Metastasis , Multivariate Analysis , Neoplasm Metastasis , Prognosis , Retrospective Studies
18.
Korean Journal of Clinical Oncology ; (2): 96-101, 2017.
Article in English | WPRIM | ID: wpr-788014

ABSTRACT

PURPOSE: Colonic stenting as a bridge to surgery is an alternative to emergency surgery in patients with acute malignant colonic obstruction. This study aimed to compare the outcomes of early and late surgery after colonic stenting for obstructive colorectal cancer.METHODS: From March 2004 to August 2014, the medical records of obstructive colorectal cancer patients who underwent surgery after colonic stent insertion were retrospectively reviewed. The patients were divided into early surgery (≤7 days after stenting) and late surgery (>7 days after stenting) groups.RESULTS: Eighty-four patients underwent colonic stenting for obstructive colorectal cancer. Forty-six patients were ultimately enrolled: 18 in the early and 28 in the late surgery groups. The mean ages were 63.7 and 71.8 years, respectively (P=0.01). Blood loss was lower in the early surgery group (median [interquartile range], 50 [50–50] mL vs. 50 [50–100] mL; P=0.020). The time to first flatus was longer in the early surgery group (3.0 [3.0–5.0] days vs. 2.0 [2.0–3.0] days; P=0.010). The time to first soft food intake was similar. Postoperative complications did not differ (16.7% vs. 14.3%, respectively; P=0.525) and no patients died.CONCLUSION: Surgical outcomes were similar between early and late surgery. However, the former featured less blood loss, indicating less surgical difficulty. These results show that early surgery can be performed safely in obstructive colorectal cancer patients after colonic stenting if the patient's clinical condition is amenable to early surgery.


Subject(s)
Humans , Colon , Colorectal Neoplasms , Eating , Emergencies , Flatulence , Intestinal Obstruction , Medical Records , Postoperative Complications , Retrospective Studies , Stents
19.
Journal of Minimally Invasive Surgery ; : 120-121, 2017.
Article in English | WPRIM | ID: wpr-120524

ABSTRACT

In rectal cancer surgery, gentle opening of the plane by continuous traction and optimized visualization is essential. Recently, a wristed robotic suction-irrigation device was developed for efficient traction of the rectum and good surgical visualization. This video shows a technique of robotic total mesorectal excision using a wristed robotic suction-irrigation device. A 74-year-old woman with rectal cancer had a biopsy-proven adenocarcinoma within 9 cm of the anal verge. She underwent totally robotic total mesorectal excision using a dual-docking technique. Total procedure time was 445 minutes. The patient was discharged on postoperative day 8 without any complications. Total number of lymph nodes harvested was 12, and proximal and distal resection margins were 11.2 and 4.7 cm, respectively. Totally robotic total mesorectal excision using a wristed robotic suctionirrigation device was an efficient and useful procedure for rectal cancer.


Subject(s)
Aged , Female , Humans , Adenocarcinoma , Laparoscopy , Lymph Node Excision , Lymph Nodes , Rectal Neoplasms , Rectum , Robotic Surgical Procedures , Traction , Wrist
20.
Journal of Minimally Invasive Surgery ; : 25-31, 2016.
Article in English | WPRIM | ID: wpr-119398

ABSTRACT

PURPOSE: Single-port laparoscopic surgery has been used increasingly in treatment of a variety of conditions, and one recently introduced technique is single-port laparoscopic total extraperitoneal (SPLTEP) hernia repair. The aim of this study was to evaluate the safety and technical feasibility of SPLTEP hernia repair without fixation of the mesh. METHODS: From June 2010 to October 2012, 112 consecutive patients underwent SPLTEP hernia repair. RESULTS: We performed 129 inguinal hernia repairs in 112 patients, 17 were bilateral and 95 unilateral. There were 107 indirect hernias (83.0%), 20 direct hernias, and 2 hernias had both of types. Successful SPLTEP hernia repair was performed in 110 patients, with two conversions to an open surgical approach. Median operative times for unilateral and bilateral hernias were 70 minutes (40~145 minutes) and 90 minutes (67~135 minutes), respectively, and the hospital stay was 1 day (1~5 days). Postoperative complications included 10 patients with wound seromas or hematomas, 2 with urinary retention, 4 with groin pain, and 1 with bleeding from the incision site. There were 3 early recurrences (2.4%) during a median follow-up period of 42 months (range, 6~55). CONCLUSION: SPLTEP inguinal hernia repair without fixation of the mesh is both safe and technically feasible, and provides acceptable operative outcomes. Conduct of a prospective randomized study with long-term follow-up is needed to confirm the benefit of this technique in patients with inguinal hernia.


Subject(s)
Humans , Follow-Up Studies , Groin , Hematoma , Hemorrhage , Hernia , Hernia, Inguinal , Herniorrhaphy , Laparoscopy , Length of Stay , Operative Time , Postoperative Complications , Prospective Studies , Recurrence , Seroma , Urinary Retention , Wounds and Injuries
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