Clinical outcomes of locking polymeric clip for laparoscopic appendectomy in patients with appendicitis: a retrospective comparison with loop ligature

Purpose@#This study aimed to compare the clinical outcomes of laparoscopic appendectomy (LA) according to the method of appendiceal stump closure. @*Methods@#Patients who underwent LA for appendicitis between 2010 and 2020 were retrospectively reviewed. Patients were classified into locking polymeric clip (LPC) and loop ligature (LL) groups. Clinical outcomes were compared between the groups. @*Results@#LPC and LL were used in 188 (56.6%) and 144 patients (43.4%), respectively for appendiceal stump closure. No significant differences were observed in sex, age, comorbidities, and the severity of appendicitis between the groups. The median operative time was shorter in the LPC group than in the LL group (64.5 minutes vs. 71.5 minutes, P=0.027). The median hospital stay was longer in the LL group than in the LPC group (4 days vs. 3 days, P=0.020). Postoperative incidences of intraabdominal abscess and ileus were higher in the LL group than in the LPC group (4.2% vs. 1.1%, P=0.082 and 2.8% vs. 0%, P=0.035; respectively). The readmission rate was higher in the LL group than that in the LPC group (6.3% vs. 1.1%, P=0.012). @*Conclusion@#Using LPC for appendiceal stump closure during LA for appendicitis was associated with lower postoperative complication rate, shorter operative time, and shorter hospital stay compared to the use of LL. Operative time above 60 minutes and the use of LL were identified as independent risk factors for postoperative complications in LA. Therefore, LPC could be considered a more favorable closure method than LL during LA for appendicitis.

The Impact of Primary Tumor Resection on Survival in Asymptomatic Colorectal Cancer Patients With Unresectable Metastases

Purpose@#This study was conducted to evaluate the effectiveness of primary tumor resection (PTR) in asymptomatic colorectal cancer (CRC) patients with unresectable metastases using the inverse probability of treatment weighting (IPTW) method to minimize selection bias. @*Methods@#We selected 146 patients diagnosed with stage IV CRC with unresectable metastasis between 2001 and 2018 from our institutional database. In a multivariate logistic regression model using the patients’ baseline covariates associated with PTR, we applied the IPTW method based on a propensity score and performed a weighted Cox proportional regression analysis to estimate survival according to PTR. @*Results@#Upfront PTR was performed in 98 patients, and no significant differences in baseline factors were detected. The upweighted median survival of the PTR group was 18 months and that of the non-PTR group was 15 months (P = 0.15). After applying the IPTW, the PTR was still insignificant in the univariate Cox regression (hazard ratio [HR], 0.26; 95% confidence interval [CI], 0.5–1.21). However, in the multivariate weighted Cox regression with adjustment for other covariates, the PTR showed a significantly decreased risk of cancer-related death (HR, 0.61; 95% CI, 0.40–0.94). @*Conclusion@#In this study, we showed that asymptomatic CRC patients with unresectable metastases could gain a survival benefit from upfront PTR by analysis with the IPTW method. However, randomized controlled trials are mandatory.

Nutritional Therapy Related Complications in Hospitalized Adult Patients: A Korean Multicenter Trial

PURPOSE: Nutritional therapy (NT), such as enteral nutrition (EN) or parenteral nutrition (PN), is essential for the malnourished patients. Although the complications related to NT has been well described, multicenter data on symptoms in the patients with receiving NT during hospitalization are still lacking. METHODS: Nutrition support team (NST) consultations, on which NT-related complications were described, were collected retrospectively for one year. The inclusion criteria were patients who were (1) older than 18 years, (2) hospitalized, and (3) receiving EN or PN at the time of NST consultation. The patients' demographics (age, sex, body mass index [BMI]), type of NT and type of complication were collected. To compare the severity of each complication, the intensive care unit (ICU) admission, hospital stay, and type of discharge were also collected. RESULTS: A total of 14,600 NT-related complications were collected from 13,418 cases from 27 hospitals in Korea. The mean age and BMI were 65.4 years and 21.8 kg/m2. The complications according to the type of NT, calorie deficiency (32.4%, n=1,229) and diarrhea (21.6%, n=820) were most common in EN. Similarly, calorie deficiency (56.8%, n=4,030) and GI problem except for diarrhea (8.6%, n=611) were most common in PN. Regarding the clinical outcomes, 18.7% (n=2,158) finally expired, 58.1% (n=7,027) were admitted to ICU, and the mean hospital days after NT-related complication were 31.3 days. Volume overload (odds ratio [OR]=3.48) and renal abnormality (OR=2.50) were closely associated with hospital death; hyperammonemia (OR=3.09) and renal abnormality (OR=2.77) were associated with ICU admission; “micronutrient and vitamin deficiency” (geometric mean [GM]=2.23) and volume overload (GM=1.61) were associated with a longer hospital stay. CONCLUSION: NT may induce or be associated with several complications, and some of them may seriously affect the patient's outcome. NST personnel in each hospital should be aware of each problem during nutritional support.

Changes of Cognitive Function and Fatigue following Chemotherapy in Patients with Gastrointestinal Cancer: A Prospective Controlled Study

PURPOSE: This study was to identify changes in cognitive function and fatigue following chemotherapy in patients with stomach or colorectal cancer. METHODS: Of the participants, 67 underwent adjuvant chemotherapy, while 66 healthy participants made up the comparison group. Three assessment tools were used: 1) the Korean Mini-Mental State Examination; 2) Everyday Cognition; 3) Functional Assessment of Chronic Illness Therapy-Fatigue. The questionnaires were administered in three stages, before chemotherapy, towards the end of chemotherapy, and 6 months after the final chemotherapy session. Data were analyzed using descriptive statistics and repeated measures analysis of variance (RM ANOVA). RESULTS: At the post-chemotherapy stage, 38.8% of the patients who underwent adjuvant chemotherapy complained of subjective cognitive impairment and reported greater difficulty in the cognitive domains of attention and concentration, memory, and executive function. RM ANOVA revealed a significant decline in cognitive function after chemotherapy. However, improvement was observed six months after the completion of chemotherapy (F=42.68, p< .001). Cancer-related fatigue also showed similar patterns as observed in the case of cognitive function (F=44.76, p< .001). CONCLUSION: Chemotherapy was associated with increased cognitive decline and fatigue in cancer patients with cancer. Nursing intervention programs need to be developed to counteract cognitive decline and fatigue in patients undergoing chemotherapy.

Neutrophil to Lymphocyte Ratio: A Predictive Marker for Treatment Outcomes in Patients With Rectal Cancer Who Underwent Neoadjuvant Chemoradiation Followed by Surgery

PURPOSE: In this study, we investigated the role of neutrophil to lymphocyte ratio (NLR) as a predictor of tumor response and as a prognostic factor in patients with rectal cancer who had undergone curative surgery after neoadjuvant chemoradiation therapy (nCRT). METHODS: Between January 2009 and July 2016, we collected 140 consecutive patients who had undergone curative intent surgery after nCRT due to rectal adenocarcinoma. We obtained the pre- and post-nCRT NLR by dividing the neutrophil count by the lymphocyte count. The cutoff value was obtained using receiver operating characteristic analysis for tumor response and using maximally selected rank analysis for recurrence-free survival (RFS). The relationship among NLR, tumor response, and RFS was assessed by adjusting the possible clinico-pathological confounding factors. RESULTS: The possibility of pathologic complete response (pCR) was significantly decreased in high pre- (>2.77) and postnCRT NLR (>3.23) in univariate regression analysis. In multivariate analysis, high post-nCRT NLR was an independent negative predictive factor for pCR (adjusted odds ratio, 0.365; 95% confidence interval [CI], 0.145–0.918). The 5-year RFS of all patients was 74.6% during the median 37 months of follow-up. Patients with higher pre- (>2.66) and post-nCRT NLR (>5.21) showed lower 5-year RFS rates (53.1 vs. 83.3%, P = 0.006) (69.2 vs. 75.7%, P = 0.054). In multivariate Cox analysis, high pre-nCRT NLR was an independent poor prognostic factor for RFS (adjusted hazard ratio, 2.300; 95% CI, 1.061–4.985). CONCLUSION: Elevated NLR was a negative predictive marker for pCR and was independently associated with decreased RFS. For confirmation, a large-scale study with appropriate controls is needed.

Is the Location of the Tumor Another Prognostic Factor for Patients With Colon Cancer?

PURPOSE: In this study, we investigated both the characteristics of right colon cancer (RTCC) in comparison with those of left colon cancer (LTCC) and the impact of the location of the colon cancer on the prognosis. METHODS: We retrospectively analyzed the cases of 974 patients with nonmetastatic colon cancer who had undergone surgery with a curative intent from January 2001 to December 2011. RTCC was defined as a tumor located proximal to the splenic flexure. The characteristics of RTCC cancer were investigated by using descriptive analyses, and their impacts on the prognosis were assessed by using a Cox multivariate regression. RESULTS: Compared to LTCC, RTCC showed a female-dominant feature, and an undifferentiated pathology was more frequently observed. The number of lymph nodes retrieved from patients with RTCC was significantly higher than that retrieved from patients with LTCC. During 75 months of follow-up, peritoneal recurrence was more common in patients with RTCC than it was in patients with LTCC, and among the patients with stage III colon cancer, the disease-free and the overall survival rates were significantly worse in patients with RTCC. After adjustments with the other prognostic factors associated with colon cancer had been made, a tumor located at the right colon was found to be independently associated with poor prognosis. CONCLUSION: RTCC showed unique clinicopathologic features and was associated with a poorer prognosis.

Association between Metformin Use and Survival in Nonmetastatic Rectal Cancer Treated with a Curative Resection: A Nationwide Population Study / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Metformin is associated with an anticancer effect. However, the effects of metformin in rectal cancer are controversial. This study investigated the impact of metformin on the survival of patients with diabetes mellitus and nonmetastatic rectal cancer who underwent curative surgery. MATERIALS AND METHODS: The database was provided by the Korea Center Cancer Registry and National Health Insurance Service of the Republic of Korea. A cohort of patients with newly diagnosed rectal cancer between 2005 and 2011 was identified. Drug exposure was defined as receiving the oral hypoglycemic agent for at least 90 days over the period from 6 months before the initial diagnosis of rectal cancer to the last follow-up. RESULTS: A total of 4,503 patients were prescribed oral hypoglycemic agents and classified as the diabetic group, of which 3,694 patients received metformin for at least 90 days. Unadjusted analyses showed a significantly higher overall survival (hazard ratio, 0.596; 95% confidence interval, 0.506 to 0.702) and rectal cancer-specific survival (hazard ratio, 0.621; 95% confidence interval, 0.507 to 0.760) in the metformin group than in the nonmetformin group. The adjusted overall survival (hazard ratio, 0.631; 95% confidence interval, 0.527 to 0.755) and cancer-specific survival (hazard ratio, 0.598; 95% confidence interval, 0.479 to 0.746) in the group with a medication possession ratio of 80% or greater was significantly higher than in the group with a medication possession ratio of less than 80%. CONCLUSION: Metformin use is associated with overall and cancer-specific survival in diabetic patients with a nonmetastatic rectal cancer treated with a curative resection.

Is Microsatellite Instability Really a Good Prognostic Factor of Colorectal Cancer?

PURPOSE: The aim of this study was to investigate the clinicopathologic features of and the prognosis for colorectal cancers (CRCs) with microsatellite instabilities (MSIs). METHODS: Between 2006 and 2009, genotyping was performed on 245 patients with stage II/III CRCs to establish the MSI status. The clinicopathologic differences and the prognostic value of MSI were analyzed. The median follow-up period was 38 months (range, 7-68 months). RESULTS: Of the total 245 patients, 20 (8.2%) had MSI-high (H) and 225 (91.8%) had MSI-low (L) or stable (S) CRCs. Adjuvant chemotherapies were performed on 101 stage II (87.8%) and 107 stage III patients (82.3%). Patients with MSI-H CRCs more frequently had a family history of colon cancer (10% vs. 2.7%, P = 0.003), more frequently had a cancer located at the proximal colon (90.0% vs. 19.1%, P < 0.0001), and more often showed a mucinous phenotype or poor differentiation (35.0% vs. 7.1%, P = 0.001). Despite less frequent lymph node metastasis (25% vs. 55.6%, P = 0.01), the number of retrieved lymph nodes was higher (26.3 +/- 13.1 vs. 20.7 +/- 1.2, P = 0.04) in the MSI-H group. The overall survival and the disease-free survival (DFS) did not differ with respect to MSI status. However, in the stage II subgroup, the DFS for patients with MSI-H CRCs was significantly worse (72.2% vs. 90.7%, P = 0.03). The multivariate analysis performed on this subgroup revealed that MSI-H was an independent poor prognostic factor (adjusted hazard ratio, 4.0; 95% confidence interval, 1.0-15.6, P = 0.046). CONCLUSION: MSI-H CRCs had distinct clinicopathologic features, and MSI-H was an independent poor prognostic factor in stage II CRCs. Considering the majority of stage II patients were administrated adjuvant chemotherapy, the efficacy of adjuvant chemotherapy for treating MSI CRCs might be different from that for treating MSI-L/S tumors.

Role of Peritoneal Lavage Cytology and Prediction of Prognosis and Peritoneal Recurrence After Curative Surgery for Colorectal Cancer

PURPOSE: In colorectal cancer, the role of detecting free malignant cells from peritoneal lavage is currently unclear. In this study, we investigated the positive rate of free malignant cells in peritoneal lavage fluid and their predictive value for prognosis and peritoneal recurrence after a curative resection. METHODS: From October 2009 to December 2011, in a prospective manner, we performed cytologic examinations of peritoneal lavage fluid obtained just after the abdominal incision from 145 patients who underwent curative surgery for colorectal cancer. We used proportional hazard regression models to analyze the predictive role of positive cytology for peritoneal recurrence and survival. RESULTS: Among total 145 patients, six patients (4.1%) showed positive cytology. During the median follow-up of 32 months (range, 8-49 months), 27 patients (18.6%) developed recurrence. Among them, 5 patients (3.4%) showed peritoneal carcinomatosis. In the multivariate analysis, positive cytology was an independent predictive factor for peritoneal recurrence (hazard ratio [HR], 136.5; 95% confidence interval [CI], 12.2-1,531.9; P < 0.0001) and an independent poor prognostic factor for overall survival (HR, 11.4; 95% CI, 1.8-72.0; P = 0.009) and for disease-free survival (HR, 11.1; 95% CI, 3.4-35.8; P < 0.0001). CONCLUSION: Positive cytology of peritoneal fluid was significantly associated with peritoneal recurrence and worse survival in patients undergoing curative surgery for colorectal cancer. Peritoneal cytology might be a useful tool for selecting patients who need intraperitoneal or systemic chemotherapy.

Immunogenicity of Influenza Vaccine in Colorectal Cancer Patients / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Although influenza is regarded as a major cause of morbidity and mortality in immunocompromised patients, vaccine coverage remains poor. We evaluated the immunogenicity of influenza vaccines in colorectal cancer patients. MATERIALS AND METHODS: In this study, 40 colorectal cancer patients who received an influenza vaccine at the Korea Cancer Center Hospital during the 2009-2010 and 2010-2011 influenza seasons were analyzed. The blood samples were collected at prevaccination and 30 days post vaccination, and antibody titers were measured using the hemagglutination-inhibition tests. RESULTS: In the 2009-2011 season, the seroprotection rate for H1N1 (94.7%) was significantly higher than that for H3N2 (42.1%) and B (47.3%). The seroconversion rate was 52.6%, 26.3%, and 36.8% for H1N1, H3N2, and B, respectively. Fold increase of geometric mean titer (MFI) was 3.86, 1.49, and 3.33 for H1N1, H3N2, and B, respectively. In the 2010-2011 season, the seroprotection rate for H1N1 (57.1%) was significantly higher than that for H3N2 (52.4%) and B (38.1%). The seroconversion rate was 52.4%, 47.6% and 33.3% for H1N1, H3N2, and B, respectively. MFI was 12.29, 3.62 and 4.27 for H1N1, H3N2, and B, respectively. CONCLUSION: Our study cohort showed an acceptable immune response to an influenza vaccine without significant adverse effects, supporting the recommendation for annual influenza vaccination in colorectal cancer patients.

Incidence and Risk Factors of Parastomal Hernia

PURPOSE: Among the various stoma complications, the parastomal hernia (PSH) is the most common. Prevention of PSH is very important to improve the quality of life and to prevent further serious complications. The aim of this study was to analyze the incidence and the risk factors of PSH. METHODS: From January 2002 and October 2008, we retrospectively reviewed 165 patients who underwent an end colostomy. As a routine oncologic follow-up, abdomino-pelvic computed tomography was used to examine the occurrence of the PSH. The associations of age, sex, body mass index (BMI), history of steroid use and comorbidities to the development of the PSH were analyzed. The median duration of the follow-up was 36 months (0 to 99 months). RESULTS: During follow-up, 50 patients developed a PSH and the 5-year cumulative incidence rate of a PSH, obtained by using the Kaplan-Meier method, was 37.8%. In the multivariate COX analysis, female gender (hazard ratio [HR], 3.29; 95% confidence interval [CI], 1.77 to 6.11; P < 0.0001), age over 60 years (HR, 2.37; 95% CI, 1.26 to 4.46; P = 0.01), BMI more than 25 kg/m2 (HR, 1.8; 95% CI, 1.02 to 3.16; P = 0.04), and hypertension (HR, 2.08; 95% CI, 1.14 to 3.81; P = 0.02) were all independent risk factors for the development of a PSH. CONCLUSION: The 5-year incidence rate of a PSH was 37.8%. The significant risk factors of a PSH were as follows: female gender, age over 60 years, BMI more than 25 kg/m2, and hypertension. Using a prophylactic mesh during colostomy formation might be advisable when the patients have these factors.

Impact on Prognosis of Lymph Node Micrometastasis and Isolated Tumor Cells in Stage II Colorectal Cancer

PURPOSE: Even though the importance of micrometastases (MMS) and isolated tumor cells (ITC) has been brought up by many physicians, its impact on the prognosis in stage II colorectal cancer is uncertain. In this research, we tried to investigate the clinical features of MMS and ITC and to prove any correlation with prognosis. METHODS: The research pool was 124 colorectal cancer patients who underwent a curative resection from April 2005 to November 2009. A total of 2,379 lymph nodes (LNs) were examined, and all retrieved LNs were evaluated by immunohistochemical staining with anti-cytokeratin antibody panel. Clinicopathologic parameters and survival rates were compared based on the presence of MMS or ITC and on the micrometastatic lymph node ratio (mmLNR), which is defined as the number of micrometastatic LNs divided by the number of retrieved LNs. RESULTS: Out of 124 patients (26.6%) 33 were found to have MMS or ITC. There were no significant differences in clinicopathologic features, such as gender, tumor location and size, depth of invasion, histologic grade, except for age (P = 0.04). The three-year disease-free survival rate for the MMS or ITC positive group was 85.7%, and that for MMS and ITC negative group was 92.8% (P = 0.209). The three-year disease-free survival rate for the mmLNR > 0.25 group was 73.3%, and that for the mmLNR < or = 0.25 group was 92.9% (P = 0.03). CONCLUSION: The presence of MMS or ITC was not closely correlated to the prognosis. However, mmLNR is thought to be a valuable marker of prognosis in cases of stage II colorectal cancer.

Effectiveness of Adjuvant Chemotherapy with 5-FU/Leucovorin and Prognosis in Stage II Colon Cancer

PURPOSE: The aims of this study were to investigate the survival results and the prognostic factors of adjuvant chemotherapy in stage II colon cancer in the sparsity of Korean data. METHODS: From 1993 to 2006, 363 curatively resected pathologic stage II colon cancer patients were enrolled. Six cycles of adjuvant chemotherapy was performed: intravenous bolus 5-fluorouracil (5-FU) 500 mg/m2 with leucovorin 20 mg/m2 for 2 hours daily for 5 days, followed by a 3-week resting period (n = 308). Fifty-five patients received only curative surgery. A high risk of recurrence was defined as the presence of one or more of the following factors: T4 tumor, lympho-vascular invasion, perineural invasion, perforation, obstruction, retrieved lymph node < 12, and poorly differention. The median follow-up period was 68 months (1 to 205 months). RESULTS: The five-year overall survival (OS) rate was 90.1%, and the five-year disease-free survival (DFS) rate was 84.7%. Among high-risk patients, the OS and the DFS rates of the treatment group were significantly higher than those of the non-treatment group (OS: 90.6% vs. 69.1%, P < 0.0001; DFS: 85.9% vs. 54.1%, P < 0.0001). Among low-risk patients, the survival results of the treatment group were also significantly superior (OS: 97.7% vs. 88.2%, P < 0.0001; DFS: 93.0% vs. 80.0%, P = 0.001). In the multivariate analysis, adjuvant chemotherapy was a significantly favorable prognostic factor for overall survival (hazard ratio, 0.41; 95% confidence interval, 0.22 to 0.75; P = 0.004). CONCLUSION: In our population, adjuvant chemotherapy showed superior survival to curative surgery alone and significantly reduced the risk of death. A nationwide multicenter randomized trial is needed.

Usefulness of an Open Cecostomy in the Treatment of a Distal Colon Obstruction

PURPOSE: Stoma formation has usually been used for bowel decompression or fecal diversion. For these, a cecostomy is rarely performed because of disadvantages such as incomplete fecal diversion or fatal complications. The aim of this study was to evaluate the usefulness of an open cecostomy in treating patients with colonic obstruction. METHODS: Between May 2005 and August 2008, 20 patients underwent an open cecostomy because of colonic obstruction. All information on the patients was reviewed retrospectively for underlying disease, obstruction site, diameter of the cecum and transverse colon, and complications. RESULTS: Of the 20 patients, 14 had colorectal cancer, 3 had stomach cancer, 1 had cervical cancer, 1 had a carcinoid tumor, and 1 had an osteosarcoma. The cause of the obstruction was the primary tumor in 7 patients, peritoneal carcinomatosis in 7 patients, local recurrence in 5, and tissue edema after cyberknife treatment in 1 patient. All patients, except for 1 patient with a hopeless discharge due to rapid disease progression, were discharged on the tenth day postoperatively. No fatal complication developed. In 2 patients, the cecostomy closed spontaneously at 5.5 mo postoperatively after the distal obstruction had been resolved. CONCLUSION: An open cecostomy may be a useful and simple method for the decompression of a colonic obstruction, even though the diversion may not be complete.

Voiding and Sexual Function after Autonomic-Nerve-Preserving Surgery for Rectal Cancer in Disease-Free Male Patients

PURPOSE: We evaluated the effects of surgery for rectal cancer on postoperative voiding and sexual function over the course of time. MATERIALS AND METHODS: Data from 28 patients who underwent autonomic nerve preserving rectal cancer surgery were retrospectively analyzed. Operations were performed between October 2005 and July 2007 and all patients were followed-up for more than 3 years. Preoperatively, all patients underwent urodynamic studies including uroflowmetry, and filled out the International Prostate Symptom Score (IPSS). The evaluation of sexual function consisted of Erectile Function domain score in International Index of Erectile Function (IIEF-EFD) and Ejaculation domain score in Male Sexual Health Questionnaire (MSHQ-EjD). Data from uroflowmetry and questionnaires were examined. RESULTS: At 3 years postoperatively the prostate volume was similar to the preoperative value (P=0.727). There were no statistically significant postoperative changes in the average maximum flow rate (15.9 ml/s vs. 16.2 ml/s, p=0.637) and post-void residual urine volume (34.7 ml vs. 36.8 ml, p=0.809). No statistically significant differences were observed in the IPSS (13.2 vs. 12.2, p=0.374). However, although pelvic autonomic nerve preservation have been performed, a significant proportion of rectal cancer patients suffer from sexual dysfunction and the average of IIEF-EFD and MSHQ-EjD scores was decreased postoperatively until 3 years (25.1 vs. 16.1 and 28.3 vs. 14.2 respectively, p<0.001). CONCLUSIONS: Voiding function was not affected after autonomic nerve-preserving rectal cancer surgery, however sexual function was significantly aggravated. We recommend that the baseline genitourinary function should be evaluated before the treatment for male rectal cancer patients, and penile rehabilitation is necessary for their quality of life after treatment.

Outcomes of a Hepatic Resection for Colorectal-Carcinoma Liver Metastases

PURPOSE: Recent managements of liver metastasis from colorectal cancer consist of multi-disciplinary treatments. Although hepatic resection is the only curative treatment, for which long-term survival is expected, the recurrence rates is still high. Recently, liver resections, combined with chemotherapy and other additional therapy, have produced promising outcomes. We analyzed the outcomes of hepatic resection for liver metastasis from colorectal cancer. METHODS: From 1993 to 2007, we performed 116 hepatic resections for the treatment of liver metastasis from colorectal cancer. All patients received adjuvant chemotherapy. We reviewed their medical records and investigated the clinico-pathologic data retrospectively. RESULTS: One in hospital mortality occurred, and the postoperative morbidity rate was 37.5%, including major complication (11.7%). Five-yr overall survival rate and disease free survival rate were 33.2% and 25.0%, respectively. T stage and postoperative morbidity were independent prognostic factors for survival whereas metachronous metastases and postoperative morbidity were independent prognostic factors for recurrence. During the follow-up periods, 67 recurrences occurred. CONCLUSION: Hepatic resections for liver metastasis from colorectal cancer were safe and effective. The surgical T stage, complications, and metastasis type (metachronous or synchronous) may determine the results in patients with surgically-curable liver metastasis from colorectal cancer.

Voiding and Sexual Dysfunction following Total Mesorectal Excision and Autonomic Nerve Preservation for Rectal Cancer in Males:A Prospective Study / 대한비뇨기과학회지

PURPOSE: We designed a prospective study to evaluate the effects of total mesorectal excision and autonomic nerve preservation(TME-ANP) on postoperative genitourinary function in the course of time and the quantitative effects of various peri-operative risk factors on the postoperative genitourinary dysfunction. MATERIALS AND METHODS: Forty-five patients who underwent TME-ANP with rectal cancer were prospectively examined before and after operation, as well after the first, third and sixth postoperative month. The preoperative urological evaluation consisted of International Prostate Symptom Score(IPSS), Erectile Function Domain score in International Index of Erectile Function(IIEF-EFD), Ejaculation domain in Male Sexual Health Questionnaire(MSHQ-EjD) and urodynamic study. RESULTS: Preoperative IPSS decreased significantly in postoperative 1 month. But there was no difference between preoperative IPSS and postoperative IPSS after 3 month of operation. Erectile function significantly decreased in the course of time(p-trend<0.05). Ejaculation function also significantly decreased after 1 month of operation, however no significant change of MSHQ-EjD was observed thereafter. Multivariate analysis revealed history of abdominoperineal resection and baseline mild erectile dysfunction were found to be the risk factors of decreasing erectile function. Diabetes was associated with diminishing ejaculatory function. CONCLUSIONS: While the voiding dysfuncion was no longer problematic following TME-ANP, substantial number of sexual dysfunction persisted despite TME-ANP.

Retrospective Analysis of Patients Treated with Cetuximab plus FOLFIRI for Previous Irinotecan-combined Chemotherapy in Metastatic Colorectal Cancer

PURPOSE: Many reports about efficacy of cetuximab in the prolongation of survival have been published. Especially, the combination of cetuximab and FOLFIRI has a high activity even in prior irinotecan refractory metastatic colorectal cancer (mCRC). Beside small number of patients, we are trying to evaluate the efficacy and safety of cetuximab combined with FOLFIRI for patients who prior irinotecan chemotherapy had failed. METHODS: A retrospective analysis of 26 patients treated with cetuximab with FOLFIRI from July 2006 to August 2007 was done. All patients had already been treated with FOLFIRI chemotherapy in 1st line or 2nd line regimens for mCRC. The initial dose of cetuximab was 400 mg/m2 at the 1st week, after which the dose was 250 mg/m2 weekly plus FOLFIRI biweekly. We defined 1 cycle as 8 weeks, and the responses were evaluated at week 8. RESULTS: The median follow-up period was 6.2 (1.1~13.9) months. After 8 weeks, 50% of the patients had a partial response, and the disease control rate was 57.5%. The median time to progression was 3 months. EGFR expression and tumor response had no correlation (P=0.07). Skin reaction and tumor response (median time to progression) had a significant correlation (P= 0.022). Cetuximab did not increase the toxicity associated with FOLFIRI, except for an acneiform rash. CONCLUSIONS: Cetuximab combined with FOLFIRI chemotherapy was effective in treating mCRC patients after FOLFIRI regimen chemotherapy.

Clinical Characteristics of Ovarian Metastasis from Colorectal Cancer

PURPOSE: Treatment of ovarian metastasis from colorectal cancer has been controversial, and only limited data on ovarian metastasis have been reported. We reviewed the clinical features of patients with ovarian metastasis from a colorectal carcinoma. METHODS: From 1993 to 2002, 568 women were treated for colorectal cancer. Of those, 17 cases were diagnosed as ovarian metastasis. We reviewed the 17 cases retrospectively. RESULTS: The incidence of ovarian metastasis was 3.0% (17/568). The number of cases involving synchronous ovarian metastasis was 7 (1.2%). Those 7 patients also had another metastasis including ovarian metastasis. Ten cases (1.8%) involved metachronous ovarian metastasis. Of those 10 patients, 8 had ovarian metastasis in combination with other organ metastasis. The median disease-free interval from the diagnosis of the primary colorectal cancer to the diagnosis of ovarian metastasis was 9.8 months, and the median survival after the diagnosis of ovarian metastasis was 17.2 months. The median survival after the diagnosis of ovarian metastasis was 23.4 months in the ovarian- metastasis-only group, compared with 10.1 months in the group with ovarian and other metastasis. The difference in survival between the two groups was statistically significant. CONCLUSIONS: The incidence of ovarian metastasis from colorectal cancer was low. When such an event occurred, it was frequently associated with widespread disease and resulted in a poor prognosis. However, patients having only ovarian metastasis had a higher survival rate.

The Role of Preoperative Chest CT in the Evaluation of a Colorectal Adenocarcinoma

PURPOSE: The most common metastatic site of colorectal adenocarcinomas is the liver, and the next common site is the lung. Pulmonary metastasis has been reported to be more common in rectal cancer (esp. lower rectum) than in colon cancer, and for pulmonary survival metastasis, a hepatic metastatectomy results in longer. Likewise, for hepatic metastasis, a pulmonary metastatectomy may prolong survival, and many reports of longer survival after a pulmonary metastatectomy have been published. We compared chest CT to chest PA as a preoperative diagnostic tool for the detection of pulmonary metastasis. METHODS: The retrospective analysis was done for 369 consecutive patients with preoperative chest CT and chest PA who had a histologically-proven adenocarcinoma. RESULTS: The detection rates of pulmonary metastases by preoperative chest PA and preoperative chest CT were 3.5% (13/369) and 8.4% (31/369), respectively. Pulmonary metastases were confirmed by surgical pathology and follow up for over 6 months to have occurred in 22 patients. Chest PA's sensitivity and specificity for metastasis of colorectal cancer were 45% and 99%, respectively, and the positive predictive value was 76.9%. Chest CT had a sensitivity of 86%, a specificity of 96%, and a predictive positive value of 61.2% for pulmonary metastasis. CONCLUSIONS: Chest CT was more sensitive than chest PA in identifying pulmonary metastasis. Also, the detection rate for pulmonary metastasis by using chest CT was higher than that by using chest PA. Chest CT may be more useful in the diagnosis of pulmonary metastasis than chest PA as a preoperative work-up tool. The preoperative chest CT may help surgeons make decisions in the treatment for patients with a colorectal adenocarcinoma.