Oncologic comparison between nonradical management and total mesorectal excision in good responders after chemoradiotherapy in patients with mid-to-low rectal cancer

Purpose@#This study was performed to compare the oncologic outcomes between nonradical management and total mesorectal excision in good responders after chemoradiotherapy. @*Methods@#We analyzed 75 patients, who underwent 14 watch-and-wait, 30 local excision, and 31 total mesorectal excision, in ycT0–1N0M0 based on magnetic resonance imaging after chemoradiotherapy for advanced mid-to-low rectal cancer in 3 referral hospitals. The nonradical management group underwent surveillance with additional sigmoidoscopy and rectal magnetic resonance imaging every 3–6 months within the first 2 years. @*Results@#Nonradical management group had more low-lying tumors (P < 0.001) and less lymph node metastasis based on magnetic resonance imaging (P = 0.004). However, cT stage, ycT, and ycN stage were not different between the 2 groups. With a median follow-up period of 64.7 months, the 5-year locoregional failure rate was higher in the nonradical management group than in the total mesorectal excision group (16.7% vs. 0%, P = 0.013). However, the 5-year overall survival and disease-free survival rates of the nonradical management and total mesorectal excision groups were not different (95.2% vs. 93.5%, P = 0.467; 76.4% vs. 83.6%, P = 0.665; respectively). @*Conclusion@#This study shows that nonradical management for ycT0–1N0 mid-to-low rectal cancer may be an alternative treatment to total mesorectal excision under proper surveillance and management for oncologic events.

Oncologic comparison between nonradical management and total mesorectal excision in good responders after chemoradiotherapy in patients with mid-to-low rectal cancer

Purpose@#This study was performed to compare the oncologic outcomes between nonradical management and total mesorectal excision in good responders after chemoradiotherapy. @*Methods@#We analyzed 75 patients, who underwent 14 watch-and-wait, 30 local excision, and 31 total mesorectal excision, in ycT0–1N0M0 based on magnetic resonance imaging after chemoradiotherapy for advanced mid-to-low rectal cancer in 3 referral hospitals. The nonradical management group underwent surveillance with additional sigmoidoscopy and rectal magnetic resonance imaging every 3–6 months within the first 2 years. @*Results@#Nonradical management group had more low-lying tumors (P < 0.001) and less lymph node metastasis based on magnetic resonance imaging (P = 0.004). However, cT stage, ycT, and ycN stage were not different between the 2 groups. With a median follow-up period of 64.7 months, the 5-year locoregional failure rate was higher in the nonradical management group than in the total mesorectal excision group (16.7% vs. 0%, P = 0.013). However, the 5-year overall survival and disease-free survival rates of the nonradical management and total mesorectal excision groups were not different (95.2% vs. 93.5%, P = 0.467; 76.4% vs. 83.6%, P = 0.665; respectively). @*Conclusion@#This study shows that nonradical management for ycT0–1N0 mid-to-low rectal cancer may be an alternative treatment to total mesorectal excision under proper surveillance and management for oncologic events.

Small Bowel Perforation Associated With Gastrointestinal Graft-Versus-Host Disease and Cytomegalovirus Enteritis in a Patient With Leukemia: A Case Report With Literature Review

Gastrointestinal graft-versus-host disease (GVHD) is a common complication after hematopoietic stem cell transplantation. Concomitant cytomegalovirus (CMV) enteritis worsens the prognosis of this condition. We report a case of small bowel perforation associated with gastrointestinal GVHD and CMV enteritis in a patient with leukemia who was successfully treated surgically. A 39-year-old man presented with intestinal perforation necessitating emergency surgical intervention. He was diagnosed with T-cell acute lymphoblastic leukemia and developed severe gastrointestinal GVHD and CMV enteritis after hematopoietic stem cell transplantation. His terminal ileum showed a perforation with diffuse wall thinning, and petechiae were observed over long segments of the distal ileum and the proximal colon. Small bowel segmental resection and a subtotal colectomy with a double-barreled ileocolostomy were performed. The patient recovered uneventfully after the operation. Based on reports described in the literature, surgery plays a minor role in the management of gastrointestinal GVHD; however, timely surgical intervention could be effective in selected patients.

Motor Evoked Potentials of Trunk Muscles in Stroke Patients

OBJECTIVE: To evaluate the reorganization of descending motor pathways of trunk muscles in stroke patients. METHOD: Nine patients with unilateral hemispheric stroke were enrolled. Their mean age was 56 years. Transcranial magnetic stimulation (TMS) was applied to unaffected and affected motor cortices in turn and bilateral electromyographic recordings were made from rectus abdominis, external oblique abdominal, and 4 th and 9 th thoracic erector spinae muscles during resting. The onset latency and peak-to-peak amplitude of motor evoked potential (MEP) were measured for each muscle on both sides. RESULTS: Stimulation of the unaffected hemisphere evoked contralateral responses in all patients. Ipsilateral responses were more common in TMS of affected hemisphere. Ipsilateral but not contralateral MEPs were obtained in TMS of affected hemisphere. CONCLUSION: These results demonstrated that the variable availability of bilateral crossed and uncrossed corticomotorneuronal projections among patients could be related with the inconstant occurrence of trunk weakness after unilateral hemispheric stroke.

The Change of Neurogenic Bowel Dysfunction in Spinal Cord Injury Patients during Admission

OBJECTIVE: To investigate the change of neurogenic bowel dysfunction (NBD) in spinal cord injury (SCI) patients during admission. METHOD: Thirty eight SCI patients were enrolled. The NBD score by Krogh was converted to the Korean-version of NBD score. The questionnaires of NBD score included questions about neurogenic bowel symptoms, signs, gender, age, duration, injury level, American spinal cord injury association impairment scale (AIS) and Spinal cord independence measure (SCIM) were used for evaluation of the functional impairment of the SCI. The Korean version of NBD score was applied to the SCI patients at the time of admission and discharge. Neurogenic bowel was treated according to scheduled bowel care. The subcomponents of bowel care protocol were education of bowel habit, abdominal massage, triggered defecation, oral medication and rectal stimulants insertion. RESULTS: The NBD score at the time of discharge decreased significantly in all patients within three months after SCI (p0.05). CONCLUSION: We could reveal the significant improvement of NBD in patients within three months after SCI during admission. The change was more evident in AIS A, C, D patients.

Characteristics of Motor Evoked Potential Recording from Swallowing Muscles Obtained by Transcranial Magnetic Stimulation in Healthy Subjects

OBJECTIVE: To evaluate the characteristics of the motor evoked potentials (MEPs) and the cortical topography of swallowing muscles in healthy subjects. METHOD: Fourteen healthy subjects were enrolled. Their mean age was 31 years. Transcranial magnetic stimulation was applied to left and right motor cortices in turn and contralateral electromyographic recordings were done from orbicularis oris, masseter, submental and infrahyoid muscles during resting. The scalp sites of maximal response and the lowest stimulus output which elicited motor evoked potential (MEP) of these muscles were recorded. The onset latency and peak-to-peak amplitude of MEP were measured for each muscle. RESULTS: Most of the maximal MEPs of swallowing muscles were evoked within 9~17 cm lateral and 1~5 cm anterior from Cz and they showed interhemispheric symmetry. In submental and infrahyoid muscles, the threshold of right cortical excitability was significantly lower than that of left cortical excitability. The latency of the left submental MEP was statistically shorter than that of right submental MEP. CONCLUSION: These results demonstrated that the cortical representation of swallowing muscles displays interhemispheric symmetry. In addition, we suggest that submental and infrahyoid muscles have right cortical dominant tendency.