A Comprehensive Review of Percutaneous Nephrostomy and Suprapubic Cystostomy

Percutaneous nephrostomy is widely used for the diagnosis and treatment of various urinary tract diseases, such as ureteral fistula, stenosis, and percutaneous nephrolithotomy, and the relief of urinary obstruction. Suprapubic cystostomy is also known as a good method for bladder drainage in patients with lower urinary tract obstruction or injury and neurogenic bladder. Despite the frequent use of these procedures, reports in the literature are insufficient for an interventional radiologist to understand the procedures easily and thoroughly. In this article, the indication, anatomy, placement, and postoperative management of percutaneous nephrostomy and suprapubic cystostomy have been described, explaining that the procedures are safe and effective.

Which strategy is better for resectable synchronous liver metastasis from colorectal cancer, simultaneous surgery, or staged surgery? Multicenter retrospective analysis

PURPOSE: The optimal treatment for synchronous liver metastasis (LM) from colorectal cancer (CRC) depends on various factors. The present study was intended to investigate the oncologic outcome according to the time of resection of metastatic lesions. METHODS: Data from patients who underwent treatment with curative intent for primary CRC and synchronous LM between 2004 and 2009 from 9 university hospitals in Korea were collected retrospectively. One hundred forty-three patients underwent simultaneous resection for primary CRC and synchronous LM (simultaneous surgery group), and 65 patients were treated by 2-stage operation (staged surgery group). RESULTS: The mean follow-up length was 41.2 ± 24.6 months. In the extent of resection for hepatic metastasis, major hepatectomy was more frequently performed in staged surgery group (33.8% vs. 8.4%, P < 0.001). The rate of severe complications of Clavien-Dindo classification grade III or more was not significantly different between the 2 groups. The 3-year overall survival (OS) rate was 85.0% in staged surgery group and 69.4% in simultaneous surgery group (P = 0.013), and the 3-year recurrence-free survival (RFS) rate was 46.4% in staged surgery group and 30.2% in simultaneous surgery group (P = 0.143). In subgroup analysis based on the location of primary CRC, the benefit of staged surgery for OS and RFS was clearly shown in rectal cancer (P = 0.021 and P = 0.015). CONCLUSION: Based on our results, staged surgery with or without neoadjuvant chemotherapy should be considered for resectable synchronous LM from CRC, especially in rectal cancer, as a safe and fairly promising option.

Impact of Adjuvant Therapy Type on Survival in Stage II/III Rectal Cancer Without Preoperative Chemoradiation: A Korean Multicenter Retrospective Study

PURPOSE: This study compared the oncologic impact of postoperative chemotherapy and chemoradiotherapy on patients with rectal cancer without preoperative chemoradiation. METHODS: This retrospective study analyzed 713 patients with a mean follow-up of 58 months who had undergone radical resection for stage II/III rectal cancer without preoperative treatment in nine hospitals from January 2004 to December 2009. The study population was categorized a chemotherapy group (CG, n = 460) and a chemoradiotherapy group (CRG, n = 253). Five-year overall survival (OS) and disease-free survival (DFS) were analyzed, and independent factors predicting survival were identified. RESULTS: The patients in the CRG were significantly younger (P < 0.001) and had greater incidences of low rectal cancer (P < 0.001) and stage III disease (P < 0.001). Five-year OS (P = 0.024) and DFS (P = 0.012) were significantly higher in the CG for stage II disease; however, they were not significantly different for stage III disease. In the multivariate analysis, independent predictive factors were male sex, low rectal cancer and stage III disease for OS and male sex, abdominoperineal resection, stage III disease and tumor-positive circumferential margin for DFS. However, adjuvant therapy type did not independently affect OS (hazard ratio [HR], 1.243; 95% confidence interval [CI], 0.794–1.945; P = 0.341) and DFS (HR, 1.091; 95% CI, 0.810–1.470; P = 0.566). CONCLUSION: Adjuvant therapy type did not affect survival of stage II/III rectal cancer patients without neoadjuvant chemoradiotherapy. These results suggest that adjuvant therapy can be chosen based on the patient’s condition and the policies of the surgeons and hospital facilities.

Treatment for the Recalcitrant Anterior Shin Skin Lesion after Chronic Osteomyelitis of the Tibia: Diaphyseal Osteoplasty and Soft Tissue Primary Closure / 대한정형외과학회잡지

PURPOSE: We aimed to report the clinical results of diaphyseal osteoplasty and primary soft tissue closure in recalcitrant poor skin lesion with superficial or localized bone infection on the anterior shin after chronic osteomyelitis. MATERIALS AND METHODS: We retrospectively reviewed 7 patients with poor shin skin lesion complicated by superficial and localized bone infection after chronic osteomyelitis. The average duration of chronic osteomyelitis was 39 years. After excision of the poor skin lesion, diaphyseal osteoplasty of the tibia was performed for the resection of infected bone and primary closure of the soft tissue defect. Postoperative results were evaluated with recovery of skin lesion, the amount of bone resection by osteoplasty and complications including recurrence of osteomyelitis. RESULTS: Mean size of excised skin lesion during surgery was 3.0×14.1 cm and successful primary closures of the defect were possible in all cases. All shin skin lesions were recovered and the amount of resected bone was mean of 18.7% of the anteroposterior diameter of the tibia. There was no recurrence of skin lesion, osteomyelitis or stress fracture. CONCLUSION: After treatment of a previous intramedullary infection in chronic osteomyelitis of the tibia, recalcitrant poor shin skin lesion complicated with superficial or localized bone infection was effectively recovered by diaphyseal osteoplasty and primary soft tissue closure. This procedure is relatively simple compared to other surgeries and effective in recovery of healthy shin skin without recurrence of osteomyelitis.

Clinical Significance of Peroxisome Proliferator-Activated Receptor gamma and TRAP220 in Patients with Operable Colorectal Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The peroxisome proliferator-activated receptor gamma (PPARgamma) is a nuclear receptor that regulates expression of mediators of lipid metabolism and the inflammatory response. Thyroid hormone receptor-associated proteins 220 (TRAP220) is an essential component of the TRAP/Mediator complex. The objective of this study was to clarify whether PPARgamma or TRAP220 are significant prognostic markers in resectable colorectal cancer (CRC). MATERIALS AND METHODS: A total of 399 patients who underwent curative resection for CRC were enrolled. We investigated the presence of PPARgamma and TARP220 in CRC tissues and adjacent normal tissues by immunohistochemistry. Correlation between the expression of these factors and clinicopathologic features and survival was investigated. RESULTS: Median age of the patients was 63 years (range, 22 to 87 years), and median follow-up duration 61.1 months (range, 2 to 114 months). PPARgamma and TRAP220 expression showed significant correlation with depth of invasion (p=0.013 and p=0.001, respectively). Expression of TRAP220 also showed association with lymph node metastasis and TNM stage (p=0.001). Compared with patients with TRAP220 negative tumors, patients with TRAP220 positive tumors had longer 5-year disease-free survival (DFS) tendency (p=0.051). Patients who were PPARgamma positive combined with TRAP220 positive had a better 5-year DFS (64.8% vs. 79.3%, p=0.013). In multivariate analysis expression of both PPARgamma and TRAP220 significantly affected DFS (hazard ratio, 0.620; 95% confidence interval, 0.379 to 0.997; p=0.048). CONCLUSION: TRAP220 may be a valuable marker for nodal metastasis and TNM stage. Tumor co-expression of PPARgamma and TRAP220 represents a biomarker for good prognosis in CRC patients.

Gravity Valgus Stress Ultrasonographic Assessment of Ulnar Collateral Ligament Injury among Baseball Players / 대한스포츠의학회지

The purpose of this study is to evaluate the gravity valgus stress ultrasonographic findings of ulnar collateral ligament (UCL) injury among baseball players. Twenty-eight (age, 16-30; mean, 19.5 years) UCL injured players, diagnosed by magnetic resonance imaging (MRI), were examined by bilateral elbow ultrasonography. On MRI findings, partial and complete tears were 17 and 11 players, respectively. Ultrasonographic examinations were performed in 90 degree elbow flexion with gravity valgus stress, and abnormalities around UCL and ulnohumeral distance were compared with contralateral uninjured elbow. 22 of 28 (79%) players had sonographic abnormalities in injured elbow such as thickening, wavy contour of the UCL (32%), hypoechoic foci in the ligament (43%), osteophyte on trochlear or ulnar articular margin (36%), joint effusion (29%) and ossicles in or around the UCL (68%) that were the most common finding in both partial and complete tears. In all players, the ulnohumeral distance was significantly wider on the injured side than it was on the uninjured side (4.0+/-1.5 mm and 2.5+/-0.43 mm, respectively; p=0.015). Significant increased average ulnohumeral distance in injured elbow was observed with complete UCL tears compared with partial tears (5.4+/-0.9 mm and 3.1+/-0.8 mm, respectively; p=0.021) and the mean difference between injured and uninjured elbow was more significant in complete tears than partial tears (2.8+/-1.2 mm and 0.7+/-0.6 mm, respectively; p=0.012). Gravity valgus stress ultrasonography is rapid noninvasive diagnostic tool and can provide clinicians valuable information regarding the condition of the UCL and medial elbow laxity in partial and complete UCL tear players.

Analysis of the Short-term Result of Laparoscopic Liver Resection vs Open Liver Resection for Hepatocellular Carcinoma

PURPOSE: Laparoscopic surgery has recently shown rapid development, and has been applied in most abdominal surgeries. It has also been adopted in hepatobiliary surgery, especially in the resection of liver tumors. Significant advantages of laparosopic surgery over the conventional open method have been reported, however, the safety of the surgical resection margin and radicality of the tumor resection remain to be clarified. This study was conducted in order to assess the feasibility and potential superiority of laparoscopic liver resection of hepatocellular tumors to open surgery. METHODS: This study included 76 patients who underwent liver resection for hepatocellular carcinoma at Dong-A University Hospital from January 2008 through June 2010. Of these 63 cases, 31 patients underwent laparoscopic resections and 33 underwent open liver resections. Both groups were confirmed as hepatocellular carcinoma by postoperative pathology and analyzed retrospectively. RESULTS: There were no statistically significant differences in preoperative parameters, such as age, height, body weight, Child Pugh score, ASA, and tumor size in both groups. There were no significant differences in operating time, duration of hospital stay, safety margins of surgical resection, postoperative complications, and rate of recurrence and occurrence of new lesions in both groups, however, better disease free survival was observed in the laparoscopic group (p=0.024). CONCLUSION: Findings of this study showed that the laparoscopic group had better results in free survival period than the open group. Conduct of larger scale prospective studies wound confirm the superiority of the laparoscopic liver resection to the conventional open procedure in patients with hepatocellular carcinoma. Findings of this study also suggest that assessment of the factors associated with the quality of life, such as degree of postoperative pain, and size of the incisional scar, and long term postoperative complications may play an additional role in favoring the laparoscopic liver resection. To elucidate the superiority of the laparoscopic liver resection to the conventional open method, conduct of study involving a larger study group and a longer prospective research period will be needed.

Comparative Study of Hand-Sutured versus Circular Stapled Anastomosis for Gastrojejunostomy in Laparoscopy Assisted Distal Gastrectomy

PURPOSE: Mechanical stapler is regarded as a good alternative to the hand sewing technique, when used in gastric reconstruction. The circular stapling method has been widely applied to gastrectomy (open orlaparoscopic), for gastric cancer. We illustrated and compared the hand-sutured method to the circular stapling method, for Billroth-II, in patients who underwent laparoscopy assisted distal gastrectomy for gastric cancer. MATERIALS AND METHODS: Between April 2009 and May 2011, 60 patients who underwent laparoscopy assisted distal gastrectomy, with Billroth-II, were enrolled. Hand-sutured Billroth-II was performed in 40 patients (manual group) and circular stapler Billroth-II was performed in 20 patients (stapler group). Clinicopathological features and post-operative outcomes were evaluated and compared between the two groups. RESULTS: Nosignificant differences were observed in clinicopathologic parameters and post-operative outcomes, except in the operation times. Operation times and anastomosis times were significantly shorter in the stapler group (P=0.004 and P<0.001). CONCLUSIONS: Compared to the hand-sutured method, the circular stapling method can be applied safely and more efficiently, when performing Billroth-II anastomosis, after laparoscopy assisted distal gastrectomy in patients with gastric cancer.

Review of 100 cases of single port laparoscopic cholecystectomy / 대한외과학회지

PURPOSE: Single port laparoscopic cholecystectomy (SPLC) is a new advanced technique in laparoscopic surgery. Many laparoscopic surgeons seek to gain skill in this new technique. However, little data has been accumulated and published formally yet. This article reports the achievement of 100 cases of SPLC with the hopes it will encourage laparoscopic surgery centers in the early adoption of SPLC. METHODS: A retrospective review of 100 prospectively selected cases of SPLC was carried out. All patients had received elective SPLC by a single surgeon in our center from May 2009 to December 2010. Our review suggests patients' character, perioperative data and postoperative outcomes. RESULTS: Forty-two men and 58 women with an average age of 45.8 years had received SPLC. Their mean body mass index (BMI) was 23.85 kg/m2. The mean operating time took 76.75 minutes. However, operating time was decreased according to the increase of experience of SPLC cases. Twenty-one cases were converted to multi-port surgery. BMI, age, previous low abdominal surgical history did not seem to affect conversion to multi-port surgery. No cases were converted to open surgery. Mean duration of hospital stay was 2.18 days. Six patients had experienced complications from which they had recovered after conservative treatment. CONCLUSION: SPLC is a safe and practicable technique. The operating time is moderate and can be reduced with the surgeon's experience. At first, strict criteria was indicated for SPLC, however, with surgical experience, the criteria and area of SPLC can be broadened. SPLC is occupying a greater domain of conventional laparoscopic cholecystectomy.

The Complete Surgical Resection Without the Radiotherapy for a Recurred Anaplastic Ependymoma at the Cervicomedullary Junction

The intramedullary anaplastic ependymoma rarely occurs in the cervicomedullary junction. A 45-year-old woman had a history of right arm pain for several months. Magnetic resonance imaging (MRI) of the cervical spine demonstrated an intramedullary tumor with syrinx at the cervicomedullary junction. The patient underwent a partial resection at another institute. Neurologic deficit worsened after the first surgery. The follow up MRI showed that the enlarged enhancing tumor and syrinx still existed with the same size and configuration. Complete surgical resection was achieved in the revision surgery. Final histologic examination confirmed the diagnosis of an anaplastic ependymoma, and since complete surgical resection was achieved the patient did not receive adjuvant radiation or chemotherapy. The patient was followed-up periodically at the outpatient department, and at the 7 months follow-up the muscle tone of the right hand was normal but with mild sensory deficit, and the MRI demonstrated no evidence of recurrent disease. Intramedullary anaplastic ependymoma that occur in the cervicomedullary junction which are completely resected may be followed-up without adjuvant radiation or chemotherapy to attain good clinical outcome.

Intestinal Anastomosis by Use of a Memory-shaped Compression Anastomosis Clip (Hand CAC 30): Early Clinical Experience

PURPOSE: The safety and the efficacy of the compression anastomosis clip (Hand CAC 30) have been demonstrated by animal studies. This study was designed to evaluate the clinical validity of the Hand CAC 30 in enterocolic side-to-side anastomosis after colonic or enteric resections. METHODS: A non-randomized prospective data collection was performed for patients undergoing a side-to-side anastomosis using the Hand CAC 30. Eligibility criteria for the use of the Hand CAC 30 were for anastomoses between the colon and the ileum or between two small bowels. The primary short-term endpoint was the rate of anastomotic leakage. Other clinical outcomes, including intra- and postoperative complications, length of operation time and hospital stay, and the clip elimination time were recorded. RESULTS: A total of 63 patients (male, 36) underwent an enteric or right-sided colonic resection followed by a side-to-side anastomosis using the Hand CAC 30. Laparoscopic surgery was performed in 36 patients, in whom one patient who underwent a laparoscopic right hemicolectomy was converted to an open procedure (1/32, 3.1%). One patient with ascending colon cancer showed postoperative anastomotic leakage and died of co-morbid ischemic heart disease. There were no other surgical mortalities. The exact date of expulsion of the clip could not be recorded because most patients were not aware of clip elimination. No patients manifested clinical symptoms of anastomotic stricture. CONCLUSION: Short-term evaluation of the Hand CAC 30 anastomosis in patients undergoing enterocolic surgery proved it to be a safe and efficacious alternative to the standard hand-sewn or stapling technique.

Prognostic implication of metastatic lymph node ratio in node-positive rectal cancer / 대한외과학회지

PURPOSE: The aim of this study was to evaluate the prognostic significance of the ratio between metastatic and examined lymph nodes (LNs) in patients with stage III rectal cancer. METHODS: A review was made of 175 (male, 98) patients with stage III rectal cancer of R0 resection. LN disease was stratified both by the American Joint Committee on Cancer/International Union Against Cancer nodal classification (pN) and by quartiles of the lymph node ratio (LNR). Disease-free survivals (DFS) were made using Kaplan-Meier curves and assessed by the log rank test and multivariate analysis was performed using the Cox proportional hazards model. RESULTS: Patients ranged in age from 29 to 83 (median, 60) years with median follow-up of 47 months (range, 13 to 181 months). months. There was a significant correlation between the number of metastatic LNs and the LNR (r = 0.8681, P < 0.0001). Cut-off points of LNR quartiles best to separate patients with regard to 5-year DFS were between quartile 2 and 3, and between 3 and 4 (LNR1, 2, and 3); the 5-year DFS according to such stratification was 89.6%, 55.8%, and 18.2% in LNR1, 2, and 3, respectively (P < 0.0001). Cox model identified the LNR as the most significant independent prognostic covariate; LNR2 showed 3.6 times (95% confidence interval [CI], 1.682 to 7.584; P = 0.0009) and LNR3, 18.7 times (95% CI, 6.872 to 50.664; P < 0.0001) more risky than LNR1. CONCLUSION: This study suggests that ratio-based LN staging, which reflects the number of LNs examined and the quality of LN dissection, is a simple and reliable system for prognostic LN stratification in patients with stage III rectal cancer.

Isolated primary schwannoma arising on the colon: report of two cases and review of the literature / 대한외과학회지

Primary schwannoma of the large intestine is an extremely rare neoplasm. Here, we report two cases of colonic schwannoma confirmed pathologically after laparoscopic resection. A 52-year-old female and a 59-year-old female were referred by their general practitioners to our coloproctologic clinic for further evaluation and management of colonic submucosal masses. Colonoscopies performed in our institution revealed round submucosal tumors with a smooth and intact mucosa in the mid-ascending and descending colon, respectively. Computed tomography (CT) scans showed an enhancing soft tissue mass measuring 2 x 2 cm in the right colon and well-defined soft tissue nodule measuring 1.5 x 1.7 cm in the proximal descending colon, respectively. We performed laparoscopic right hemicolectomy and segmental left colectomy under the preoperative impression of gastrointestinal stromal tumors. Two cases were both diagnosed to be benign schwannoma of the colon after immunohistochemical stains (S-100 (+), smooth muscle actin (-), CD117 (-), and CD34 (-)).

Thermally induced bone necrosis during implant surgery: 3 case reports

Thermally induced bone necrosis during implant surgery is a rare phenomenon and a potential contributing factor to implant failure. The frictional heat generated at the time of surgery causes a certain degree of necrosis of the surrounding differentiated and undifferentiated cells. The bone necrosis occurred in the mandible in all three cases, leading to a soft tissue lesion and pain. In each case, radiolucent areas appeared in the middle and apical portions of the implant 4 weeks after surgery. Thermally induced bone necrosis did not improve following systemic antibiotic medication, necessitating surgical treatment. The nonintegrated implants were removed, and meticulous debridement of dead bone and granulation tissue was performed. Then, new implants were implanted along with the placement of autogenous and xenogenic bone covered with a collagen membrane. No further complications occurred after re-operation. The radiolucencies around the new implants gradually resolved entirely, and the soft tissue lesions healed successfully. At 4-5 months after reoperation, implant loading was initiated and the implant-supported restorations have been functioning. The aim of this case report is to present the successful clinical treatment of three cases suspected to be caused by thermally induced bone necrosis after implant drilling.

Adjuvant Chemotherapy Using the FOLFOX Regimen in Colon Cancer

PURPOSE: Great progress has been made in the adjuvant treatment of colon cancer. The aim of this study was to evaluate the efficacy of postoperative adjuvant chemotherapy using the FOLFOX regimen in patients with stage III and high-risk stage II colon cancer. METHODS: Eighty-two patients who underwent a potentially curative resection for stage III or high-risk stage II colon cancer were enrolled in this retrospective study. They received FOLFOX4 or modified FOLFOX6. The primary endpoint was disease-free survival. RESULTS: During the median follow-up of 37 months (range, 21 to 61 months), 14 patients experienced disease relapse. The disease-free survival rate at 3 years was 82.9%: 84.6% for stage II and 82.6% for stage III. At the time of the analysis, 8 patients were dead from recurrence. The probability of overall survival at 5 years was 74.5%: 90% for stage II and 74.6% for stage III. Grade 3 or 4 hematologic adverse events included neutropenia (40.2%), anemia (2.4%), and thrombocytopenia (1.2%). Gastrointestinal toxicities included grade 3 or 4 nausea (4.9%) and stomatitis (2.4%). Peripheral sensory neuropathy was observed in 81.7% of the patients during treatment. Of the 11 patients (13.4%) who had grade 3 peripheral sensory neuropathy during treatment, grade 3 symptoms were persistent in 3 patients with gait disturbance at the time of analysis. No treatment-related deaths were recorded. CONCLUSION: Postoperative chemotherapy using the FOLFOX regimen, oxaliplatin in combination with 5-fluorouracil and leucovorin, is effective and tolerable in patients with stage III and high-risk stage II colon cancer.

Colorectal Cancer with Multiple Metastases: Is Palliative Surgery Needed?

In patients with symptomatic incurable metastatic colorectal cancer (mCRC), the goal of resection of the primary lesion is to palliate cancer-related morbidity, including obstruction, bleeding, or perforation. In patients with asymptomatic primary tumors and incurable metastatic disease, however, the necessity of primary tumor resection is less clear. Although several retrospective analyses suggest survival benefit in patients who undergo resection of the primary tumor, applying this older evidence to modern patients is out of date for several reasons. Modern chemotherapy regimens incorporating the novel cytotoxic agents oxaliplatin and irinotecan, as well as the target agents bevacizumab and cetuximab, have improved median survival from less than 1 year with the only available single-agent 5-fluorouracil until the mid-1990s to over 2 years. In addition to significant prolongation of overall survival, combinations of novel chemotherapeutic and target agents have allowed improved local and distant tumor control, decreasing the likelihood of local tumor-related complications requiring surgical resection. Resection of an asymptomatic primary tumor risks surgical complications and may postpone the administration of chemotherapy that may offer both systemic and local control. In conclusion, the morbidity and the mortality of unnecessary surgery or surgery that does not improve quality of life or survival in patients with mCRC of a limited life expectancy should be carefully evaluated. With the availability of effective combinations of chemotherapy and target agents, systemic therapy for the treatment of life-threatening metastases would be a preferable treatment strategy for unresectable asymptomatic patients with mCRC.

The Learning Curve for Single-Port Laparoscopic Cholecystectomy by Experienced Laparoscopic Surgeon

PURPOSE: Single-port laparoscopic surgery is a rapidly advancing technique in laparoscopic surgery. However, there is currently limited evidence on the learning curve for this procedure. The aim of this study was to estimate the number of single port laparoscopic cholecystectomies required until improvement in the performance of the technique ceases. METHODS: This is a descriptive, single-center study using routinely collected clinical data from 70 patients who underwent single port laparoscopic cholecystectomy between May 2009 and June 2010 at Dong-A University Medical Center in Busan, Korea. The review includes the mean operating time, conversion cases, intra-operative GB perforation, post-operative wound infection and mean hospital stay. RESULTS: The mean operating time of the first 30 cases (the learning period) was 91.83 minutes. After 30 operations (the experience period), it plateaued to an average of 75.25 minutes, which remained steady in the next 40 operations - a reduction of more than 16%. Reduction in the operating time was significant (P<0.001) between the learning period and the experience period. Other factors including additional ports, intraoperative gall bladder perforation, mean hospital stay, post-operative wound infection were not significantly different between the two periods. CONCLUSION: We suggest that the learning curve for single port laparoscopic cholecystectomy should be around thirty cases for a surgeon with prior conventional laparoscopic cholecystectomy experience and for self-taught single port technique.

Bisphosphonate Related Osteonecrosis of Jaw on Mandibular Molar Area: a Case Report

A Giant Sialolith in a Wharton's Duct: Report of Two Cases

Capecitabine-based Neoadjuvant Chemoradiation Therapy in Locally-advanced Rectal Cancer

PURPOSE: The aim of the study was to evaluate the efficacy and the toxicity of preoperative treatment with capecitabine in combination with radiation therapy (RT) in patients with locally-advanced, resectable rectal cancer. METHODS: Thirty-five patients with locally-advanced rectal cancer (cT3/4, N-/+) were treated with capecitabine (825 mg/m2, twice daily for 7 days/wk) and concomitant RT (50.4 Gy/28 fractions). Surgery was performed 6-8 wk after completion of the chemoradiation followed by 4-6 cycles of adjuvant capecitabine monotherapy (1,250 mg/m2, twice daily for 14 days every 3 wk). RESULTS: The chemoradiation program was completed in all but 2 patients, for whom both capecitabine and RT were interrupted for 2 wk because of grade-3 diarrhea. A R0 resection under the principle of total mesorectal excision (low anterior resection, 26; intersphincteric resection, 6; abdominoperineal resection, 2) was performed in all but one patient with a low anterior resection with positive circumferential margin (R1). Primary tumor and node downstaging occurred in 57% and 60% of patients, respectively. The overall rate of downstaging, including both the primary tumor and node, was 77% (27 patients). A pathological complete response of the primary tumor was achieved in 4 patients (11%). No patient had grade-4 toxicity, and the only grade-3 toxicity developed was diarrhea in 2 patients (6%) during chemoradiation. During a median follow-up of 38 mo, distant metastases developed in 4 patients (multiple lung metastases, 2; aortocaval nodal metastases, 2), and another 2 patients showed local recurrence. The three-year disease-free survival was 83%. CONCLUSION: This study suggests that preoperative capecitabine-based chemoradiation therapy is an effective and safe treatment modality for the tratment of locally-advanced, resectable rectal cancer.