Features of Late Recurrence Following Transanal Local Excision for Early Rectal Cancer.

BACKGROUND: Transanal local excision has recently received attention as an alternative to radical surgery for early rectal cancer. Recurrence usually occurs within 5 years after surgery, but recurrences later than this have also been reported. OBJECTIVE: The aim of this study was to investigate the incidence and risk factors of recurrence in patients who have early rectal cancer 10 years after transanal local excision. DESIGN: Patients with early rectal cancer who underwent transanal local excision from October 1994 to December 2010 were retrospectively reviewed. We reviewed the demographics and clinicopathologic features of primary lesions and analyzed the incidence and risk factors of recurrence. SETTINGS: This investigation was conducted at a tertiary university hospital. PATIENTS: A total of 295 patients who underwent transanal local excision for pTis (n = 155) or pT1 (n = 140) early rectal cancer were included in the analysis. INTERVENTION: Transanal local excision was performed for each patient to excise primary rectal lesions. MAIN OUTCOME MEASURES: The primary end point of this study was the incidence of recurrence, especially late recurrence. The secondary end point was risk factors for recurrence. RESULTS: The 10-year cumulative local recurrence rate was 6.7% in pTis and 18.0% in pT1 patients. The rate of late local recurrence was 2.8% in pTis and 3.7% in pT1 patients. There was no evidence of late systemic recurrence 5 years after transanal local excision. In pT1 patients, a higher risk of recurrence was associated with an invasion depth of sm3, the presence of lymphovascular invasion, and a positive resection margin. LIMITATION: The main limitation of this study is its retrospective nature. CONCLUSIONS: Late recurrence can occur in patients with early rectal cancer who have undergone transanal local excision. Transanal local excision can be performed in selective patients with biologically favorable tumors, and 10-year postoperative surveillance should be considered for these patients.

Local excision after neoadjuvant chemoradiation therapy in advanced rectal cancer: a national multicenter analysis.

BACKGROUND: The aim of the current study was to evaluate the clinical availability of local excision (LE) for advanced rectal cancer without lymph node metastasis after neoadjuvant chemoradiation therapy (nCRT) in Korea. METHODS: From June 2000 to October 2009, 40 patients with cT2-3N0M0 rectal cancer underwent nCRT followed by LE according to a retrospective multicenter analysis. RESULTS: Of the 40 patients, 22 were men and 18 were women. Eighteen patients were cT2, and 22 patients were cT3. The median follow-up duration was 38 months. Three patients (7.5%) had morbidity after LE. Four patients (10%) had recurrence (local recurrence [1 patient] and systemic metastasis [3 patients]). The 3-year disease-free survival rate was 85.9%. Only pCR was a recurrence-related prognostic factor (P = .040). CONCLUSIONS: Although the current study was not a randomized controlled study, LE after nCRT in T2-3N0 rectal cancer patients appears to be a safe and effective treatment, especially in pCR patients.

An alternative pathway in colorectal carcinogenesis based on the mismatch repair system and p53 expression in Korean patients with sporadic colorectal cancer.

PURPOSE: Microsatellite instability (MSI) and chromosomal instability are main mechanisms underlying colorectal carcinogenesis. We determined the features and prognosis of colorectal cancer based on MSI including mismatch repair genes and expression of p53. METHODS: Between 1999 and 2008, a total of 2,649 colorectal cancer patients were analyzed using a prospective database. A mismatch repair defect (MMR-D) was defined as a loss of expression of more than one MMR protein and/or MSI-high. MMR-proficiency (MMR-P) was defined as expression of all MMR proteins and microsatellite stable (MSS)/MSI-low. Groups 1 (G1), 2 (G2), 3 (G3), and 4 (G4) were defined as MMR-D and p53-positive expression, MMR-D and p53-negative expression, MMR-P and p53-positive expression, MMR-P and p53-negative expression, respectively. RESULTS: Eighty-two (3.0%), 181 (6.8%), 1,368 (51.7%), and 1,018 (38.5%) patients were classified into groups 1-4, respectively. Comparison between G1 and G2 showed differences in location (p < 0.001), size (p = 0.030), node metastasis (p = 0.027), distant metastasis (p = 0.009), and stage (p = 0.040). Comparison between G3 and G4 showed differences in location (p < 0.001) and histology (p < 0.001). Comparison between G1 and G3 showed differences in location (p < 0.001) and histology (p < 0.001). Comparison between G2 and G4 showed differences in age (p < 0.001), location (p < 0.001), size (p = 0.006), histology (p < 0.001), node metastasis (p < 0.001), distant metastasis (p < 0.001), and stage (p < 0.001). On multivariate analysis, stage (p = 0.007) and histology (p < 0.001) were associated with improved overall survival, and stage (p < 0.001) was associated with disease-free survival. CONCLUSIONS: According to the MSI and p53 subsets, colorectal cancers showed different clinicopathologic features, but these subsets had no prognostic impact on overall and disease-free survival rate.

Adjuvant chemotherapy increase survival and decrease recurrence in stage IIA colon cancer.

BACKGROUND/AIMS: The aim of the present study is to evaluate the prognostic factors and efficacy of adjuvant chemotherapy in stage IIA colon cancer patients. METHODOLOGY: From 1994 to 2004, we retrospectively analyzed 447 patients with stage IIA colon cancer. The patients were divided into the surgery only and the surgery with adjuvant chemotherapy. The reviewed factors were age, gender, the size of tumor, differentiation, the number of harvested lymph nodes, lymphovascular invasion, perineural invasion and obstruction. RESULTS: Of the 447 patients, 351 patients (78.5%) received the adjuvant chemotherapy and 96 patients (21.5%) underwent the surgery alone. The significant predictors of survival were lymphovascular invasion (p=0.045) and adjuvant chemotherapy (p<0.001) on the multivariate analysis. For the recurrence, male (p=0.014), the number of harvested lymph node (>=15 vs. <15) (p=0.021), lymphovascular invasion (p=0.050) and adjuvant chemotherapy (p=0.049) were significant on the multivariate analysis. There were similar therapeutic efficacy for survival and recurrence among 5-fluorouracil, capecitabine and uracil/tegafur (p=0.854 and p=0.937, respectively). CONCLUSIONS: Lymphovascular invasion and adjuvant chemotherapy were independent prognostic factors. Adjuvant chemotherapy was effective in preventing recurrence and improving survival for the stage IIA colon cancer patients, especially for those patients with less than 15 harvested lymph nodes.

Transanal endoscopic microsurgery for the treatment of well-differentiated rectal neuroendocrine tumors.

PURPOSE: Recently, an increase in well-differentiated rectal neuroendocrine tumors (WRNETs) has been noted. We aimed to evaluate transanal endoscopic microsurgery (TEM) for the treatment of WRNETs. METHODS: Between December 1995 and August 2009, 109 patients with WRNETs underwent TEM. TEM was performed for patients with tumors sizes of up to 20 mm and without a lymphadenopathy. These patients had been referred from other clinics after having been diagnosed with WRNETs by using a colonoscopic biopsy; they had undergone a failed endoscopic submucosal dissection (ESD) or endoscopic mucosal resection (EMR) and exhibited an involved resection margin and remaining tumor after ESD or EMR, regardless of the distance from the anal verge. This study included 38 patients that had more than three years of follow-up. RESULTS: The mean age of the patients was 51.3 ± 11.9 years, the mean tumor size was 8.0 ± 3.9 mm, and no morbidity occurred. Thirty-five patients were asymptomatic. TEM was performed after a colonoscopic resection in 13 cases because of a positive resection margin, a residual tumor or a non-lifting lesion. Complete resections were performed in 37 patients; one patient with a positive margin was considered surgically complete. In one patient, liver metastasis and a recurrent mesorectal node occurred after five and 10 years, respectively. CONCLUSION: TEM might provide an accessible and effective treatment either as an initial or as an adjunct after a colonoscopic resection for a WRNET.

Early surgical outcomes of NiTi endoluminal compression anastomotic clip (NiTi CAC 30) use in patients with gastrointestinal malignancy.

BACKGROUND: The NiTi endoluminal Compression Anastomotic Clip (CAC™) 30 (NiTi CAC 30) (NiTi Alloys Technologies, Ltd., Netanya, Israel) is a new device with shape-memory characteristics. We aimed to investigate the safety and early surgical outcomes of NiTi CAC 30 for intestinal anastomosis in patients with gastrointestinal malignancy. SUBJECTS AND METHODS: Fifty patients operated on with NiTi CAC 30 were matched for sex, age, body mass index, operation type (open versus laparoscopy), operation name, and anastomosis type with patients in a control group operated on with a stapling device between November 2009 and May 2010. Early clinical outcomes were investigated. RESULTS: One misfired case of NiTi CAC 30 was excluded. Between the two groups, no significant differences were observed in demographics except for previous abdominal operation history. The results of early clinical outcomes were investigated, including operation time, estimated blood loss, time to first flatus, first defecation, and discharge, and complications. No differences were noted. Postoperatively, migration started in 1 patient between 3 and 5 days, 11 patients between 6 to 7 days, and 37 patients after 8 days. The expulsion of 31 cases occurred between 2 and 3 weeks, postoperatively. The NiTi CAC 30 was expulsed within 1 week in 4 patients and between 1 to 2 weeks in 8 patients. An expulsion occurred in 1 case at over 4 weeks. No problems related to early migration and expulsion were observed, and no anastomotic leakage and bleeding occurred. CONCLUSIONS: Intestinal anastomosis with the NiTi CAC 30 was safe and feasible without anastomotic leakage and reoperation compared with the stapling technique.

Routine chest computed tomography as a preoperative work-up for primary colorectal cancer: is there any benefit in short-term outcome?

PURPOSE: The aim of this study was to assess the role of pre-operative chest computed tomography (CT) compared with abdominopelvic CT (AP-CT) and chest radiography (CXR) for detecting pulmonary metastasis in patients with primary colorectal cancer (CRC). METHODS: We retrospectively analyzed the data of 619 patients with primary CRC who simultaneously received a preoperative chest CT (chest CT group), AP-CT with hilar extension, and CXR (CXR group). RESULTS: In the chest CT group, there were 297 (48.0%) normal, 198 (32%) benign, 96 (15.5%) indeterminate, 26 (4.2%) metastasis, and two lung cancers. Eighteen patients (2.9%) in the CXR group who had no pulmonary metastasis were diagnosed with pulmonary metastasis on a chest CT. The sensitivity and accuracy were 83.9% and 99.0% in the chest CT group, respectively, and 29.0% and 91.5% in the CXR group, respectively (P < 0.0001 and P = 0.0003). CONCLUSION: Chest CT appears to improve the accuracy of pre-operative staging in patients with CRC and is useful for the early detection of pulmonary metastasis as a baseline study for abnormal lung nodules.

Narrow distal resection margin may be sufficient for rectal cancer after chemoradiation.

BACKGROUND/AIMS: What constitutes an adequate length for the distal resection margin in patients with mid-to-distal rectal cancer after pre-operative chemoradiation therapy (PCRT) continues to be debated. The purpose of the present study was to determine the effect of the distal resection margin on oncological outcome and establish a guideline for the distal resection margin in patients with rectal cancer after PCRT. METHODOLOGY: Data from 204 patients undergoing low anterior resection after completion of chemoradiation therapy were examined. Associations between clinicopathological parameters, including the distal resection margin and oncological outcome, were analyzed retrospectively. RESULTS: The distal resection margin was not significantly associated with local recurrence-free survival, disease-free survival, or overall survival; subgroup analysis of the T3,4 group showed the same results. Further analysis using various lengths (0.5, 1.5, 1 and 2cm) of the resection margin did not show statistical significance for oncological outcomes. Pre-PCRT clinical stage, post-PCRT pathological T stage, and histological grade were significantly associated with disease-free survival. CONCLUSIONS: For patients with locally advanced rectal cancer undergoing resection and pre-operative chemoradiotherapy, a narrow distal resection margin did not compromise oncological outcomes.

Treatment outcomes of anorectal melanoma.

PURPOSE: An anorectal melanoma (AM) is a very rare tumor. However, sufficient data supporting effective surgical options for the disease do not exist. This retrospective review aimed to analyze treatment outcomes for an AM. METHODS: From June 1999 to December 2008, we retrospectively reviewed a prospectively collected consecutive series of 19 patients who had undergone a surgical resection for an AM at a single institute. Surgical method and clinicopathological factors were analyzed. RESULTS: The median age was 61.4 years (range, 46 to79 years). Main symptoms were an anal mass, hematochezia, perianal pain, tenesmus, fecal incontinence, and bowel habit change. The average duration of symptoms before diagnosis was 7.8 months (range, 1 to 36 months). S-100 and HMB-45 were positive in all patients, even in non-melanin pigmentation. There were 12 abdominoperineal resections (APRs) and 7 wide local excisions (WEs). The APR showed longer overall survival when compared with the WE (64.1 months vs. 10.9 months, P < 0.001). No patients who underwent a WE survived more than 13 months. CONCLUSION: A high index of suspicion is necessary to establish the diagnosis for an AM in patients with anal symptoms, and S-100 and HMB-45 can be useful markers for an AM. Even with the small number of cases and the short follow-up, our data suggest that an APR for an AM may provide longer survival than a WE.

Oncologic outcome after cessation or dose reduction of capecitabine in patients with colon cancer.

PURPOSE: Oral capecitabine has been used as adjuvant therapy for colorectal cancer patients since the 1990s. Patient-initiated cessation or reduced use of capecitabine occurs widely for various reasons, yet the consequences of these actions are unclear. The present study sought to clarify treatment outcomes in such patients. METHODS: The study included 173 patients who had been diagnosed with stage II or III colon cancer according to the pathologic report after radical surgery at Samsung Medical Center from May 2005 to June 2007 and who had received capecitabine as adjuvant therapy. The patients were divided into groups according to whether the dose was reduced (I, dose maintenance; II, dose reduction) or stopped (A, cycle completion; B, cycle cessation). Recurrence and disease-free survival rates between the two groups each were analyzed. RESULTS: Of the 173 patients, 128 (74.6%) experienced complications, most frequently hand-foot syndrome (n = 114). Reduction (n = 35) or cessation (n = 18) of medication was most commonly due to complications. Concerning reduced dosage, both groups displayed no statistically significant differences in recurrence rate and 3-year disease-free survival rate. Concerning discontinued medication use, the cycle completion group showed an improved recurrence rate (P = 0.048) and 3-year disease-free survival rate (P = 0.028). CONCLUSION: The results demonstrate that maintaining compliance with capecitabine as an adjuvant treatment for colon cancer to preventing complications positively affects patient prognosis.

Comparison and short-term outcomes between hand-assisted laparoscopic surgery and conventional laparoscopic surgery for anterior resections of left-sided colon cancer.

BACKGROUND: Hand-assisted laparoscopic surgery has been introduced as an alternative to conventional laparoscopic surgery. This study compared the efficacies and short-term clinical outcomes between hand-assisted laparoscopic anterior resection (HAL-AR) and conventional laparoscopic anterior resection (CL-AR) for treating left-sided colon cancer. MATERIALS AND METHODS: We retrospectively analyzed 248 patients who underwent anterior resection for colon cancer (118 HAL-AR and 128 CL-AR) between May 2000 and December 2006. The collected data included the perioperative and short-term oncologic outcomes. RESULTS: There were no significant differences between the HAL-AR and CL-AR groups, except for the operation time and the size of the primary tumor. The operation time of the HAL-AR group was significantly shorter than that of the CL-AR group (p = 0.004), and the size of the primary tumor in the HAL-AR group was significantly larger than that of the CL-AR group (p = 0.019). The operating time of the HAL-AR group reached an earlier mean plateau than did that of the CL-AR group. Before and after reaching the plateau, there were no differences in the perioperative results between the two groups. The operating time for the HAL-AR group was significantly shorter than that of the CL-AR group after reaching a plateau (p = 0.012). The short-term outcomes for both groups were similar in terms of survival and recurrence (p = 0.996 and p = 0.476, respectively). CONCLUSION: Hand-assisted laparoscopic anterior resection has a shorter operative time than does CL-AR and is more successful than CL-AR for resecting larger tumors, while both procedures result in similar short-term oncologic outcomes. Hand-assisted laparoscopic anterior resection is thought be a comparable operative technique for anterior resection of left-sided colon cancer.

Cytokeratin staining for complete remission in rectal cancer after chemoradiation.

BACKGROUND AND AIMS: Pathologic complete remission (CR) of rectal cancer after neoadjuvant chemoradiation therapy (CRT) is generally confirmed by routine hematoxylin and eosin (H&E) staining. The aim of this study was to identify residual rectal cancer cells in primary lesions of patients with pathologic CR by immunohistochemical staining for cytokeratin. PATIENTS AND METHODS: The medical records of 358 rectal cancer patients who underwent neoadjuvant CRT prior to radical surgery between October 2002 and August 2007 were reviewed. The authors stained sections of resected specimens of 58 patients (15.9%; 42 males; mean age 54 years) who achieved pathologic CR (as determined originally by H&E staining) with H&E and performed immunohistochemistry (IHC) using monoclonal anti-cytokeratin antibody. These stained sections were reviewed for residual rectal cancer cells by a pathologist. RESULTS: Of the 58 patients that achieved CR by initial pathologic examinations, eight (13.8%) were found to contain tumor by cytokeratin IHC. H&E staining revealed that six of these were positive for cancer cells, but the remaining two were negative for residual rectal cancer cells. CONCLUSION: Through better identification of residual rectal cancer cells, cytokeratin IHC offers a means of improving staging accuracy and thus provides useful information for prognosis and treatment decisions for patients with rectal cancer who had a clinical CR after CRT.

Location-related differences in sporadic microsatellite unstable colorectal cancer.

BACKGROUND: Microsatellite unstable CRC is associated with female gender, large tumours, and poor differentiation. However, there are few reports about the characteristics and differences of sporadic microsatellite unstable CRC based on tumour location. AIMS: Site-specific heterogeneity of sporadic microsatellite unstable colorectal cancer (CRC) based on location was elucidated. METHODS: We enrolled 164 CRC patients with high-frequency microsatellite instability (MSI-H) from the prospective database of 2686 consecutive CRC patients who underwent surgical resection. We analysed microsatellite instability (MSI) and expression of mismatch repair (MMR) proteins (MLH1, MSH2, and MSH6). RESULTS: Among the 164 MSI-H CRC, 105 (64.0%) were located in the proximal colon and 59 (36.0%) were located in the distal colon. The proximal MSI-H CRC was predominantly in female (p=0.014), had a more aggressive differentiation (p=0.001), was of advanced stage (p=0.035), and had a frequent loss of MLH1 expression (p=0.005) compared to the distal MSI-H CRC. CONCLUSION: There were different clinicopathologic characteristics and MMR protein expression between proximal and distal MSI-H CRC. These findings suggest that the underlying carcinogenic pathway or molecular background differs according to location, despite being microsatellite unstable CRC.

Relationship of polymorphism of the tandem repeat sequence in the thymidylate synthase gene and the survival of stage III colorectal cancer patients receiving adjuvant 5-flurouracil-based chemotherapy.

BACKGROUND: The aim of this study was to determine whether the different polymorphisms in the thymidylate synthase (TS) gene, novel G>C single nucleotide polymorphism (SNP) and variable number of tandem repeat (VNTR), may be related with disease-free survival (DFS) in patients with stage III colorectal cancer receiving adjuvant chemotherapy. METHODS: The study included 201 patients with pathologic TNM stage III colon cancer who received adjuvant 5-fluorouracil (5-FU)-based chemotherapy after surgery. DNA was extracted from fresh tumor tissue and sequenced. Patients with TS genotypes of 2R3G, 3C3G, or 3G3G were assigned to a high expression group, and those with 2R2R, 2R3C, or 3C3C, to a low expression group. RESULTS: Frequencies of the TS tandem repeat polymorphisms among the tumor genotypes were 6.0% in 2R2R, 25.4% in 2R3R, and 68.7% in 3R3R. The low expression group included 52 patients (25.9%), and the high expression group included 149 patients (74.1%). Groups classified according to possession of VNTR, SNP, and low- or high-expression genotypes did not differ significantly in DFS. In multivariate analysis, only tumor stage showed significant prognostic value (hazard ratio (HR) 2.05, 95% CI = 1.24-3.37, P = 0.005). CONCLUSIONS: TS polymorphisms do not predict clinical outcome of colorectal cancer patients treated with adjuvant 5-FU-based chemotherapy.

Histological grade predicts survival time associated with recurrence after resection for colorectal cancer.

BACKGROUND/AIMS: This study analyzed the patients who died of recurrent colorectal cancer and determined the clinicopathologic indicators that were associated with the survival time. METHODOLOGY: The study included 282 patients who died of recurrent colorectal cancer after resection. The clinicopathologic findings were compared between 162 patients who died within 3 years after resection (the short-term survival group) and 120 patients who died more than 3 years after resection (the long-term survival group). Multivariate analysis was performed to determine the independent factors correlated with the timing of death. RESULTS: When compared with the long-term survival group, the short-term survival group was characterized by a tumor size >5 cm (51.2% in the short-term survival group vs. 39.2% in the long-term survival group), poorly differentiated tumor (13.3% vs. 0.9%), invasion through the muscularis propria (98.8% vs. 88.3%), positive lymphatic invasion (43.2% vs. 20.8%), positive vascular invasion (34.0% vs. 16.7%), positive perineural invasion (17.9% vs. 8.3%), extended lymph node metastasis and Dukes' stage C disease (80.9% vs. 60.8%). The mean survival time was significantly influenced by the histologic grade, the depth of wall invasion, the presence of lymphatic or vascular invasion, the level of lymph node metastasis and the Dukes' stage. On multivariate analysis, however, histologic grade was the only independent factor associated with the survival time. CONCLUSIONS: The histological grade was the only significant factor influencing the survival time after resection of colorectal cancer. The patients with poorly differentiated adenocarcinoma frequently died of recurrence within 3 years after colorectal resection.

The necessity of chemotherapy in T3N0M0 colon cancer without risk factors.

BACKGROUND: For patients with T3N0M0 colon cancer without known risk factors, the necessity of chemotherapy has no definite consensus. METHODS: From 1994 to 2004, we retrospectively analyzed 247 patients who had pathologically confirmed T3N0M0 colon cancer without risk factors. RESULTS: Among the 247 patients, 198 (80.2%) received chemotherapy and 49 (19.8%) underwent surgery alone. The 5-year survival rate was 92.8% for patients with T3N0M0 colon cancer without risk factors. Only chemotherapy increased survival (P = .032) by multivariate analysis. The 5-year survival rates were 85.4% in the surgery-only group and 94.2% in the group that received surgery with chemotherapy. There was no difference in the therapeutic efficacy of 5-fluorouracil, capecitabine, and uracil/tegafur (P = .424) for survival. CONCLUSION: The results of this study showed that chemotherapy improved the survival of patients with T3N0M0 colon cancer without risk factors.

Curved cutter stapler vs. linear stapler in rectal cancer surgery: a pilot prospective randomized study.

OBJECTIVE: This study aimed to compare the safety and technical accessibility of linear stapler and curved cutter stapler (CCS) during mid to low rectal cancer surgery. MATERIALS AND METHODS: Between April and November 2006, 60 patients were randomly assigned to either linear staplers (DST TA; United States Surgical, Tyco Healthcare Group LP, Norwalk, CT) or the CCS (Contour Curved Cutter Stapler(R); Ethicon Endo-Surgery, Inc., Cincinnati, OH) during low anterior resection for mid to low rectal cancers. RESULTS: There were no significant differences in age, gender, body mass index, and mean carcinoembryonic antigen level between the two groups. Distal resection margin was longer in the CCS group as compared with the linear stapler group but did not reach statistical significance (24.7 vs. 20.8 mm, P = 0.065). There was no difference in the incidence of postoperative complications. CONCLUSION: In this study, both the CCS and linear staplers were satisfactory devices for securing the distal rectum during low anterior resection in mid to low rectal cancers.

Sodium hyaluronate-based bioresorbable membrane (Seprafilm) reduced early postoperative intestinal obstruction after lower abdominal surgery for colorectal cancer: the preliminary report.

PURPOSES: This study is a prospective randomized clinical trial to evaluate the clinical safety and the effect of a sodium hyaluronate-based bioresorbable membrane (Seprafilm; Genzyme, Cambridge, MA, USA) for reducing adhesive intestinal obstruction after colorectal cancer surgery. MATERIALS AND METHODS: Between November 2002 and December 2003, 504 patients underwent radical resection for sigmoid or rectal cancer. Among these patients, 427 patients were enrolled in this study. The patients were randomized into the Seprafilm group (N = 185) and the control group (N = 242). All the patients in the Seprafilm) group received one sheet of Seprafilm over the pelvic inlet where the peritoneum was denuded due to pelvic dissection. Intestinal obstruction was defined when there were symptoms of nausea, vomiting, and abdominal distension combined with an obstructive bowel pattern on the radiologic evaluation. RESULTS: The median follow-up period was 25.0 months. There were no significant differences between the Seprafilm and the control groups for the clinicopathologic parameters. There were no differences in the incidence of complications between the two groups; however, the incidence of early postoperative intestinal obstruction was significantly less in the Seprafilm group than in the control group (2.7% vs 7.0%, respectively, p = 0.045). Five patients in the Seprafilm group experienced postoperative intestinal obstruction (2.7%) compared with 11 patients in the control group (4.6%) during the follow-up period; however, there was no statistical difference. CONCLUSIONS: Seprafilm appears to be effective in preventing early postoperative intestinal obstruction and there was a trend for reduced intestinal obstruction after lower abdominal surgery for colorectal cancer.

Carcinoma obstruction of the left colon and long-term prognosis.

BACKGROUND/AIMS: The purpose of this study was to assess the long-term prognosis of patients with carcinoma obstruction of the left colon and determine the associated clinical and pathological characteristics to identify independent prognostic factors. METHODOLOGY: From 1996 to 2003, 915 patients who underwent curative resection for left-sided colon carcinoma were classified as either the obstruction group (n = 169) or the non-obstruction group (n = 746). Clinical and pathological findings were compared between the 2 groups. Univariate and multivariate analyses were performed to identify independent prognostic factors correlated with survival and disease recurrence. RESULTS: Distribution of tumor location, tumor size, macroscopic type and histological grade were found to be different in comparisons between the 2 groups. The tumor stage was more advanced in the obstruction group. The overall and disease-free survival rates were significantly lower in the obstruction group compared to the non-obstruction group. However, the results of the multivariate analysis demonstrated that obstruction itself was not an independent prognostic factor. Instead, patient age, serum carcinoembryonic antigen (CEA) level and tumor stage were significant prognostic indicators for long-term outcome. CONCLUSIONS: Obstruction in left-sided colon cancer was not an independent risk factor for long-term patient outcome. The study results confirmed the conventional prognostic factors of patient age, serum CEA level and tumor stage.

Risk factors and clinical outcome for anastomotic leakage after total mesorectal excision for rectal cancer.

BACKGROUND: Anastomosis leakage is a major complication of rectal surgery. The aim of this study was to identify risk factors for anastomotic leakage after low anterior resection (LAR) in rectal cancer patients and study its impact on long-term prognosis and disease-free survival and overall survival in rectal cancer patients. METHODS: Consecutive patients who underwent rectal resection with primary anastomosis below the pelvic peritoneal reflexion for rectal cancer between October 1996 to February 2006 were included. RESULTS: Anastomosis leakage after LAR occurred in 51 patients (4.0%). The median time to leakage was 4 days (range = 2-30 days). In univariate analysis, gender, level of anastomosis less than 4 cm, preoperative concomitant chemoradiation (CCRT), and length of operation greater than 120 min were significantly associated with anastomosis leakage. In a multivariate analysis, gender (p = 0.041; relative risk = 2.007; 95% CI = 1.030-3.912) and preoperative CCRT (p = 0.003; relative risk = 2.861; 95% CI = 1.417-5.778) were identified as independent prognostic factors. The overall survival of the nonleakage group and the leakage group was 80.2% and 64.9%, respectively (p = 0.170). The 5-year disease-free survival rates were not significantly different between the nonleakage and leakage groups (78.1% vs. 65.9%, p = 0.166). CONCLUSIONS: The incidence of anastomotic leakage after low anterior resection is relatively low. Male gender and preoperative CCRT were associated with increased risk for anastomotic leakage after rectal cancer surgery. No effect of anastomosis leakage on local recurrence was found in this series.