Is Laparoscopic Multivisceral Resection Applicable to Colorectal Cancer Adherent to Adjacent Organs? / 대한내시경복강경외과학회지

PURPOSE: The aim of this study was to assess the feasibility and safety of laparoscopic multivisceral resection of colorectal cancer adherent to adjacent organs. METHODS: We reviewed retrospectively 32 patients undergoing elective laparoscopic multivisceral resection for colorectal cancer adherent to adjacent organs between June 2003 and May 2009. Survival curves were generated by Kaplan-Meier method. RESULTS: The median age of 32 patients was 73 years. In 10 of 17 rectal cancer patients (59%), neoadjuvant chemoradiation was performed. All the surgeries were completed laparoscopically. The postoperative complications occurred in 21.9% and there was no operative mortality. The median length of hospital stay was 15.5 days. In 23 of 32 patients (72%), the resection was considered curative. Median follow-up period of all patients and curatively resected patients was 22 (range, 2~65) months, 34 (range, 4~65) months respectively. Local recurrence rate, the 3-year overall survival rate and the 3-year disease free survival rate of 23 curatively resected patients was 4.3%, 92.9% and 84.4%, respectively. CONCLUSION: Laparoscopic multivisceral resection is feasible and safe in highly selected patients with colorectal cancer adherent to adjacent organs. Further validation is needed.

Surgical Outcome of Synchronous Second Primary Cancer in Patients with Gastric Cancer

PURPOSE: In order to improve the likelihood of curative and safe gastric surgery, this study investigated the clinical features and surgical outcomes of gastric cancer with a synchronous cancer. PATIENTS AND METHODS: The clinicopathological data of 10,090 gastric cancer patients at Samsung Medical Center from September 1994 to December 2006 were retrospectively analyzed. Of them, 90 patients with gastric cancer and a synchronous second primary cancer underwent simultaneous surgery for gastric cancer and second primary cancer. The clinicopathological characteristics of the patients, surgical outcome, and prognosis were examined. RESULTS: The most common synchronous second primary cancer was colorectal cancer (37 patients), followed by hepatocellular carcinoma (13 patients), renal cell carcinoma (11 patients), and pancreatic carcinoma (5 patients). The incidence of a second primary cancer in the gastric cancer patients was higher than the incidence in the general population. Stage I gastric cancer patients had more synchronous cancers than stage II patients (59 vs. 31). Postoperative complications were encountered in 7 patients. Four patients underwent reoperation. Two patients died from hepatic failure and leakage of esophagojejunal anastomosis. The 5-year survival rate of stage I and II gastric cancer was 61% and 39%, respectively. CONCLUSION: Since gastric cancer patients with a synchronous second primary cancer are not rare, the possibility of synchronous cancers in gastric cancer patients should be considered. The prognosis of early stage gastric cancer patients with a synchronous second primary cancer was influenced more by the presence of the second primary cancer than by the gastric cancer itself.

Safety of Completion Thyroidectomy for Thyroid Cancer

PURPOSE: Completion thyroidectomy is defined as the surgical removal of the remnant thyroid tissue following procedures less than total thyroidectomy. However the roles and indications of completion thyroidectomy remain controversial. This study was performed to review the clinical and pathologic features of patients who underwent completion thyroidectomy and to evaluate the safety of this procedure. METHODS: A retrospective analysis from Nov. 1994 to Dec. 2002 at Samsung Medical Center yielded 36 patients, 11 male and 25 female, who had undergone completion thyroidectomy. Their median follow-up was 29 months. RESULTS: The patients ranged in age from 20 to 58 years. Of the 36 patients, 24 had undergone prophylactic thyroidectomy and 12 therapeutic thyroidectomy for recurrence. The most common cause of completion thyroidectomy was cancers undiagnosed during the primary operation and 12 cases (75%) among these 16 undiagnosed cancers were follicular carcinoma. Three patients harbored carcinoma at the perithyroidal lymph node or remnant thyroid as a result of prophylactic completion thyroidectomy. Postoperative complications occurred in 11 patients (31%): 10 transient hypocalcemia and 1 transient hoarseness. There were no differences in postoperative complication rate between total thyroidectomy group and completion thyroidectomy during the same period at our hospital. CONCLUSION: The most common indication that is considered for completion thyroidectomy is a follicular carcinoma undiagnosed during primary operation. Completion thyroidectomy might be a safe operation with minimal morbidity if it is performed meticulously by an experienced surgeon.