Risk of recurrence after endoscopic resection of early colorectal cancer with positive margins.

BACKGROUND AND STUDY AIM: Additional surgery is recommended if an endoscopically resected T1 colorectal cancer (CRC) specimen shows a positive resection margin. We aimed to investigate the significance of a positive resection margin in endoscopically resected T1 CRC. PATIENTS AND METHODS: We enrolled 265 patients with T1 CRC who underwent endoscopic resection between January 2001 and December 2016. The inclusion criteria were: 1) complete resection by endoscopy, and 2) pathology of a positive margin. Among the 265 patients, 213 underwent additional surgery and 52 did not. In the additional surgery group, various clinicopathological factors were evaluated with respect to the presence or absence of residual tumor. The follow-up results were assessed in the group that did not undergo additional surgery. RESULTS: In the 213 patients who underwent additional surgery, residual tumor was detected in 13 patients (6.1 %), and none of the clinicopathological factors was significantly associated with the presence of residual tumor. Among the 52 patients who did not undergo additional surgery, recurrence was detected in 4 (7.7 %), and all 4 underwent salvage surgery. Among these four patients, three had no risk factors for lymph node metastasis and recurrence was at the previous resection site; pathology was high grade dysplasia, rpT3N0M0, and rpT1N0M0, respectively. CONCLUSIONS: A positive resection margin in endoscopically resected T1 CRC is related to a relatively low incidence of residual tumor (6.1 %). Although current guidelines recommend additional surgery for such cases, surveillance and timely salvage surgery could be another option in selected cases.

Differences in the survival rates of older patients with colorectal cancers in 2003 and 2009.

PURPOSE: The aim of this study was to investigate survival in patients aged ≥70 years who underwent colorectal cancer surgery in 2003 and 2009. In addition, we aimed to identify the factors that could affect survival in these patients. METHODS: In a cross-sectional study, a retrospective review of the data for 878 patients who underwent colorectal cancer surgery with curative intent in the years 2003 and 2009 was performed. The primary outcome was the 5-year overall survival rate (5-OSR), and the clinicopathologic factors that could affect overall survival were analyzed. RESULTS: The 5-OSR was 77.8% and 84.9% in 2003 and 2009, respectively (P = 0.013). Age, American Society of Anesthesiologists physical status classification, stage, type of surgery, and length of hospital stay possibly affected survival per the univariate and multivariate analyses. In patients aged ≥70 years, the 5-OSR in 2009 was 75.9%, which showed improvement compared to 53.7% in 2003 (P = 0.027). The stage, type of surgery, and hospital stay were the variables that possibly affected survival in patients aged ≥70 years per the univariate analysis, whereas the stage (III; hazard ratio [HR], 2.188; P = 0.005) and length of hospital stay (>12 days; HR, 2.307; P = 0.004), were the variables that showed statistical significance on the multivariate analysis. CONCLUSION: We found that early stage and shortening the length of hospital stay could affect survival in older patients with colorectal cancers. Because of limited evidence on the influence of shortening the length of hospital stay on survival in older patients, further investigations are warranted.

Oncologic outcomes of early adjuvant chemotherapy initiation in patients with stage III colon cancer.

PURPOSE: Although adjuvant chemotherapy reduces the risk of disease recurrence in stage III colon cancer patients, published guidelines do not specify when it should be initiated. This study aimed to assess the effect of adjuvant chemotherapy initiation time on disease recurrence and survival in stage III colon cancer patients undergoing curative surgical resection. METHODS: The medical records of stage III colon cancer patients undergoing curative resection between February 2004 and December 2009 were reviewed. RESULTS: Of the 133 enrolled patients, 27 (20.3%) began adjuvant chemotherapy within 3 weeks of surgery, whereas 106 (79.7%) did after 3 weeks following surgery. Patients receiving chemotherapy within 3 weeks of surgery were less likely to experience recurrences than those beginning treatment later (11.1% vs. 33%, P = 0.018). The mean disease-free survival of patients receiving adjuvant therapy earlier was 54.6 months, whereas that of patients with later treatment was 43.5 months (P = 0.014). However, no significant differences in overall survival were observed between the 2 groups. CONCLUSION: Adjuvant chemotherapy should be initiated as soon as a patient's clinical condition allows. Patients with stage III colon cancer may benefit from adjuvant chemotherapy initiated within 3 weeks of surgery.

Exposure to music and noise during pregnancy influences neurogenesis and thickness in motor and somatosensory cortex of rat pups.

PURPOSE: Prenatal environmental conditions affect the development of the fetus. In the present study, we investigated the effects of exposure to music and noise during pregnancy on neurogenesis and thickness in the motor and somatosensory cortex of rat pups. METHODS: The pregnant rats in the music-applied group were exposed to 65 dB of comfortable music for 1 hour, once per day, from the 15th day of pregnancy until delivery. The pregnant rats in the noise-applied group were exposed to 95 dB of sound from a supersonic sound machine for 1 hour, once per day, from the 15th day of pregnancy until delivery. After birth, the offspring were left undisturbed together with their mother. The rat pups were sacrificed at 21 days after birth. RESULTS: Exposure to music during pregnancy increased neurogenesis in the motor and somatosensory cortex of rat pups. In contrast, rat pups exposed to noise during pregnancy showed decreased neurogenesis and thickness in the motor and somatosensory cortex. CONCLUSIONS: Our study suggests that music and noise during the developmental period are important factors influencing brain development and urogenital disorders.

The impact of old age on surgical outcomes after pancreaticoduodenectomy for distal bile duct cancer.

BACKGROUNDS/AIMS: To compare surgical results and survival of two groups of patients, age ≥70 vs. age <70, who underwent pancreaticoduodenectomy and to identify the safety of this procedure for elderly patients for the treatment of distal common bile duct (CBD) cancer. METHODS: Between January 2003 and December 2009, 55 patients who underwent pancreaticoduodenectomy for the treatment of distal CBD cancer at Keimyung University Dong San Medical Center were enrolled in our study. RESULTS: Of 55 patients, 28 were male and 27 female. Nineteen were over 70 years old (older group) and 36 were below 70 years (younger group). The mean ages of the two groups of patients were 73.5 years and 60.5 years respectively. Although patients of the older group had significantly more comorbid diseases, perioperative results including operation time, amount of intraoperative bleeding, duration of postoperative hospital stay and postoperative complications were not significantly different. A higher level (more than 5 mg/dl) of preoperative initial bilirubin showed significant correlations with operative morbidity by univariate analysis, and age was not an independent risk factor of operative morbidity. Overall 5 year survival of older and younger groups were 45.9% and 39.5% respectively (p=0.671) and disease-free 5-year survival were 31.7% and 31.1%, respectively (p=0.942). CONCLUSIONS: Surgical outcomes of elderly patients were similar to those of younger patients, despite a higher incidence of comorbid disease. This results shows that pancreaticoduodenectomy can be applied safely to elderly patients.