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1.
Annals of Coloproctology ; : 253-261, 2022.
Article in English | WPRIM | ID: wpr-937133

ABSTRACT

Purpose@#Systemic inflammation is associated with various malignancies, including colorectal cancer, as possible prognostic predictors. We aimed to evaluate the correlation of pretreatment the platelet-to-lymphocyte (PLR) and the neutrophil-to-lymphocyte (NLR) ratio with long-term oncologic outcomes and pathologic complete response (pCR) in locally ad vanced rectal cancer patients who received neoadjuvant concurrent chemoradiotherapy (CRT) followed by curative resection. @*Methods@#Between October 1996 and December 2015, 168 rectal cancer patients treated with preoperative CRT followed by surgery were enrolled. The set cut-off/mean PLR and NLR were 170 and 2.8. We analyzed the relationship between PLR, NLR, and the 5-year overall survival (OS), disease-free survival (DFS), and pCR rate. @*Results@#The 5-year OS rates were 75.9% and 59.8% in the highand low-PLR groups. The 5-year DFS rates were 62.9% and 50.8% in the high- and low-PLR groups, with no significant difference. In addition, the 5-year OS rates were 75.7% and 58.4%, and the 5-year DFS rates were 62.5% and 50.0% in the high- and low-NLR groups, respectively, both without any significant difference. Multivariate analysis showed only pretreatment PLR as an independent prognostic factor for OS (hazard ratio, 1.850; 95% confidence interval, 1.041–3.287; P=0.036), and both serologic markers were not independent prognostic factors for 5-year DFS. @*Conclusion@#Neither PLR nor NLR was associated with 5-year DFS nor pCR to neoadjuvant CRT. Only pretreatment PLR can be used in predicting OS in locally advanced rectal cancer patients who received neoadjuvant CRT followed by curative resection.

2.
Annals of Surgical Treatment and Research ; : 315-323, 2020.
Article in English | WPRIM | ID: wpr-889261

ABSTRACT

Purpose@#To compare the hospital length of stay (LOS), duration of antibiotic use, medical costs, and incidence of surgical site infection (SSI) between laparoscopic colorectal surgery (Lap-CRS) and open CRS (Open-CRS). @*Methods@#We retrospectively reviewed data of the Health Insurance Review and Assessment Service Surgical Antibiotic Prophylaxis assessment (7th assessment, 2015); the nationwide data were collected from patients who underwent CRS from September to November 2015 in low volume hospital to the tertiary hospital level in Korea. @*Results@#All 2,751 patients who underwent elective CRS were assessed. The mean hospital LOS (12.18 days vs. 14.16 days, P < 0.001) and mean postoperative LOS (8.21 days vs. 9.46 days, P < 0.001) were shorter in the Lap-CRS group than in the Open-CRS group. The mean duration of antibiotic use was shorter in the Lap-CRS group (2.91 days vs. 3.64 days, P = 0.033). The rate of SSI was lower in the Lap-CRS group, but there was no significant difference between the groups (3.57% vs. 5.01%, P = 0.133). Among the SSI group, the mean LOS (19.5 days vs. 24.9 days, P = 0.081), duration of antibiotic use (12.62 days vs. 15.46 days, P = 0.097), and medical costs showed no significant difference between the 2 groups. @*Conclusion@#Lap-CRS is significantly associated with reduced hospital LOS and the duration of antibiotic use in this study. However, we could not identify significant differences in the incidence of SSI according to the type of surgery. To assess the overall benefits of Lap-CRS, studies including the rate of SSI up to 30 days postoperatively will be needed in the future.

3.
The Korean Journal of Gastroenterology ; : 79-85, 2020.
Article in Korean | WPRIM | ID: wpr-811444

ABSTRACT

The presence of bowel contents during colorectal surgery has been related to surgical site infections (SSI), anastomotic leakage (AL) and postoperative complications theologically. Mechanical bowel preparation (MBP) for elective colorectal surgery aims to reduce fecal materials and bacterial count with the objective to decrease SSI rate, including AL. Based on many observational data, meta-analysis and multicenter randomized control trials (RTC), non-MBP did not increase AL rates or SSI and other complications in colon and even rectal surgery. In 2011 Cochrane review, there is no significant benefit MBP compared with non-MBP in colon surgery and also no better benefit MBP compared with rectal enemas in rectal surgery. However, in surgeon's perspectives, MBP is still in widespread surgical practice, despite the discomfort caused in patients, and general targeting of the colon microflora with antibiotics continues to gain popularity despite the lack of understanding of the role of the microbiome in anastomotic healing. Recently, there are many evidence suggesting that MBP+oral antibiotics (OA) should be the growing gold standard for colorectal surgery. However, there are rare RCT studies and still no solid evidences in OA preparation, so further studies need results in both MBP and OA and only OA for colorectal surgery. Also, MBP studies in patients with having minimally invasive surgery (MIS; laparoscopic or robotics) colorectal surgery are still warranted. Further RCT on patients having elective left side colon and rectal surgery with primary anastomosis in whom sphincter saving surgery without MBP in these MIS and microbiome era.


Subject(s)
Humans , Anastomotic Leak , Anti-Bacterial Agents , Bacterial Load , Colon , Colorectal Surgery , Enema , Microbiota , Minimally Invasive Surgical Procedures , Postoperative Complications , Surgical Wound Infection
4.
Annals of Coloproctology ; : 83-87, 2020.
Article | WPRIM | ID: wpr-830364

ABSTRACT

Purpose@#Patients who undergo radical surgery for rectal cancer often experience low anterior resection syndrome (LARS). Symptoms of this syndrome include frequent bowel movements, gas incontinence, fecal incontinence, fragmentation, and urgency. The aim of this study was to investigate the convergent validity, discriminative validity, and reliability of the Korean version of the LARS score questionnaire. @*Methods@#The English LARS score questionnaire was translated into Korean using the forward-and-back translation method. A total of 146 patients who underwent radical surgery for rectal cancer answered the Korean version of the LARS score questionnaire including an anchor question assessing the impact of bowel function. Participants answered the questionnaire once more after 2 weeks. @*Results@#The Korean LARS score questionnaire showed high convergent validity in terms of high correlation between the LARS score and quality of life (perfect fit 55.5% vs. moderate fit 37.6% vs. no fit 6.8%, respectively; P 8 cm; P = 0.021), and radiotherapy (32 for yes vs. 24 for no; P = 0.001). The LARS score also demonstrated high reliability at test-retest with no difference between scores at the first and second tests (intraclass correlation coefficient: Q1 = 0.932; Q2 = 0.909, Q3 = 0.944, Q4 = 0.931, and Q5 = 0.942; P < 0.001, respectively). @*Conclusion@#The Korean version of the LARS score questionnaire has proven to be a valid and reliable tool for measuring LARS in Korean patients with rectal cancer.

5.
Annals of Surgical Treatment and Research ; : 315-323, 2020.
Article in English | WPRIM | ID: wpr-896965

ABSTRACT

Purpose@#To compare the hospital length of stay (LOS), duration of antibiotic use, medical costs, and incidence of surgical site infection (SSI) between laparoscopic colorectal surgery (Lap-CRS) and open CRS (Open-CRS). @*Methods@#We retrospectively reviewed data of the Health Insurance Review and Assessment Service Surgical Antibiotic Prophylaxis assessment (7th assessment, 2015); the nationwide data were collected from patients who underwent CRS from September to November 2015 in low volume hospital to the tertiary hospital level in Korea. @*Results@#All 2,751 patients who underwent elective CRS were assessed. The mean hospital LOS (12.18 days vs. 14.16 days, P < 0.001) and mean postoperative LOS (8.21 days vs. 9.46 days, P < 0.001) were shorter in the Lap-CRS group than in the Open-CRS group. The mean duration of antibiotic use was shorter in the Lap-CRS group (2.91 days vs. 3.64 days, P = 0.033). The rate of SSI was lower in the Lap-CRS group, but there was no significant difference between the groups (3.57% vs. 5.01%, P = 0.133). Among the SSI group, the mean LOS (19.5 days vs. 24.9 days, P = 0.081), duration of antibiotic use (12.62 days vs. 15.46 days, P = 0.097), and medical costs showed no significant difference between the 2 groups. @*Conclusion@#Lap-CRS is significantly associated with reduced hospital LOS and the duration of antibiotic use in this study. However, we could not identify significant differences in the incidence of SSI according to the type of surgery. To assess the overall benefits of Lap-CRS, studies including the rate of SSI up to 30 days postoperatively will be needed in the future.

6.
Annals of Coloproctology ; : 139-145, 2017.
Article in English | WPRIM | ID: wpr-49452

ABSTRACT

PURPOSE: The anaphase-promoting complex (APC) is a multiprotein complex with E3 ubiquitin ligase activity and is required for ubiquitination of securin and cyclin-B. Several APC-targeting molecules are reported to be oncogenes. Dysregulation of APC may be associated with tumorigenesis. This study examines the relationship between APC expression and clinicopathological factors and evaluates the possibility of an aberrant APC function in colorectal carcinomas (CRCs). METHODS: To determine whether the loss of APC7 expression is related to tumorigenesis, we used tissue micro-arrays in 114 resected CRCs to scrutinize the expressions of APC7 and Ki-67 immunohistochemistry and to find relations with clinocopathologic parameters. The expression of APC7 was defined as positive for summed scores of staining intensities from 0 to 3+. RESULTS: Forty-four cases (67.7%) of colon cancer and 38 cases (77.6%) of rectal cancer showed immunopositive reactions to APC. The grade of APC expression was not statistically correlated with tumor location, age, T or TNM stage, or differentiation. However, the expression of APC did correlate with the expression of Ki-67 and to the tumor recurrent. Higher APC expression showed the better 5-year overall survival rate in 74% of grades 2, 3 groups (high expression) than 57% of grades 0, 1 groups (lower expression) respectively (P = 0.042). CONCLUSION: Positive APC expression may be a good prognostic factor for patients with CRC, and the loss of APC expression in tumor tissue may be related with the risk for recurrence and a poor survival rate compared to high APC expression. Further study of APC in controlling the cell cycle as aberrant function in CRC is needed.


Subject(s)
Humans , Adenocarcinoma , Anaphase-Promoting Complex-Cyclosome , Carcinogenesis , Cell Cycle , Colonic Neoplasms , Colorectal Neoplasms , Immunohistochemistry , Oncogenes , Rectal Neoplasms , Recurrence , Securin , Survival Rate , Ubiquitin , Ubiquitin-Protein Ligases , Ubiquitination
7.
Annals of Coloproctology ; : 88-89, 2016.
Article in English | WPRIM | ID: wpr-80315

ABSTRACT

No abstract available.


Subject(s)
Abscess , Appendectomy , Appendicitis
8.
Annals of Coloproctology ; : 45-46, 2016.
Article in English | WPRIM | ID: wpr-215152

ABSTRACT

No abstract available.


Subject(s)
Humans , Colorectal Neoplasms , Microsatellite Instability , Microsatellite Repeats , Mucins
9.
Annals of Coloproctology ; : 119-120, 2015.
Article in English | WPRIM | ID: wpr-115944

ABSTRACT

No abstract available.


Subject(s)
Biofeedback, Psychology , Rectal Neoplasms
10.
Annals of Coloproctology ; : 205-205, 2014.
Article in English | WPRIM | ID: wpr-185022

ABSTRACT

No abstract available.


Subject(s)
Rectal Neoplasms
11.
Annals of Coloproctology ; : 59-59, 2014.
Article in English | WPRIM | ID: wpr-41993

ABSTRACT

No abstract available.

12.
Annals of Surgical Treatment and Research ; : 156-160, 2014.
Article in English | WPRIM | ID: wpr-16066

ABSTRACT

We report a case of synchronous multiple colon adenocarcinomas in a patient with neurofibromatosis type 1 (NF1). NF1 is an autosomal dominant inherited disorder and patients with NF1 have high risk for both benign and malignant tumors. However, adenocarcinomas involving the colon have rarely been reported in patients with NF1. A 61-year-old man was referred for generalized peritonitis due to descending colon perforation. Left hemicolectomy was performed and pathologic examination showed four adenocarcinomas. Peritoneal nodules were confirmed as metastatic adenocarcinoma (pT4N1M1). The patient also had clinical features compatible with NF1 such as cafe au lait macules, axillary freckles, neurofibromas across the body, and Lisch nodules. Upon review of the literature, colon adenocarcinoma in patients with NF1 tends to occur in males and relatively young age groups, and is associated with advanced tumor stages and multiple colon cancers. To improve treatment outcome, early colonoscopic surveillance should be considered in patients with NF1.


Subject(s)
Humans , Male , Middle Aged , Adenocarcinoma , Colon , Colon, Descending , Colonic Neoplasms , Melanosis , Neurofibroma , Neurofibromatoses , Neurofibromatosis 1 , Peritonitis , Treatment Outcome
13.
Yonsei Medical Journal ; : 1273-1280, 2014.
Article in English | WPRIM | ID: wpr-210333

ABSTRACT

PURPOSE: To evaluate the influence of preoperative mechanical bowel preparation (MBP) based on the occurrence of anastomosis leakage, surgical site infection (SSI), and severity of surgical complication when performing elective colorectal surgery. MATERIALS AND METHODS: MBP and non-MBP patients were matched using propensity score. The outcomes were evaluated according to tumor location such as right- (n=84) and left-sided colon (n=50) and rectum (n=100). In the non-MBP group, patients with right-sided colon cancer did not receive any preparation, and patients with both left-sided colon and rectal cancers were given one rectal enema before surgery. RESULTS: In the right-sided colon surgery, there was no anastomosis leakage. SSI occurred in 2 (4.8%) and 4 patients (9.5%) in the non-MBP and MBP groups, respectively. In the left-sided colon cancer surgery, there was one anastomosis leakage (4.0%) in each group. SSI occurred in none in the rectal enema group and in 2 patients (8.0%) in the MBP group. In the rectal cancer surgery, there were 5 anastomosis leakages (10.0%) in the rectal enema group and 2 (4.0%) in the MBP group. SSI occurred in 3 patients (6.0%) in each groups. Severe surgical complications (Grade III, IV, or V) based on Dindo-Clavien classification, occurred in 7 patients (14.0%) in the rectal enema group and 1 patient (2.0%) in the MBP group (p=0.03). CONCLUSION: Right- and left-sided colon cancer surgery can be performed safely without MBP. In rectal cancer surgery, rectal enema only before surgery seems to be dangerous because of the higher rate of severe postoperative complications.


Subject(s)
Aged , Female , Humans , Male , Middle Aged , Anastomosis, Surgical , Colorectal Surgery/adverse effects , Elective Surgical Procedures/adverse effects , Preoperative Care/adverse effects , Propensity Score , Retrospective Studies , Surgical Wound Infection/epidemiology , Treatment Outcome
14.
Annals of Coloproctology ; : 247-247, 2014.
Article in English | WPRIM | ID: wpr-84166

ABSTRACT

No abstract available.


Subject(s)
Humans , Colorectal Neoplasms , Positron-Emission Tomography
15.
Annals of Coloproctology ; : 44-54, 2013.
Article in English | WPRIM | ID: wpr-122836

ABSTRACT

There are still debates regarding the appropriate primary treatment policy for asymptomatic primary colorectal lesions in cases of unresectable metastatic colorectal cancer. Even though there are patients with asymptomatic primary tumors when starting chemotherapy, those patients may still undergo surgery due to complications related to primary tumors in the middle of chemotherapy; therefore, controversy exists regarding surgical resection of primary colorectal lesions in cases where symptoms are absent when making a diagnosis. Thus, based on the published literature, we discuss opinions that prefer first-line surgery for primary tumors as well as opinions favoring first-line chemotherapy for treating unresectable synchronous metastatic colorectal cancer. Although the upfront chemotherapy including targeted agents is suggested as an effective treatment in recent years, the first line surgery has been a preferred treatment for decades. The first line surgery is beneficial to prolong the survival duration given the retrospective analysis of randomized trial data. So far, no prospective comparison study has only focused on the first-line treatment modality; thus, future clinical studies focusing on the survival duration and the quality of life should be performed as soon as possible. Furthermore, at this point, multidisciplinary team approaches would be helpful in finding the appropriate therapy. Regardless of symptoms, the performance status and the tumor burden should be taken into consideration as well. In case of surgical resection, minimally invasive surgery, such as laparoscopic surgery, is recommended.


Subject(s)
Humans , Colorectal Neoplasms , Laparoscopy , Quality of Life , Tumor Burden
16.
Journal of Minimally Invasive Surgery ; : 126-132, 2012.
Article in Korean | WPRIM | ID: wpr-188629

ABSTRACT

PURPOSE: Colorectal resection for elderly patients is associated with significant morbidity and mortality. It is still unclear whether or not laparoscopic colorectal resection (Lap CR) is indicated in elderly patients. The aim of this study is to evaluate the outcome of colonic surgery in elderly patients and to assess the feasibility and safety of laparoscopic colorectal surgery in elderly patients. METHODS: Patient characteristics and perioperative and pathologic data on 295 patients who underwent Lap CR for cancer from Jan. 2004 to Aug. 2011 were prospectively collected. Exclusion criteria were emergency and palliative by-pass surgery. Outcomes for elderly patients (> or =75 years) were compared with those of younger patients ( or =75 years, median age 79 years) showed a greater proportion off emale gender (52.6% vs. 37.0%, p=0.065) and American Society of Anesthesiologists score 2~3 (97.3% vs.42.0%, p<0.001). No differences in tumor location, median operative time, conversion rate, duration of hospital stay, and perioperative complications (23.7% vs. 30.0%, p=0.427) were observed between the two groups. Distributions of American Joint Committee on Cancer stages and number of harvested lymph nodes were comparable between groups. CONCLUSION: Although elderly patients are more likely to be affected by co morbidities, postoperative outcome in this group after Lap CR is comparable with that of younger patients. Use of Lap CR in elderly patients is safe, and is associated with a low morbidity. It should be also regarded as the optimal approach for very elderly patients.


Subject(s)
Aged , Humans , Colon , Colorectal Neoplasms , Colorectal Surgery , Emergencies , Joints , Laparoscopy , Length of Stay , Lymph Nodes , Operative Time , Prospective Studies
17.
Journal of the Korean Society of Coloproctology ; : 309-310, 2010.
Article in English | WPRIM | ID: wpr-103045

ABSTRACT

No abstract available.

18.
Journal of the Korean Society of Coloproctology ; : 29-33, 2010.
Article in Korean | WPRIM | ID: wpr-8549

ABSTRACT

PURPOSE: Fournier's disease is polymicrobial necrotizing fasciitis of the perineal, perianal, or genital areas. The objective of this study was to investigate patients with Fournier's gangrene and to determine risk factors that affect mortality. METHODS: This study was a retrospective clinical study. Clinical presentations and outcomes of surgical treatments were evaluated in 27 patients with Fournier's gangrene that were treated in a single institution from January 2000 to March 2009. RESULTS: The mean age of patients was 52.8+/-14.4 yr, and the male-to-female ratio was 25:2. Among the predisposing factors, diabetes mellitus was the most common (n=8, 29.6%). The most common infection source was anorectal (n=16, 59.3%). Sepsis on admission was detected in 16 cases (59.3%). Four patients died during treatment, for an overall mortality of 14.8%. A logistic regression test showed a Fournier's gangrene severity index greater than 9 and sepsis on admission to be prognostic factors. CONCLUSION: The mortality rate was higher in patients with sepsis on admission and with a Fournier's gangrene severity index greater than nine.


Subject(s)
Humans , Diabetes Mellitus , Fasciitis, Necrotizing , Fournier Gangrene , Logistic Models , Retrospective Studies , Risk Factors , Sepsis
19.
Journal of the Korean Surgical Society ; : 369-375, 2010.
Article in Korean | WPRIM | ID: wpr-10363

ABSTRACT

PURPOSE: Spontaneous hemoperitoneum is not a common disease but may cause a fatal outcome. Warfarin is a coumarin anticoagulant, used widely for therapeutic and prophylactic anticoagulation. Although, it is considered a life saving medicine, it is associated with significant adverse effects including intraabdominal bleeding. Literatures about spontaneous hemoperitoneum in patients taking anticoagulants have been reported, but until now there have not been a definite establishment in diagnostic criteria and treatment strategy. METHODS: Among 209 patients who were diagnosed hemoperitoneum from Jan 2005 through May 2009, we identified 9 patients with spontaneous hemoperitoneum without any trauma history or solid organ abnormalities. All 9 patients were taking warfarin for various durations. Initially, we evaluated vital signs, laboratory, CT findings, and clinical course, retrospectively. In addition, we analyzed risk factors potentiating the pharmacologic effect of anticoagulants. RESULTS: One of the most prominent features in this study is that all patients showed prolonged international normalized ratio (6.36~15.11). One patient received an exploratory laparotomy for hemoperitoneum secondary to warfarin, presenting as a localized peritonitis in the right lower quadrant of the abdomen. Mean hospital stay was 15.2 days. Five patients were transfused with packed red blood cells (500~1,000 ml) and fresh frozen plasma (300~900 ml). All patients were discharged without any mortality. CONCLUSION: It is important to identify and confirm the factors that can potentiate the pharmacologic effect of anticoagulants, when acute abdomen is suspected in patients taking anticoagulants. If the patients are hemodynamically stable, they can be treated without surgical intervention.


Subject(s)
Humans , Abdomen , Abdomen, Acute , Anticoagulants , Coumarins , Erythrocytes , Fatal Outcome , Hemoperitoneum , Hemorrhage , International Normalized Ratio , Laparotomy , Length of Stay , Peritonitis , Plasma , Retrospective Studies , Risk Factors , Vital Signs , Warfarin
20.
Journal of the Korean Gastric Cancer Association ; : 250-255, 2008.
Article in Korean | WPRIM | ID: wpr-111195

ABSTRACT

PURPOSE: The purpose of this study was to assess the diagnostic value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) for detecting the lymph node (LN) metastasis of gastric cancer. MATERIALS AND METHODS: 119 patients (M:F=89:30; mean age: 64) with gastric cancer were referred for preoperative FDG-PET/CT scanning and spiral enhanced abdominal pelvic CT from June 2006 to July 2008, and these were the subjects of our study. All the patients underwent curative radical gastrectomy and lymph node dissection. A final diagnosis was made for all the patients by the histology of the surgical specimens. RESULTS: Both PET/CT and enhanced CT showed similar sensitivity for detecting regional lymph node metastasis (32.6% vs 39.5%, respectively). PET/CT was more accurate than enhanced CT for detecting regional lymph node metastasis (67.2% vs 63.0%, respectively), and PET/CT showed better specificity (86.8% vs 76.3, respectively) and a better positive predictive value (PPV) (58.3% vs 48.6%, respectively). PET/CT showed better specificity (98.0% vs 88.2%, respectively) and accuracy (79.4% vs 73.9%, respectively) than enhanced CT for detecting early gastric cancer. PET/CT showed better specificity (64.0% vs 52.0%, respectively), a better PPV (60.9% vs 57.1%), a better negative predictive value (NPV) (48.5% vs 46.4%, respectively) and better accuracy (53.6% vs 51.8%, respectively) than enhanced CT for detecting advanced gastric cancer. CONCLUSION: FDG-PET/CT is more usefulness than enhanced CT for making the preoperative diagnosis of regional LN metastases from gastric cancers.


Subject(s)
Humans , Electrons , Gastrectomy , Lymph Node Excision , Lymph Nodes , Neoplasm Metastasis , Sensitivity and Specificity , Stomach Neoplasms
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