Age Over 80 is a Possible Risk Factor for Postoperative Morbidity After a Laparoscopic Resection of Colorectal Cancer

PURPOSE: With extended life expectancy, the mean age of patients at the time of diagnosis of colorectal cancer and its treatment, including radical resection, is increasing gradually. We aimed to evaluate the impact of age on postoperative clinical outcomes after a laparoscopic resection of colorectal cancers. METHODS: This is a retrospective review of prospectively collected data. Patients with primary colorectal malignancies or premalignant lesions who underwent laparoscopic colectomies between January 2009 and April 2013 were identified. Patients were divided into 6 groups by age using 70, 75, and 80 years as cutoffs: younger than 70, 70 or older, younger than 75, 75 or older, younger than 80, and 80 or older. Demographics, pathological parameters, and postoperative clinical outcomes, including postoperative morbidity, were compared between the younger and the older age groups. RESULTS: All 578 patients underwent a laparoscopic colorectal resection. The overall postoperative complication rate was 21.1% (n = 122). There were 4 cases of operative mortality (0.7%). Postoperative complication rates were consistently higher in the older groups at all three cutoffs; however, only the comparison with a cutoff at 80 years showed a statistically significant difference between the younger and the older groups. CONCLUSION: Age over 80 is a possible risk factor for postoperative morbidity after a laparoscopic resection of colorectal cancer.

Comparison of Radiofrequency Ablation and Resection for Hepatic Metastasis from Colorectal Cancer / 대한소화기학회지

BACKGROUND/AIMS: Radiofrequency ablation (RFA) has been mostly used as a therapeutic alternative to hepatic resection for treating liver metastasis of colorectal cancer. The purpose of the present study was to determine whether there were differences in outcome between RFA and surgical resection in the treatment of colorectal cancer with liver metastases. METHODS: We performed a retrospective analysis of 53 patients who underwent only hepatic resection or only RFA for colorectal liver metastases. Twenty-five patients who underwent hepatic resection were compared with 28 patients who underwent RFA for synchronous or metachronous liver metastases. RESULTS: The median CEA level at the time of diagnosis of liver metastases was significantly higher in the resection group (14.2 ng/mL vs. 2.8 ng/mL, p=0.002). The median size of main liver metastases was significantly larger in the resection group (4.0 cm vs. 2.05 cm, p=0.002). There was no difference in the percentage of patients experiencing major complication (one patient in each group). The marginal recurrence rate was significantly higher in the RFA group (p=0.004). Disease-free and overall survival were longer in the resection group (p=0.008 and 0.017, respectively). In multivariate analysis, only the type of treatment was a factor associated with disease-free and overall survival (p=0.004 and 0.007, respectively). CONCLUSIONS: Because of the high marginal recurrence rate, RFA shows an inferior outcome in comparison with surgical resection. Therefore, RFA should be considered for only selected patients with unresectable (by any means) disease or with high operative risk.

Pain after laparoscopic appendectomy: a comparison of transumbilical single-port and conventional laparoscopic surgery / 대한외과학회지

PURPOSE: Conventional laparoscopic appendectomy is performed using three ports, and single-port appendectomy is an attractive alternative in order to improve cosmesis. The aim of this study was to compare pain after transumbilical single-port laparoscopic appendectomy (SA) with pain after conventional three-port laparoscopic appendectomy (TA). METHODS: From April to September 2011, 50 consecutive patients underwent laparoscopic appendectomy for simple appendicitis without gangrene or perforation. Patients who had undergone appendectomy with a drainage procedure were excluded. The type of surgery was chosen based on patient preference after written informed consent was obtained. The primary endpoint was postoperative pain evaluated by the visual analogue scale score and postoperative analgesic use. Operative time, recovery of bowel function, and length of hospital stay were secondary outcome measures. RESULTS: SA using a SILS port (Covidien) was performed in 17 patients. The other 33 patients underwent TA. Pain scores in the 24 hours after surgery were higher in patients who underwent SA (P = 0.009). The change in postoperative pain score over time was significantly different between the two groups (P = 0.021). SA patients received more total doses of analgesics (nonsteroidal anti-inflammatory drugs) in the 24 hours following surgery, but the difference was not statistically significant. The median operative time was longer for SA (P < 0.001). CONCLUSION: Laparoscopic surgeons should be concerned about longer operation times and higher immediate postoperative pain scores in patients who undergo SA.

Laparoscopic totally extraperitoneal repair without suprapubic port: comparison with conventional totally extraperitoneal repair / 대한외과학회지

PURPOSE: We have treated 24 patients through laparoscopic totally extraperitoneal (TEP) repair without suprapubic port by using reliability and reducing the invasiveness of two surgery. This study is aimed to assess the safety and feasibility of the TEP repair without suprapubic port compared to conventional TEP repair. METHODS: From September 2007 to 11 May 2010, we compared two groups that suffer from inguinal hernias. One is comprised of 24 patients who were treated without suprapubic port laparoscopic totally extraperitoneal repair (Group A), and the other is comprised of 100 patients who were treated with conventional laparoscopic totally extraperitoneal repair (Group B). Data regarding patient demographics (sex, age, site of hernia, and the type of hernia), operating time, postoperative hospital stay, the use of analgesics, and complications were prospectively collected. RESULTS: There was no significant difference noted between two groups in relation to sex, age, site, and the type of hernia. The mean operating time and postoperative hospital stay was longer for the Group B (62.9 minutes, 3.55 days) than for the Group A (59.0 minutes, 2.54 days) (P = 0.389, P < 0.001). Postoperative urinary retention, seroma, wound infection were respectively 4.2%, 8.3%, 0% in Group A, and 12.0%, 8.0%, 7% in group B. There was difference between the two groups, but not statistical significance. Group B used more analgesics than Group A (0.33 vs. 0.48), but it wasn't significant statistically (P = 0.234). CONCLUSION: Although prospective randomized studies with long-term follow-up evaluation are needed to confirm our study between laparoscopic totally extraperitoneal repair without suprapubic-port and conventional laparoscopic totally extraperitoneal repair, our method have some advantages in postoperative pain, urinary retention, operating time, postoperative hospital stay, and cosmetic effect.

The Significance of Staple Line Height in a Stapled Hemorrhoidopexy

PURPOSE: In 1998, Longo introduced a novel operative technique for hemorrhoids. That technique uses a prolapse and hemorrhoid (PPH) stapler. His results showed minimal pain, short hospital stay, and rapid return to normal social life. However, a higher height of staple line yields less postoperative pain, but more residual piles, and vice versa. This study was designed to find the optimal height of the staple line for a PPH hemorrhoidopexy. METHODS: A total of 65 consecutive patients scheduled for a PPH hemorrhoidopexy on grade II or higher internal hemorrhoids were included in this study. The hemorrhoidopexy was performed as in the literature. A purse-string suture was made 5 cm from the anal verge. Remaining piles were excised immediately after the firing of the PPH stapler. Patients were divided into 2 groups. In group A, the staple line was located above 2 cm proximal to the dentate line, and in group B, it was located below 2 cm proximal to the dentate line. RESULTS: The mean subjective pain score of group A was 2.00, and that of group B was 1.98 (P=0.898). The mean hospital stay of group A was 2.5 days, and that of group B was 2.7 days (P=0.431). Group A returned to normal life in a mean of 7.1 days whereas group B returned to normal life in a mean of 6.8 days (P=0.474). Complications included 6 cases of voiding difficulty, 3 cases of heavy sensation in anus, 1 case of temporary fecal incontinence, and 1 case of anal pain caused by long-standing residual staples. CONCLUSION: No meaningful relationship was found to exist between the staple line height and either pain or the number of days to return to normal life. However, the incidence of residual piles was lower in cases with a low staple line height. Therefore, the level of the staple line should be lower than it is for a conventional Longo procedure.

Efficacy of a Laparoscopic Appendectomy When Performed by Surgeons Early in Their Laparoscopic Training Courses

PURPOSE: Laparoscopic surgery has many advantages and has been a popular method for the treatment of various diseases. Although a laparoscopic appendectomy (LA) is now a common practice, it has not yet become the treatment of choice for appendicitis of inexperienced surgeons in their early days of individual laparoscopic training courses. The purpose of this study was to compare the results obtained by inexperienced surgeons to those obtained by experienced surgeons. METHODS: From May 2007 to January 2008, 130 patients underwent a LA at our department. The surgeries were performed by three surgeons. The patients were divided into 2 groups. In Group I, the LAs were performed by one surgeon who was experienced with laparoscopic procedures, and in Group II, the LAs were performed by two surgeons who were relatively inexperienced with laparoscopic procedures. We retrospectively reviewed patient's medical records for age, sex, previous abdomen operation history, operation method, operation time, surgical complications, length of hospital stay, and the time to resume soft diet. RESULTS: The age was younger in Group I (29.8+/-18.2 vs. 36.0+/-16.0 yr, P=0.041). The operation time was longer in Group II (48.4+/-28.7 vs. 64.1+/-30.0 min, P=0.003). In Group I, wound infections developed in 4 cases. In Group II, wound infections developed in 7 cases, and an intraabdominal abscess developed in 1 case. The differences in conversion rates, times to start of diet, uses of analgesics, and hospital stays were not statistically significant. CONCLUSION: Even though an inexperienced surgeon performs the LA for acute appendicitis, there are no differences in postoperative complications and returns to daily activities compared to a LA performed for acute appendicitis by an experienced surgeon. LA is a safe method for the treatment of acute appendicitis for surgeons who are new to laparoscopic procedures.

Analysis of Results after Percutaneous Catheter Drainage for Anastomotic Leakage

PURPOSE: Anastomotic leakage is a serious and life- threatening complication after colorectal surgery. The management of clinical anastomotic leakage remains largely operative. The aim of this study was to analyze the clinical characteristics and the natural history of percutaneous catheter drainage (PCD) for anastomotic leakage after colorectal surgery. METHODS: Twenty patients who were managed by PCD after anastomotic leakage between January 2002 and December 2006 were studied. Charts were reviewed for information on clinical characteristics and biolologic finding prePCD and postPCD. RESULTS: Anastomotic leakage was managed by using only PCD in 16 of 20 patients (80%), and twenty percent of patients (4/20) were managed by using a loop ileostomy after PCD. Nine patients (45%) had peritoneal drains left in place at diagnosis. Before PCD, the mean of the peak white blood cell (WBC) was 12,800/mm3, and the mean period of fever (>38degrees C) was 3.4 (2~5) days. After PCD, the mean time until the body temperature dropped below 37oC was 3.1 (1~5) days, the mean time until the WBC count dropped below 10,000/mm3 was 3.2 (0~6) days, the mean duration of ileus and diarrhea was 3.3 (0~6) days, the mean total amount of drainage during 6 days was 880 cc, and the mean length of stay after PCD was 14.9 days. CONCLUSIONS: PCD is a safe and effective method for treating anastomtic leakage in patients without sepsis or diffuse peritonitis and with CT scans that reveal no diffuse fluid collection.

The Effect of Dexpanthenol in Postoperative Patients

PURPOSE: The purpose of this study was to compare the efficacy of dexpanthenol in postoperative patients. Dexpanthenol, the alcohol derivative of pantothenic acid, is believed to be a precursor of acetylcholine through its incorporation into coenzyme-A. METHODS: From June 2005 to December 2005, 130 curative abdominal surgery, which were divided into a dexpanthenol group with 65 patients and a control group with 65 patients, were prospectively and randomly studied for recovery of bowel motility. RESULTS: No significant difference was found between the two groups as to incidence of postoperative ileus (16.9% vs. 15.4%, P=0.081), the time to flatus (77.2+/-38.4 vs. 77.9+/-31.9 hours, P=0.90), the time to defecation (5.3+/-2.7 vs. 5.1+/-2.6 days, P=0.77), the time to resumption of meals (7.9+/-4.0 vs. 8.9+/-4.2 days, P=0.17), and the duration of hospital stay (16.4+/-7.8 vs. 17.9+/-11.5 days, P=0.39). CONSLUSIONS: Since no differences in the postoperative bowel motility were observed between the two groups, dexpanthenol is not recommended for general surgical use.

A Case of Stercoral Perforation of the Sigmoid Colon

A stercoral perforation of the colon is a rare phenomenon and is caused by severe prolonged constipation. Since the first reported case in 1894, approximately 80 additional cases have been reported. However, this rare condition seems to have been underestimated because of not only obscure diagnostic standards but also ignorance and failure to notice by surgeons. Due to its high mortality rate of about 35~40%, a stercoral ulcer perforation should be considered in any patient with chronic constipation who presents with peritonitis. We report a case of a 75-year-old female who was diagnosed as having a stercoral perforation of the sigmoid colon and review the clinical features, the diagnosis, and the treatment.

The Effect of Preoperative Oral Application of Bovine Colostrum on Endotoxemia and TNF-alpha in Abdominal Surgery

PURPOSE: We conducted this study to assess the effect of oral application of bovine colostrum on the plasma endotoxin and TNF-alpha following the abdominal surgery. METHODS: 46 patients who underwent the abdominal surgery were evenly enrolled in a prospective, randomized, double blind and placebo-controlled study. The patients were preoperatively managed by oral application of 20 g of a bovine colostrums or placebo (nonfat dried milk) per a day for 3 days. In both groups, endotoxin was sequentially determined pre-, intra- and postoperatively by a modified limulus amebocyte lysate test. TNF-alpha and CRP were also measured. The clinical course was followed and compared in both groups. RESULTS: The colostrum group showed significantly lower level of endotoxin and TNF-alpha compared to the placebo group. CRP did not differ in both groups. Clinical event did not occur in both group until the discharge. Colostrum group tends to have a lower incidence of fever and leukocytosis without statistic significance. CONCLUSION: Prophylactic preoperative oral application of bovine colostrum lower the plasma level of perioperative endotoxin and TNF-alpha. Further studies were needed for the relation of clinical effect and preoperative oral application of bovine colostrum.

Difference in Clinical Features between Appendicitis and Right-Sided Colonic Diverticulitis on Initial Diagnosis

PURPOSE: Most patients who are finally diagnosed as having cecal and right-sided colonic diverticulitis complain of pain in the right lower quadrant of the abdomen, many of them unfortunately undergo an emergency operation for presumed appendicitis. Our purpose was to differentiate the diagnosis of right-sided colonic diverticulitis from appendicitis in an emergency setting. METHODS: We retrospectively reviewed the medical records of 450 patients between January 1997 and July 2003. Among them, 92 patients who had been diagnosed as having right-sided colonic diverticulitis were classified as Group I. In the remaining 358 patients with appendicitis, 268 patients with simple appendicitis were classified as Group II and 90 patients with perforated appendicitis were classified as Group III. RESULTS: The sex ratios were similar among 3 groups. The mean age of Group I (36.5+/-10.1 years) was significantly different from that of Group II (30.7+/-14.8 years, P=0.002), but not from that of Group III (38.7+/-20.9). Incidences of fever/chill and nausea/vomiting were less common in Group I (P<0.05). The duration of prodromal symptoms in Group I (2.6 days) was longer than that of Group II (1.6 days, P=0.02), but was not significantly different from that of Group III (3.3 days, P=0.83). The mean WBC count was significantly smaller in Group I (10913.8/mm3) than in Group II (13238.3/mm3) and III (15589.3/mm3, P<0.001). The percentage of segment form in differential counts was smaller in Group I (73.6%) than in Group II (79.1%) and III (81.8%, P<0.001). The percentage of lymphocytes in differential counts was larger in Group I (17.7%) than in Group II (13.9%) and Group III (9.4%, P<0.001). CONCLUSIONS: Among the patients who complain of pain in the right lower quadrant abdomen in an emergency setting, cecum and right-sided colonic diverticulitis must be considered in the following conditions to avoid unnecessary emergency operations, relatively younger patients (20~40 years), infrequent prodromal symptoms, absent rebound tenderness with a laterally deviated maximal tenderness point, and absent or mild leucocytosis with a relatively low fraction of segment forms associated with a higher fraction of lymphocytes in CBC.

Predictive Value of Preoperative Serum CEA, CA19-9 and CA125 Levels for Peritoneal Metastasis in Patients with Gastric Carcinoma / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Peritoneal metastasis is a crucial factor for the prognosis in gastric cancer, but its diagnosis is difficult before laparotomy. This study analyzed the usefulness of diagnostic imaging and various tumor markers in the detection of peritoneal metastasis in gastric cancer. MATERIALS AND METHODS: The sera from 768 patients with gastric cancer were measured for CEA, CA19-9 and CA125 levels using a commercial immunoradiometric assay. All the patients underwent diagnostic imaging with computed tomography (CT) and ultrasound (US) before laparotomy. RESULTS: Preoperative levels of CEA, CA19-9 and CA125 were above the cut-off levels in 15.4%, 8.7% and 5.7% of all cases, respectively. Eighty-eight patients were diagnosed with peritoneal metastasis by laparotomy. CT and US revealed peritoneal dissemination in 15 of 88 patients (17%). Among the three tumor markers, CA19-9 and CA125 showed similar detection rates of peritoneal metastasis (37.5% and 38.6%, respectively). In particular, the serum CA125 levels showed the best sensitivity (38.6%), specificity (98.4%), and diagnostic accuracy (91.5%), and the highest odd ratio (24.46, 95% CI: 11.17~53.57) for predicting peritoneal metastasis among the markers tested. CEA did not add significant predictive information (p=0.471). CONCLUSION: Preoperative serum CA19-9 and CA125 levels may provide a predictable value in determining peritoneal metastasis in patients with gastric cancer.

Long-term Results of Proximal and Total Gastrectomy for Adenocarcinoma of the Upper Third of the Stomach / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The choice of surgical strategy for patients with adenocarcinoma of the upper one third of the stomach is controversial. This study was performed to analyze the surgical results of a 11-year experience with these lesions. MATERIALS AND METHODS: From January 1990 to December 2000, 259 patients with upper third gastric cancer underwent proximal gastrectomy (n=74) or total gastrectomy (n=185) through an abdominal approach. Morbidity, mortality, recurrence patterns, and survival were compared between these two groups retrospectively. RESULTS: There were no significant differences in general complication and mortality rates between the two groups. However, the incidences of reflux esophagitis (16.2%) and anastomotic stricture (35.1%) were more common in the proximal gastrectomy group compared with the total gastrectomy group (0.5 and 8.1%). Regarding the main patterns of recurrence, local recurrence was dominant in the proximal gastrectomy group, whereas distant recurrence was dominant in the total gastrectomy group. Five-year overall survival (54.8 versus 47.8%) and survival according to tumor stage were no different between the groups. Multivariate analysis showed that the extent of resection was not an independent prognostic factor. CONCLUSION: The extent of resection for upper third gastric cancer did not appear to affect long-term outcome. However, proximal gastrectomy is associated with an increased risk of reflux esophagitis, anastomotic stricture, and local recurrence.

A Study of Sixty Consecutive Whipple Procedure by Single Surgeon

PURPOSE: To review the current standards of pancreaticoduodectomies and show that excellent results can be achieved by a single surgeon. METHODS: A case series of consecutive patients, operated on during the period March 1999 to February 2003, were retrospectively evaluated. The patients' medical records were abstracted for demographic data, clinical presentation, operative indication, operative time, amount of transfusion, perioperative morbidity, mortality and other operative records. RESULTS: The average age was 57.5 years, ranging from 35 to 78. Jaundice was the main presenting symptom (68.3%) and preoperative PTBD was performed at 34 cases (56.7%). The most common indication for this procedure was cancer of the ampulla of Vater (28 cases, 47.3%) and the second was pancreatic head cancer (14 cases, 23.6%). A total of 60 patients underwent a pancreaticoduodectomy during the 4 year period. Fifty-three patients underwent a pylorus- preserving pancreaticoduodectomy (PPPD) and 5 a classical Whipple procedure. The operation lasted an average of 367 minutes, ranging from 250 to 555. The mean operative blood loss was 750 ml, ranging from 180 to 2400. About seventy- two percent of patients had no major complications, 28% had one or two more major complications and there was only one operative mortality (1.7%). The major morbidity was leakage of the pancreaticojejunostomy (5 cases, 8.3%). Delayed gastric emptying occurred in 6 patients. CONCLUSION: The above study demonstrates that a complicated procedure, such as the Whipple pancreaticoduodectomy, can be performed with excellent results by a single surgeon with sufficient experience. The most important prerequisite is that the surgeon be adequately trained in the procedure. In low-volume hospitals, the case load should be restricted to a minimal number of trained surgeons in order to concentrate the experience.

Prognostic Value of Preoperative Serum CEA and CA19-9 Levels in Gastric Cancer Patients

PURPOSE: The clinical significance of preoperative serum levels of tumor markers CEA and CA19-9 was evaluated in gastric cancer patients. METHODS: Serum levels of CEA and CA19-9 were measured in 1, 310 patients with gastric cancer who underwent laparotomies over a recent 10-year period (1992~2001). The correlations between the serum levels of tumor markers and several clinicopathological factors were evaluated by univariate analysis. The significance of the tumor markers as prognostic factor was assessed by multivariate analysis. RESULTS: The positivity rates of CEA and CA19-9 were 17.5% and 13.4%, respectively. The positivity rate of CEA was higher in the elderly, in male patients, and in those with histologically differentiated tumors, whereas CA19-9 positivity was related to tumor location. In addition, the positivity rates of each tumor marker were significantly correlated with tumor size, gross type, depth of invasion, lymph node metastasis, peritoneal and liver metastases, and cancer stage. A significant difference in survival was observed between patients positive and negative for CEA and CA19-9. The multivariate analysis showed that in addition to gross type, depth of invasion, lymph node metastasis, peritoneal and liver metastasis, preoperative serum CEA and CA19-9 levels among those undergoing However, multivariate analysis of curatively resected cases identified gross type, depth of invasion, lymph node metastasis, and CA19-9 as significant prognostic variables. CONCLUSION: Preoperative serum CEA and CA19-9 determination in patients with gastric cancer is of value for the prediction of tumor progression and prognosis. However, serum CA19-9 level was more useful than CEA as a1 prognostic factor in patients undergoing curative resection.

Proximal Gastrectomy Reconstructed by Jejunal Pouch Interposition: Surgical Technique and Evaluation of Postoperative Function

PURPOSE: Total gastrectomy has generally been performed for the treatment of upper third gastric cancer. However, the optimal extent of resection for the upper third gastric cancer is controversial until now. This article describes the surgical techniques and postoperative status for proximal gastrectomy reconstructed by jejunal pouch interposition. METHODS: We have used interposition of a double jejunal pouch between the esophagus and the remnant stomach after performing proximal gastrectomy in 22 patients to date. The postoperative courses were compared with those of 23 patients who underwent total gastrectomy during the same period. RESULTS: The age of the patients ranged from 28 to 72 years (mean 56.4 years); 18 were men and 4 were women. The lesions were mostly located along the lesser curvature or at the posterior wall. Histological examination showed that 13 patients had early gastric cancer, seven had advanced cancer, and two had malignant GISTs. Lymph node metastasis was observed in two patients. The comparative study revealed that there were no significant differences in the operation time and the length of hospital stay. There was no anastomotic leakage or intraabdominal abscess, and no operative deaths. Other complications were anastomotic stricture in 2 patients, pouch bleeding in one, pouch ulcer in one, and delayed emptying in two patients. No other symptoms, including dumping or reflux esophagitis, were recognized in any of the patients. CONCLUSION: Proximal gastrectomy reconstructed with jejunal pouch interposition was a safe procedure and led to a better quality of life, as judged from the functional studies in our patients. However, long term follow-up results of quality of life and survival will be necessary to confirm the superiority of this procedure.

The Clinical Features and Charateristics of anal Cancer Arising from Chronic Fistula-in-ano

PURPOSE: The incidence of unhealed chronic fistula is about 7% and the cancer can occur in the longstanding unhealed fistula. The most of the cancer is mucinous adenocarcinoma. The report is diverse about treatment, adjuvant chemotherapy and prognosis. The purpose of this study is review of the clinical characteristics and survival of the anal cancer arising from chronic fistula-in-ano. METHODS: The number of patients was 10. The diagnosis is made under pathological examination at the Kanbuk Samsung Hospital from 1983 to 2000. The retrograde study was done with patients' records and telephone questionnaire. The survival rate was calculated with Kaplan-Meier method. RESULTS: All patients were male. The patients had symptoms of anal discharge and anal swelling suggesting the anal fistula. The patients had history of anal surgery. The external openings were multiple. Seven patients had mucinous adenocarcinoma. The prognosis was poor. Among 8 patients' follow-up data, except one patient, 7 patients died within 43 months. CONCLUSIONS: The anal cancer can occur in longstanding unhealed fistula. In our series, all patients were male, and they had multiple opening fistula. The patient who had small size tumor have only survived. Through meticulous exploring and deep biopsy of the fistula, early detection is best method to treat the anal cancer arising from chronic fistula-in-ano.

Analysis of Local Recurrence Following Proximal Gastrectomy in Patients with Upper Third Gastric Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Little is known about local recurrence following proximal gastrectomy in patients with upper third gastric cancer. We performed this study to evaluate the long-term results of a proximal gastrectomy, and to analyze the risk factors of local recurrence affecting survival in these patients. MATERIALS AND METHODS: We undertook a retrospective study of 63 patients who underwent potentially curative proximal gastrectomy between 1990 and 1999, with special reference to local recurrence. RESULTS: During a median follow-up period of 37 months, 25 of the 63 patients (39.7%) developed a recurrence of cancer, with local recurrence in 15 patients (23.8%), the majority of these occurring at the remnant stomach or anastomosis. The median time to local recurrence was 38 months (8~78 months). Univariate analysis of risk factors for local recurrence revealed an infiltrative or diffuse gross type, with a tumor sizes>5 cm, a distal resection margin

Gastrojejunostomy with Duodenal Partition for Unresectable Periampullary Cancer

PURPOSE: The most appropriate palliative treatment to relieve symptoms caused by extrahepatic biliary obstruction appears to be a surgically constructed double bypass. However, gastrojenunostomy may be a disease rather than an operation because the ingested food would take the duodenal route and reenter the stomach through the gastrojejunostomy. Therefore, there has been a renewed interest in the role of the duodenal partition for preventing this circulus vomitig. METHODS: A total of 97 patients were treated with palliative loop gastrojejunostomy due to unresectable periampullary cancer at Kangbuk Samsung Hospital between March 1998 and December 2000. Of the 56 patients of this group who underwent prophylactic gastrojejunostomy, 25 patients had both gastojejunostomy and duodenal partition (Group I) and 31 gastrojejunostomy alone (Group II). RESULTS: The postoperative in-hospital mortality rate was 0 percent and the morbidity rate was 5.4 percent. However, the morbidity rate associated with duodenal partition was 0 percent. Circulus vomiting was absent in patients who had a duodenal partition, although statistical analysis did not show this to be significant. The reason for the statistical insignificance of the result may be the relatively small sample size. CONCLUSION: Due to the ease and safety of the technique, the duodenal partition added to the loop gastrojejunostomy decreased circulus vomiting without prolonging the operative time or increasing the compication rates. This finding suggests that the duodenal partition should be liberally applied in prophylactic gastric bypass procedures.

Routine Nasogastric Decompression Is Not Necessary in Elective Gastric Cancer Surgery

PURPOSE: Nasogastric (NG) decompression has traditionally been used following gastrectomy with extended lymph node dissection in patients with gastric cancer. A prospective randomized study of 133 patients undergoing gastric cancer surgery was performed in order to determine the necessity of routine NG decompression. METHODS: Between July 1999 and July 2000, 133 patients with gastric cancer were randomly assigned to one of two groups: NG group (n=69)-NG decompression was maintained postoperatively until a resumption of bowel function; No-NG group (n=64)-NG tube was not inserted at all, either pre- or postoperatively. RESULTS: The times to return of bowel sounds, passage of flatus and start of oral intake were all significantly (P<0.001) shortened in the No-NG group. The length of operating time and postoperative hospital stay were also decreased in the No-NG group (P<0.001). Two patients in each group (2.9% in NG and 3.1% in No-NG group) required subsequent NG decompression. There were no significant differences between the two groups concerning the presence of postoperative fever, nausea, vomiting, anastomotic leakage, pulmonary or wound complications between the two groups. There was no postoperative mortality in either group. CONCLUSION: We concluded that routine NG decompression is not necessary in elective gastric cancer surgery, even in the presence of gastric outlet obstruction.