A Study on the Tolerability of Early Postoperative Feeding in Patients with Colorectal Cancer

BACKGROUND: Resolution of postoperative ileus has traditionally been the moment at which bowel function returns. The re-start of postoperative oral feeding usually occurs after that. Recently, many reports have been published on early postoperative feeding in patients operated on laparoscopically and even in patients receiving a laparotomy. The aim of this study was to scrutinize the validity of early postoperative feeding. METHODS: Fiftyfour colorectal cancer patients who had undergone radical resective surgery for cure were included in this study and were divided into two group. Group 1 included 32 patients who were fed in a traditional manner. Group 2 consisted of 22 patients who received a regular diet on the first postoperative day. The mean age was 62, the male-to-female ratio was 1.2:1. Thirteen tumor were located on the right side colon, 4 on the left side colon, 10 on the rectosigmoid, 27 on the rectum. Operative methods were 13 right hemicolectomies, 4 left hemicolectomies, 19 low anterior resections, and 18 abdominoperineal resections. The possible problems associated with early oral feeding were well understood by the patients and consents were obtained. Immediately after the operation, the nasogastric tube was removed in the operation room, and The time of complete recovery from anesthesia was 3 to 5 hours later. At that time, liquid drink was given; then, liquid food or blended food was allowed. RESULT: Early oral intake was tolerable in 14 patients out of 21 (67%); in 8 patients a nasogastric tube was reinserted due to severe nausea, vomiting, and/or abdominal distension. All those minor problems were resolved after reinsertion of the nasogastric tube and returning to the traditional method. In one patient, who had a received a low anterior resection, a serious complication, anastomatic leakage, developed. Early oral intake was not thought to be the exact cause of the leakage, but it made the problem more complicated. A huge amount of feces soiled the peritoneal cavity and the already dissected retroperitoneum. CONCLUSIONS: The tolerability of early postoperative oral intake was 67%. In the remainder of patients, all the minor problems except one, were relieved by simply returning to the traditional method. However, early postoperative oral intake should be used with caution for patients who experience difficulty with anastomosis or have an intraoperative technical breakdown and in whom the possibility of leakage exists.

Surgical Experience for Intrahepatic duct Stones / 한국간담췌외과학회지

BACKGROUND: The stones in the biliary tree situated proximal to the origin of the common hepatic duct are considered intrahepatic duct stone. This conditon causes the serious problems including cholangitis, obstructive jaundice and liver abscess. AIM AND METHOD: This study is a clinical review for the results of surgical treatment in 178 cases of patients with intrahepatic stones in the Department of Surgery, Gyeongsang National University Hospital from January 1991 to December 1997. RESULTS: Sex ratio of male to female was 1 : 2.1 and most prevalent age group was 6th decade. Common symptom and sign was RUQ pain(83.2%) and tenderness(64.7%). Common laboratory finding were elevated alkaline phosphatase(56.6%), elevated serum GOT(47.4%), leukocytosis (44.5%) and hyperbilirubinemia(36.4%). C. Sinensis was identified in 22 cases(12.4%) of operation cases. Intrahepatic stones were located in the left hepatic duct in 87 cases(48.9%), the right duct in 27 cases(15.2%) and both intrahepatic duct in 64 cases (35.9%). Partial hepatectomy was performed in 94 cases(52.8%), non-hepatectomy was performed in 84 cases(47.2%). The remained stone was noted in 57 cases(32%) of operation cases. Among them, 39 cases(68%) were non-hepatic group, 18 cases(32%) were hepatic group. Postoperative complication rate in hepatic resection group(29.8%) was higher than that in non-resection group(15.5%). Most common complication was wound infection and operative mortality was 2.2%. The follow-up study showed that 146 cases(82%) were graded as good, 7 cases(3.9%) as fair and 25 cases(14%) as poor result and relative incidence of good result in hepatic resection group(88.3%) was higher than that in non-hepatic group(75%). CONCLUSIONS: We conclude that hepatic resection rather than biliary bypass procedure alone as an initial treatment for hepatolithiasis is satisfactory treatment.

Tumor Angiogenesis and the Relationship to the Prognosis in Breast Cancer

BACKGROUND: The status of axillary lymph nodes has been the most important prognostic factor in operable breast carcinomas, but it does not fully account for the varied disease outcome. More accurate prognostic indicators would help in the selection of patients at high risk for disease recurrence and death and in the selection of candidates for systemic adjuvant therapy. Many studies have suggested that tumor growth is angiogenesis-dependent and that implies an increase in the delivery of nutrients to the tumor cells. This neovascularization also increases the opportunity for tumor cells to enter the circulation, which indicates the importance of tumor angiogenesis to the metastastic potential of tumors. The aim of this study was designed to further define the relationship of microvessel density (MVD) to overall and relapse- free survival and to other reported prognostic indicators in breast carcinomas. METHODS: To investigate the status of angiogenesis in breast carcinomas, we highlighted the microvessels within primary invasive breast carcinomas by using a immunohistochemical study with a monoclonal antibody against the factor-VIII-related antigen. Using light microscopy, we counted the microvessels per 200x field in the most active areas of neovascularization, and we graded the microvessel density. RESULTS: In this study 86 patients with a breast carcinoma were classified into two groups. There were 47 patients with low MVD ( or =42/200xPF). The MVD was in the range between 8 and 173. A significant correlations between microvessel density and the overall survival rates (p=0.0003) and relapse-free survival rates (p=0.0003) were found in all patients. Also, there was a significant association of tumor size and lymph node metastasis states with the overall survival rates and the relapse-free survival rates in all patients. A significant correlation was found between MVD and tumor size (p=0.010). The relapse-free 5-years survival rate of low-MVD patients was 85.5+/-5.52%, and that of high-MVD patients was 44.36+/-9.73% (p=0.0003). The overall 5-yearssurvival rate of low-MVD patients was 84.12+/-6.01%, and that of high-MVD patients was 37.75+/-10.07% (p=0.0003). CONCLUSIONS: In conclusion the present study found a significant correlation between MVD and both tumor size, lymph-node metastasis. The present study shows that the MVD in the area of the most intense neovascularization in an invasive breast carcinoma is an independent and significant prognostic indicator for the overall survival rate and the relapse-free survival rate in patients. Thus, determination of the MVD in an invasive breast carcinoma would be valuable.