Sufficiency of Preoperative CT Staging of Colorectal Cancer?

PURPOSE: Establishing the preoperative stage of colorectal cancer is of primary importance in determining the management and the operative procedure. A comparative study of preoperative evaluation of colorectal cancer is necessary for proper management. METHODS: This study reports a 7 years' experience using another two species of CT for preoperative staging. One species of CT (1989, Delta 2060, Technicare, USA) was used from January 1990 to December 1992; the other species of CT (1992, Highlight Advantage, General Electric Company, USA) was used from January 1993 to December 1997. This study included retrospective analysis of 237 cases of colorectal cancer from January 1990 to December 1997. In first group, the preoperative stage evaluation was done with a much older species of CT from January 1990 to December 1992; in the other group, the preoperative stage evaluation was done with a newer species of CT from January 1993 to December 1997. RESULT: The accuracy & sensitivity of preoperative staging between the two groups showed no significant differences. CONCLUSION: CT is recommended in the preoperative staging of rectal cancer and as an aid in choosing the appropriate therapy. In addition to CT, transrectal ultrasonography and MRI are recommend for improving the accuracy of preoperative staging in assessing local invasion by cancer.

Clinical Analysis of Outpatients in Colorectal Clinic

BACKGROUND: As the incidence of coloanal diseases has been steadily increasing during the past few decades in Korea, we illustrate the necessity of a specialized colorectal clinic for the efficient management of such diseases. METHOD: Outpatients at our colorectal clinic were studied epidemiologically and clinically by retrospective studies between November 1986 to December 1996. RESULTS: During this period, the total number of outpatients were 30,590 of which 24% were new patients. The patient pool consisted of anal diseases (62%), colon diseases (28%) and other diseases (10%). In this study, we found that condyloma, perianal abscesses, anal fistulas were predominant in males compared to females while rectovaginal fistulas, functional bowel diseases, and perianal fissures were predominant in females. There was no sexual bias for rectal cancer. Colorectal diseases occurred in all age groups; however, the peak age was in the fourth or fifth decade where social activity was maximum. There was a variation in age incidence among different disease entities. The range of age for benign conditions such as hemorroids, perianal abscessess and functional bowel diseases were from the third to the fifth decades; however, malignant lesions such as colon cancer were frequently seen in older patients (> 40 years). Condyloma was frequently seen in younger patients (< 20 years). There were no monthly variations in the incidences of colorectal diseases. Yearly variations were not found for colorectal disease, but were found for cancer. Of the cancers, the incidence of rectal cancer was higher than s-colon cancer or colon cancer in year variations. The diagnostic time has been reduced significantly over the past decade. The mean time required for a diagnosis work up in the period from 1984 to 1986 was 9.4 days; the diagnostic time in the period from 1993 to 1996 was 4.7 days. CONCLUSIONS: The incidences of coloanal disease have increased recently in Korea; thus, the demand for an efficient outpatient colorectal clinic has inevitably increased. We concluding that a specialized clinic, such as our colorectal clinic, has become essential for properly managing the exploding number of coloanal patients in Korea.

Clinical Significance of Defecography in Patients with Constipation

PURPOSE: To evaluate the clinical usefulness of defecogrophy in diagnosing the etiology and pathophysiology of constipation. A retrospective study of 56 constipated patients who had no abnormalities in colonoscopy, barium enema and rectal exam were done. METHODS: Fifty-six patients (12 men, 44 women) with constipation underwent defecography and 37 of the patients underwent colonic transit studies. Fluoroscopically guided defecography was performed with barium paste introduced into the rectum. RESULTS: Normal defecography finding was observed in thirteen of the 56 patients. Rectocele, spastic levator syndrome (nonrelaxing puborectalis syndrome), sigmoidocele, rectal prolapse, rectal intussusception were observed in 67% (38/56), 30% (20/56), 7% (4/56), 5% (3/56) and 2% (1/56) of the patients, respectively. More than one pathological finding was found in 23 (53%) patients. Of the 38 rectoceles, 17 cases were found to be associated with spastic levator syndrome. In solitary rectocele, the anorectal angles at rest, during straining were 92.65 9.08o, 108.09 14.35o, while 99.85 11.85o, 95.90 17.84o, in spastic levator syndrome. In 36 difficult bowel movements, 66% (24/36), 30% (11/36), 3% (1/36) were found to have rectocele, spastic levator syndrome, and sigmoidocele, respectively. Normal colonic transit time was observed in twenty six of the 37 patients. Abnormal findings included colonic inertia in 3 (8%) patients, hindgut dysfunction in 4 (11%) patients, and, outlet obstruction in 4 (11%) patients. Of the normal colonic transit time in 26, rectocele in sixteen, rectal prolapse in 1, spastic levator in 2 were observed. Rectoceles were observed in 2 out of 3 colonic inertia, in all 4 hindgut dysfunction, in 1 out of 4 outlet obstruction. CONCLUSIONS: Our findings suggest that constipation is often a disorder of defecation rather than a impairment of colonic motility. Defecography should be considered first of all in evaluating the pathophysiology of constipation, especially for whom complaining of difficult bowel.

Usefulness of Colonic Transit Time Measurement in Chronic Constipation

A retrospective study of 274 patients who presented with constipation was done. The following results were obtained by recording colonic transit time. The male to female ratio was 72 : 197, and most patients were in their third and fifth decade, each age group accounting for 21% of total number. Associated symptoms were anal discomfort(33%), abdominal discomfort (25%), hematochezia (23%), reduced stool caliber (11%), and tenesmus (8%). As a result, 223 patients had normal transit time and 51 patients had abnormal transit time. Eighty-six patients with normal transit time and 51 patients with abnormal transit time underwent barium enema or colonoscopic examination. Abnormal lesions such as polyps and diverticulums were found in 10 patients with normal transit time and 7 patients with abnormal transit time. Therefore barium enema and colonoscopic examination in the patients with abnormal transit time were meaningful (P=0.024). Eighteen out of 25 patients with normal transit time and 8 (67%) of 12 patients with abnormal transit time showed abnormal defecogram results. The rectocele was the most frequent cause of abnormality in defecogram. Abnormal anal manometry results were obtained in 5 (22%) of 23 patients with normal transit time and 3 (50%) of 6 patients with abnormal transit time. Three types were classified in the patients with abnormal transit time. With type II patients, anal manometry findings were normal and 2 patients showed abnormal results in defecogram. With type III patients, 5 (43%) of 12 patients showed abnormal results in defecogram and 3 (50%) of 6 patients had abnormal anal manometry findings. Conclusively, if abnormal transit time is found in the patients with chronic consipation, further evaluations such as barium enema or colonoscopic examination are necessary. And even in the patients without any abnormality in transit time, selected performance of defecogram and anal manometry depending on clinical symptoms are preferable.