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Objective To investigate the relationships between the expression levels of tumor necrosis factor receptor associated factor 4 (TRAF4) and ribosomal S6 protein kinase 4 (RSK4) protein in gastric cancer tissues and the recurrence after laparoscopic radical gastrectomy. Methods In total, 176 patients were divided into the recurrence and non-recurrence group, and the expression levels of TRAF4 and RSK4 protein in cancer and adjacent tissues and in gastric cancer tissues in the recurrence and non-recurrence group were compared. The influencing factor of recurrence and the efficacy of TRAF4 and RSK4 protein expression in predicting recurrence were analyzed. Results The positive expression rate of TRAF4 protein in gastric cancer tissues was higher than that in adjacent tissues (P < 0.05) and that in the recurrence group was higher than that in the non-recurrence group (P < 0.05). The positive expression rate of RSK4 protein in gastric cancer tissues was lower than that in adjacent tissues (P < 0.05) and that in the recurrence group was lower than that in non-recurrence group (P < 0.05). The largest tumor diameter 5 cm, poor differentiation, TNM Ⅲ stage, depth of invasion T3-T4, lymph node metastasis, absence of adjuvant chemotherapy after operation, positive expression of TRAF4 and RSK4 protein, and regular diet w influenced the post-operative recurrence (all P < 0.05). The accuracy of TRAF4 and RSK4 protein in gastric cancer tissues in combined predicting the recurrence was 83.52%. Conclusion The expression of TRAF4 protein is high, and the RSK4 protein is low in gastric cancer tissue, which are related to recurrence.
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Objective:To analyze the clinical features, postoperative recurrence and prognostic factors of young patients with cervical cancer.Methods:The clinical data of hospitalized cervical cancer patients in the Affiliated Hospital of Qingdao University from January 2004 to March 2019 were retrospectively studied. 243 young cervical cancer patients ≤35 years old were selected as the study group. The method of case-control study was adopted. In the same period, 250 first and second cervical cancer patients aged >35 years were randomly selected as the control group. The clinical data of the two groups were compared, and the survival curves of the two groups were analyzed. The clinical data of patients with postoperative recurrence (17 cases) and patients without recurrence (164 cases) in the study group were compared, and the related data affecting the prognosis of young cervical cancer patients were analyzed by univariate and multivariate analysis. Statistical data were compared by χ 2 test or exact probability method. Kaplan-meier method was used to estimate survival rate and draw survival curve. Survival rate was compared by Long-Rank test. COX regression model was used for multivariate analysis. Results:Compared with the control group, the young cervical cancer patients had earlier age of marriage, menstruate, fewer pregnancies, no preoperative adjuvant therapy, more nerve infiltration and ovarian preservation, the difference was statistically significant (χ 2 values were 94.58, 67.54, 60.53, 5.44, 13.64, 5.51, and 118.24, respectively; P values were <0.001, <0.001, <0.001, 0.025, 0.022, <0.001, respectively). The proportion of irregular vaginal bleeding in study group (13.17%(32/243)) was lower than that in control group (30.40%(76/250)), and the proportion of contact vaginal bleeding (52.26%(127/243)) was higher than that in control group (43.20%(108/250)). There were significant differences between the two groups (χ 2 values were 21.39 and 4.06, respectively; P values were < 0.001 and 0.044, respectively). There was no significant difference in Kaplan-Meier survival rate between the study group and the control group (χ 2=0.03, P=0.859). Univariate analysis showed that the International Federation of Gynecology and Obstetrics(FIGO), whether to retain ovary, depth of cervical invasion, nerve invasion, lymphatic vascular space invasion and pelvic lymph node metastasis were the influencing factors of 5-year survival rate of young cervical cancer patients ( P values were 0.016, 0.008, 0.014, 0.017, 0.004, <0.001, respectively). Multivariate analysis showed FIGO staging ( OR=2.073, 95% CI: 1.017-4.228, P=0.045), lymphatic vascular space infiltration ( OR=0.041, 95% CI: 0.005-0.341, P=0.019) and pelvic lymph node metastasis ( OR=0.027, 95% CI: 0.004-0.197, P<0.001) were risk factors affecting the prognosis of young cervical cancer. The patients with low FIGO stage, no lymphatic vascular space infiltration and pelvic lymph node metastasis have a good prognosis. Conclusion In young patients with cervical cancer, the first clinical feature is mainly contact vaginal bleeding. The prognosis of young patients with cervical cancer and 5 years survival rate there was no statistically significant difference compared with control group. The later FIGO staging , no ovarinan retention and the deeper cervical infiltration depth , with the nerve or between lymphatic vascular invasion and pelvic lymph node metastasis in young patients with cervical cancer had poor prognosis, and FIGO stage, lymphatic vessel space invasion and pelvic lymph node metastasis were the most significant factors.
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OBJECTIVES: To investigate the predictive value of long non-coding RNA (lncRNA) H19 and the ten-eleven translocation enzyme 1 (TET1) transcriptional expression in postoperative recurrence of uterine fibroids (UFs). METHODS: Seventy-five patients with UF, who underwent surgical treatment, were enrolled in the treatment group, and 60 healthy individuals were enrolled in the control group. The relative expression levels of lncRNA H19 and TET1 mRNA in the serum and UF tissues were analyzed. The patients were further divided into a better curative (BC) group and a poor efficacy (PE) group to analyze the predictive value of lncRNA H19 and TET1 and the independent risk factors affecting the recurrence of UF. RESULTS: Compared with the control group, lncRNA H19 expression levels were significantly higher, while TET1 expression levels were significantly lower in the treatment group (p<0.001). The area under the receiver operating characteristic (ROC) curve (AUC) values of the two indicators for diagnostic importance were found to be 0.872 and 0.826, respectively. Compared with the PE group, lncRNA H19 expression levels were significantly lower, while TET1 expression levels were significantly higher in the BC group (p<0.001). The AUC values of the two indicators for their predictive efficacy were 0.788 and 0.812, respectively. Logistic regression analysis showed that age, menarche age, maximum diameter of UFs, number of UFs, lncRNA H19 levels, and TET1 levels were independent risk factors affecting UF recurrence. The AUC values of lncRNA H19 and TET1 for their predictive value for postoperative recurrence were 0.814 and 0.765, respectively. CONCLUSIONS: The lncRNA H19 and TET1 have high diagnostic and predictive efficacy for determining the postoperative recurrence of UFs.
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Humans , Female , RNA, Long Noncoding/genetics , Leiomyoma , RNA, Messenger , ROC Curve , Proto-Oncogene Proteins , Mixed Function Oxygenases , Neoplasm Recurrence, LocalABSTRACT
Objective:To analyze the therapeutic effects and prognosis after radiotherapy (chemotherapy) of patients with postoperative recurrent esophageal cancer.Methods:This study analyzed 501 patients with postoperative recurrent esophageal cancer who were treated in the Radiotherapy Department of the Fourth Hospital of Hebei Medical University and met enrollment conditions. Among them, 274 patients received concurrent chemotherapy and radiotherapy. The analyses in this study focused on the survival after the retreatment, postoperative recurrence patterns, prognosis of retreatment, and prognostic factors affecting the retreatment. Meanwhile, statistical analysis was conducted using the software SPSS Statistics 19.0.Results:The time of postoperative recurrence was 0.3-87.4 months, with a median number of 11.6 months. The median survival time was 12.1 months after the retreatment. Among all the patients, 344 patients suffered from only local recurrence, while the remaining 157 patients experienced distant metastasis. According to multivariate analysis result, independent prognostic factors included gender, pN stage, lymph node positive logarithmic ratio (LODDS), the number of chemotherapy cycles, time of recurrence, and distant metastasis ( P < 0.05). Meanwhile, prognostic factors affecting the 344 patients with only local recurrence included the time of recurrence, the number of chemotherapy cycles, and prescription dose ( χ2=22.605, 13.957, 10.446; P< 0.05). The remaining 157 patients suffered from distant metastasis. The 1-, 3-, and 5-year survival rates of them were 43.3%, 9.1%, and 5.5%, respectively, and those of the patients with only local recurrence were 53.6%, 22.6%, and 16.4%, respectively. The differences were statistically significant (χ 2=10.786, P< 0.05). Conclusions:Radiotherapy (chemotherapy) is safe and effective for the treatment of recurrent esophageal cancer. However, it features poor prognosis for male patients with a late pN stage, a high LODDS, the number of chemotherapy cycles ≤ 2, the time of recurrence≤ 24 months, and distant metastasis.
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Hepatocellular carcinoma(HCC) is one of the most common malignancies in the world. Liver resection and transplantation are currently the most important treatments,but the high recurrence rate of postoperative tumors significantly reduces long-term survival. Microvascular invasion(MVI) predicts the risk of postoperative tumor recurrence and is an independent risk factor for recurrence after resection. Furthermore,focusing on how the postoperative management can be improved on histopathologically confirmed patients with HCC with MVI,and the potential roles of using predictive tests to estimate the risk of presence of MVI,help in preoperative therapeutic decision-making in patients with HCC.
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Intrahepatic cholangiocarcinoma (ICC) is a primary malignant tumor derived from epithelial cell of the subbranches of the intrahepatic bile ducts,which has characteristics of atypical clinical symptom,high misdiagnosis rate and poor prognosis.Radical surgery in early stage is considered as the only effective measure to cure ICC.Nowadays,it has been a focus and still remains debatable that whether perihepatic lymph node dissection (LND) could improve the long-time survival for ICC patients in consideration of that ICC is easy to migrate via lymphatic system.Therefore,for standardization of surgical treatment of ICC and improvement of patients' survival,it is quite important to evaluate the necessity of LND in radical resection and benefits of LND in patients highly suspected lymph node metastasis or without lymph node metastasis preoperatively and intraoperatively.Based on the current situation of the global clinical research of LND in ICC,along with the clinical practice experience in authors' clinical center,this paper focused on the safety and effectiveness of LND aiming to provide some evidences for the indication of LND in ICC patients.
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We report a case of recurrent chronic subdural hematoma (CSDH) successfully treated with jidabokuippo. The patient was an 81 year-old woman who was performed burr hole surgery for left CSDH. Residual hematoma was gradually increased in postoperative serial brain CT. Although goreisan and saireito were administrated to prevent recurrence, the treatment was not effective. Thereafter, reoperation was performed because of the appearance of aphasia and right hemiparesis. Intraoperative findings revealed that the hematoma was viscous and was not enough drained. Since there was little improvement in clinical and CT findings, a phenomenon of the hematoma was considered as oketsu and jidabokuippo was administrated. Three weeks after the medication, right hemiparesis was improved. Seven weeks after the medication, the hematoma was markedly reduced. Taken together, these results strongly suggest that jidabokuippo is effective for postoperative recurrent CSDH which is difficult for drainage and has no response to the administration of goreisan and saireito.
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Objective To systematically evaluate the effectiveness of Chinese medicine(CM) combined with chemotherapy in preventing stageⅡ-Ⅲ colorectal cancer patients from postoperative recurrence and metastasis. Methods Databases of PubMed, EMBase, Cochrane Library, China National Knowledge Information(CNKI), VIP Database, Wanfang Database, and SinoMed were retrieved to collect randomized controlled trials(RCTs) of CM combined with chemotherapy in preventing stageⅡ-Ⅲ colorectal cancer patients from postoperative recurrence and metastasis. And then the quality of the included RCTs was evaluated systematically. Results Seven RCTs involving 700 cases of stageⅡ-Ⅲ colorectal cancer patients were included, 355 patients in treatment group were treated with CM combined with chemotherapy, and 345 patients in control group were treated with chemotherapy alone. The results of Meta-analysis showed that treatment group was superior to the control group in preventing the recurrence and metastasis of colorectal cancer one , 2 and 3 year(s) after the radical surgery, showing statistically significant differences(P 0.05). At the same time, CM combined with chemotherapy had better effect than chemotherapy alone on prolonging the time for recurrence and metastasis, improving performance status and relieving the symptoms, the difference being significant(P<0.05). Conclusion CM combined with chemotherapy exerts better effect than chemotherapy alone in preventing stageⅡ-Ⅲ colorectal cancer patients from postoperative recurrence and metastasis and onimproving the quality of life of the patients. However, for the low methodological quality of the included trials, the conclusion still needs more large-size sample, multiple-center, and high-quality clinical trials to be confirmed.
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Objective:To investigate the predictive value of preoperative and postoperative serum tumor markers, namely, carcinoem-bryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), and CA72-4, in the diagnosis of gastric cancer recurrence at different stag-es. Methods:Analysis was performed in 564 patients who underwent curative resection for gastric cancer between January 2002 and March 2007, received no chemotherapy at our hospital, and received complete follow-up according to the schedule determined pro-spectively. The values of CEA, CA19-9, and CA72-4 were evaluated before and after surgery. Results:In the pTNM-Ⅰ and pTNM-Ⅱ stage groups, patients with positive preoperative serum CEA, CA19-9, and CA72-4 levels showed recurrence rates of 50.0%, 24.1%, and 22.6%, respectively. Similarly, the recurrence rates of patients with positive postoperative serum CEA, CA72-4, and CA19-9 levels were 42.9%, 21.7%, and 14.3%, respectively. Multivariate analysis showed that the positive preoperative serum CEA level could be an inde-pendent factor of recurrence. In the pTNM-Ⅲ stage group, the recurrence rates of patients with positive preoperative serum CEA, CA19-9, and CA72-4 levels were 50.0%, 55.2%, and 47.6%, respectively. The recurrence rates of patients with positive postoperative se-rum CEA, CA19-9, and CA72-4 levels were 75.0%, 66.7%, and 66.7%, respectively. Multivariate analysis showed that high postoperative serum CA72-4 levels could be an independent factor of gastric cancer recurrence. Conclusion:Serum tumor markers exhibited differ-ent predictive values in different pTNM stages. Preoperative CEA level could be used to predict recurrence in patients with pTNM-Ⅰ and pTNM-Ⅱ stages of gastric cancer. Moreover, postoperative CA72-4 level could be used to predict recurrence in patients with pTNM-Ⅲ stage gastric cancer.
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Objective To explore the risk factors associated with surgery and postoperative recurrence in patients with Crohn's disease (CD).Methods A total of 183 patients diagnosed as CD from January 2008 to December 2013 were enrolled.Forty-six patients after surgery were assigned to surgery group,and 137 non-surgical CD patients were assigned to control group.All the patients were followed up until the endpoint of the study or death,and the follow-up period was at least 12 months.Typing was according to the Montreal classification.The risk factors associated with surgery and postoperative recurrence were analyzed by Logistic regression.Results The surgery rate of CD patients was 25.1 ％ (46/183),the postoperative clinical recurrence rate of surgery group was 39.1％ (18/46),and the recurrence time was 20 months (7～42 months).Before surgery,the rate of definite diagnosis of CD was only 13.0％ (6/46).Stricture (odd ratio (OR)=5.836,95％ confidence interval (CI) 2.199 to 15.487,P＜0.01) and penetration (OR=25.706,95％oo CI 7.091 to 93.190,P＜0.01) were independent risk factors for the surgery.Furthermore,perianal disease(OR=23.550,95％CI 1.311 to 422.912,P=0.032) and lack of prophylaxes treatment after surgery (OR=58.701,95％CI 1.803 to 1 991.000,P=0.022) were independent risk factors for postoperative clinical recurrence.Conclusions Stricture and penetration are risk factors for surgery.Perianal disease and lack of prophylaxes treatment after surgery are risk factors for postoperative clinical recurrence.
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Objective To study the correlation between liver fibroindex and prognosis of hepatocellular carcinoma after hepatectomy.Methods The clinical data of 77 patients with hepatocellular carcinoma who underwent hepatectomy at the 5th Hospital Affiliated to Sun Yat-sen University from 2009 October to 2014 December were analyzed retrospectively.Using data from preoperative Fibroindex,these patients were divided into 2 groups,Group 1:Fibroindex ≤5.4,and Group 2:Fibroindex ＞5.4.The clinical pathological parameters and postoperative disease free survival rates in these groups were analyzed.The Cox ratio risk pattern analysis was used for factors correlating recurrence.Results The parameters in the 2 groups which included sex (35/0 vs 29/13),type of cirrhosis (23/12 vs 14/28),numbers of tumor (35/0 vs 26/16),maximal diameter of tumor (31/4 vs 23/19),vascular invasion status (32/3 vs 26/16),resection margin status (35/0 vs 36/6),hepatic vein/portal vein tumor thrombus status (35/0 vs 29/13),perioperative change of HBV DNA levels (23/12 vs 15/27)were correlated with postoperative recurrence,and they all showed significant differences (P ＜ 0.05).Disease free survival rate in Group 2 was lower than Group 1 (71.4％,33.7％,22.4％ vs 94.3％,46.2％,46.2％,P ＜ 0.05).The Cox regression analysis showed Fibroindex ＞ 5.4,AFP-L3％ ≥ 10％,and number of tumor ＞ 3 to be independent predictors of poor disease-free survival after hepatectomy for hepatocellular carcinoma (P ＜ 0.05).Conclusions Preoperative Fibroindex ＞ 5.4 was an independent adverse predictor of poor disease-free survival.It was valuable to predict postoperative recurrence in hepatocellular carcinoma patients.
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Objective To investigate the effects of different therapeutic strategies on recurrence of postoperative Crohn's disease (CD) patients.Methods From September 2009 to September 2014,85 CD patients with intestinal resection were enrolled.The clinical features and maintenance therapeutic medication were retrospectively analyzed.The patients were divided into non-treatment group (induding continuously or cumulatively taking medicine less than three months),5-aminosalicylic acid (5-ASA) group and immunosuppressant agents group (including azathioprine,methotrexate and thalidomide).Kaplan-Meier method was performed to compare the recurrence rate in postoperative CD with different therapeutic medication and the risk factors of postoperative recurrence were also analyzed.Results Among 85 CD patients,there were 32,21 and 32 patients in non-treatment group,5-ASA group and immunosuppressive agents group,respectively.After surgery,the one year accumulated clinical recurrence rate of immunosuppressant agents group was 12.5％ (4/32),which was significantly lower than that of non-treatment group (56.3％,18/32) and 5-ASA group (38.1％,8/21),and the differences were statistically significant (x2 =12.250,P＜0.01;x2 =4.102,P =0.043).After surgery,the two years accumulated clinical recurrence rate of immunosuppressant agents group was 12.9 ％ (4/31),which was significantly lower than that of non-treatment group (75.9％,22/29) and 5-ASA group (47.6％,10/21),and the differences were statisitcally significant (x2 =17.840,P＜0.01;x2 =6.597,P=0.010).After operation,the one year accumulated endoscopic recurrences rates of non-treatment group,5-ASA group and immunosuppressant agents group were 39.1％ (9/23),5/16 and 34.6％ (9/26),respectively;while the two year accumulated endoscopic recurrence rates were 59.1％ (13/22),6/16 and 44.0％ (11/25),respectively.However,there was no statistically significant difference among the groups (all P＞0.05).Penetrating lesion was an risk factor of postoperative clinical recurrence in CD patients (x2 =4.963,P=0.026,oddsratio (OR) =2.221,95 ％ confidence interval (CI) 1.121 to 5.775).Conclusions Immunosuppressive agents rather than 5-ASA have remarkable effects in preventing postoperative clinical recurrence in CD patients.Postoperative clinical recurrence is more likely to happen in patients with penetrating lesions.
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Objective To study the risk factors of recurrence after debridement bone graft fusion in elderly patients with spi‐nal tuberculosis(TB) .Methods The data of 415 elderly patients with spinal tuberculosis in our hospital from January 2003 to De‐cember 2013 were retrospectively analyzed .Among them ,46 cases (observation group) recurred and 369 cases(control group) had no postoperative recurrence .The preoperative anti‐TB treatment duration ,surgical removal degree of lesions ,postoperative stand‐ardized therapy ,extra‐skeletal TB ,drug resistance ,postoperative braking duration ,complicating systemic disease ,anemia or malnu‐trition ,etc .were statistically analyzed .Results Preoperative anti‐TB treatment duration ,surgical removal degree of lesions ,postop‐erative standardized therapy ,extra‐skeletal TB ,drug resistance ,postoperative braking duration ,complicating systemic disease ,ane‐mia or malnutrition were the major risk factors for postoperative recurrence of senile spinal TB ;preoperative anti‐TB treatment du‐ration ,surgical removal degree of lesions ,postoperative standardized therapy ,extra‐skeletal TB ,drug resistance ,postoperative bra‐king duration ,complicating systemic disease and anemia or malnutrition were closely related with postoperative recurrence of senile spinal TB ,which were their independent risk factors .Conclusion The recurrence of senile spinal tuberculosis and bone graft fusion and is closely related to various factors .
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Objective Our study was aimed to study the clinical effect of carbon dioxide laser in the treatment of adult laryn -geal papilloma . Methods Clinical data of patients with adult laryngeal papilloma received treatment at our hospital from January 2012 to June 2014 was retrospectively analyzed .Patients were divided into two groups according to the type of treatment , observation group:received carbon dioxide laser treatment;control group:received tumor forceps treatment .Participants included 61 cases of pa-tients, the observation group of 26 cases, control group 35 cases.Compare the general clinical data , short-term clinical effects(opera-tion time, length of hospital stay , complications , short-term curative effect ) , the change of immune inflammation indexes before and after operation and postoperative recurrence in 1 year of two groups patients. Results The operation time and the length of hospital stay in observation group was significantly lower than that in control group[(33.66 ±4.71)min vs (37.19 ±5.21)min,(4.07 ±1.25)d vs (4.83 ±1.38)d, P 4.11) ng/L, (36.16 ±7.37) ng/L, (12.63 ±4.12) ng/L.The differences of these parameters between the two groups were signifi-cant (P<0.001).Observation group patients had a lower rate of recurrence 1 year after surgery than that of control group patients (12.00%vs 37.93%, P=0.029). Conclusion In the treatment of adult laryngeal papilloma , carbon dioxide laser can achieve a better minimally invasive and lower postoperative recurrence when compare to tumor forceps treatment .
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Objective To study the predictive value of preoperative blood CD4 +/CD8 + ratio in postoperative recurrence after hepatectomy for patients with hepatocellular carcinoma.Methods The clinical data of 67 patients who underwent hepatectomy for hepatocellular carcinoma at The Fifth Hospital Affiliated to Sun Yat-sen University were analyzed retrospectively.Using the preoperative blood CD4 +/CD8 + ratio,these patients were divided into 2 groups,the CD4 +/CD8 + ＜ 1 group and the CD4 +/CD8 + ≥ 1 group.These patients were followed up at the outpatient clinic and/or by telephone till June 2013.The Cox ratio risk pattern analysis was used to determine the significant risk factors of tumor recurrence.Results On univariate analysis,preoperative AFP ≥400 μg/L,maximum diameter of tumor ＞ 5 cm,number of tumor ＞ 3,CD4 +/CD8 + ＜ 1,vascular invasion,positive resection margin,and portal vein tumor thrombus were risk factors of poor disease-free survival (P ＜ 0.05).On multivariant analysis,CD4 +/CD8 + ＜ 1,number of tumor ＞ 3,and portal vein tumor thrombus were independent predictors of poor disease-free survival after hepatectomy for hepatocellular carcinoma (P ＜ 0.05).Conclusions Preoperative CD4 +/CD8 + ＜ 1 was an independent adverse predictor of poor disease-free survival.It was valuable in predicting postoperative recurrence of hepatocellular carcinoma.
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BACKGROUND/AIMS: The natural history of Crohn's disease (CD) is characterized by a remitting and relapsing course and a considerable number of patients ultimately require bowel resection. Moreover, postoperative recurrence is very common. Relatively few studies have investigated the postoperative recurrence of CD in Korea. The aim of the current study was to assess postoperative recurrence rates - both clinical and endoscopic - in CD as well as factors influencing postoperative recurrence. METHODS: Electronic medical records of patients who underwent surgery due to CD were reviewed and analyzed. Patients with incomplete surgical resection, a follow-up period of less than a year, and a history of strictureplasty or perianal surgery were excluded. RESULTS: Of 112 CD patients, 39 patients had history of bowel resection, and 34 patients met the inclusion criteria. Among them, 26 were male (76%) and the mean age of onset was 32.8 years. The mean follow-up period after operation was 65.4 months. Cumulative clinical recurrence rates were 8.8%, 12.5%, and 33.5% at 12, 24, and 48 months, respectively. Use of immunomodulators for prophylaxis was the only predictor of clinical recurrence in univariate analysis (P=0.042). Of 21 patients who had undergone follow-up colonoscopy after surgery, cumulative endoscopic recurrence rates were 33.3%, 42.9%, and 66.1% at 6, 12, and 24 months, respectively. No significant predicting factor for endoscopic recurrence was detected. CONCLUSIONS: Postoperative recurrence rates in Korean patients with CD are high, and endoscopic recurrence rates are comparable to those reported from Western studies. Appropriate medical prophylaxis seems to be important for preventing postoperative recurrence in CD.
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Humans , Male , Age of Onset , Colonoscopy , Crohn Disease , Electronic Health Records , Follow-Up Studies , Immunologic Factors , Korea , Natural History , RecurrenceABSTRACT
PURPOSE: This study was performed to assess postoperative complications and recurrence rates and to elucidate the risk factors in Crohn's disease (CD). METHODS: A retrospective review was undertaken for patients who had undergone bowel surgery at Asan Medical Center between October 1991 and June 2006. Symptomatic recurrence was defined as the presence of symptoms related to CD that was subsequently verified by radiologic or endoscopic finding. Surgical recurrence was defined as the need for repeated surgery for enteric CD. RESULTS: There were 160 patients with a mean follow up of 34 months (108 men and 52 women; mean age: 29.7+/-10.9). The most common indication for surgery was a complication of CD, such as intra-abdominal abscess (31.9%), intestinal obstruction (21.9%), and internal fistula (19.4%). Another frequent indication was medical intractability (23.8%). The types of surgical procedures were ileocolic resection (50.0%), small bowel resection (25.0%), total/subtotal colectomy (17.5%), and others. The cumulative symptomatic recurrences were 15.9% and 36.4% at 2 and 5 years, and the cumulative surgical recurrence was 13.6% at 5 years. The cumulative surgical recurrence was higher for stricturing-type CD than for penetrating-type CD (P=0.049). No other significant risk factor for recurrence was found in our study. Twenty patients (12.5%) had postoperative complications, such as intra-abdominal abscess, anastomosis leakage, obstruction, and wound infection. CONCLUSIONS: The postoperative complication and recurrence rates were acceptable. For stricturing-type Crohn's disease surgical recurrence is higher than penetrating type, but long-term follow up is needed to verify the risk factors for recurrence.
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Humans , Male , Abdominal Abscess , Colectomy , Crohn Disease , Fistula , Follow-Up Studies , Intestinal Obstruction , Postoperative Complications , Recurrence , Retrospective Studies , Risk Factors , Wound InfectionABSTRACT
In hepatocellular carcinoma distant metastasis after curative surgical resection without intrahepatic metastasis is very rare. A 55-year old man presented with a huge pelvic bone mass. Eight years ago he underwent posterior hepatic segmentectomy following diagnosis of hepatocelluar carcinoma. He has received regular check-ups with abdominal ultrasonography and serum alpha-fetoprotein. On admission an MRI on the pelvic area showed an 18x10 cm sized lobulated mass invading the pelvic bone and acetabulum. Microscopic examination revealed that the tumor was a well differentiated hepatocellular carcinoma. There was no evidence of intrahepatic recurrence. He was treated with transarterial chemoembolization, external radiotherapy (total 3750 cGy), and systemic chemotherapy using 5-fluorouracil.