Contributing Factors on Lymph Node Yield after Surgery for Mid-Low Rectal Cancer

PURPOSE: The purpose of the present study was to evaluate the contributing factors to the lymph node status as well as to define the impact of preoperative concurrent chemoradiotherapy (CCRT) on the number of lymph nodes retrieved in mid-low rectal cancer. MATERIALS AND METHODS: We retrospectively analyzed 277 patients who underwent curative surgical resection for mid-low rectal cancer between 1998 and 2007. Eighty-two patients received long course preoperative CCRT followed by surgery. RESULTS: A mean of 13.12+/-9.28 lymph nodes was retrieved. In a univariate analysis, distance from the anal verge, pT stage, pN stage, lymphovascular invasion, preoperative CCRT had significant influence on the number of lymph nodes retrieved. In a multivariate model, patients in the CCRT group had fewer retrieved lymph nodes than the non-CCRT group (p<0.001). Both univariate and multivariate analyses showed that the ypN0 group had fewer retrieved lymph nodes than the ypN1-2 group (p=0.027) in the CCRT group. CONCLUSION: Preoperative CCRT was an independent risk factor for failure to harvest an appropriate number of lymph nodes, and node-negative patients who received CCRT had fewer lymph nodes harvested.

The Clinicopathologic Features and Prognosis of Multiple Early Gastric Cancer

PURPOSE: Multiple early gastric cancer (MEGC) accounts for between 4.5% and 11.7% of all early gastric cancers (EGC). We investigated the treatment of MEGC from the viewpoint of the clinicopathologic features of the disease. MATERIALS AND METHODS: 2,281 patients with EGC underwent gastric resection at the Department of Surgery, Severance Hospital during the 11 years between January 1994 and December 2004 and we carried out a retrospective analysis of these patients. RESULTS: There were 91 cases of synchronous MEGC (4.0%) according to the diagnostic criteria of Moertel: there were 81 double, 9 triple and 1 quadruple lesions. Of the 102 accessory lesions, 64 (62.7%) were less than 10 mm in diameter and 83 (81.4%) were located in the same region as the main lesion. The most frequent histologic type of main lesion was a well differentiated adenocarcinoma, which was found in 52 cases (57.1%). There were 49 mucosal main lesions and 42 submucosal main lesions. Lymph node metastasis was detected in 6 cases (6.6%): 1 in mucosal lesions and 5 in submucosal main lesions. CONCLUSION: Solitary EGC and MEGC had very similar clinopathological features and a similar prognosis. Therefore, we believe that the general EGC treatment guidelines can be applied for multiple EGC. It is important to evaluate the whole stomach before and during the operation and then after examining the resected specimen.

Clinical Characteristics of a Hand-sewn Circumferential Mucosectomy in Hemorrhoids

PURPOSE: A stapler hemorrhoidectomy (hemorrhoidopexy) does not excise hemorrhoid tissue, but instead re-positions the prolapsed hemorrhoid. We introduced a hand-sewn circumferential mucosectomy under direct vision as a new hemorrhoidectomy method and evaluated its safety and effectiveness for the surgical treatment of hemorrhoids. METHODS: We performed 108 hand-sewn circumferential mucosectomies between June 2003 and December 2006. We evaluated the operating time, the postoperative course, and the complications. Pain was evaluated using a visual analog scale. RESULTS: The mean patient age was 48 years, and the numbers of males and females were similar. The most common indication was third-degree hemorrhoids. The mean operating time was 37.7 minutes, and most operations took between 20 and 40 minutes. The average postoperative pain score was 5.0 on the day of surgery and 3.9 on the second postoperative day. The time to the first bowel movement and the length of the hospital stay averaged 1.3 and 2.5 days, respectively. The mean time to return to work was 5.2 days. There were no serious complications with the hand-sewn circumferential mucosectomy. Postoperative complications occurred in 31.5% of the cases. Urinary complications were the most common. CONCLUSIONS: A hand-sewn circumferential mucosectomy is safe for the treatment of hemorrhoids, and there are no serious complications. The operative pain, the postoperative course, the time to return to work, and the nature of complications are acceptable, although the operating time is longer. A hand-sewn circumferential mucosectomy is considered to be an effective new alternative for the surgical treatment of hemorrhoids.

Ingested Foreign Body Trapped in the Appendix: A Case Report

Foreign body ingestion is a frequent event in the pediatric age group, but the incidence of foreign bodies in the appendix is very low. The authors report a case of ingested foreign body trapped in the appendix in a 7-year-old girl. The foreign body was successfully treated by laparoscopic appendectomy under fluoroscopic guidance.