Colonoscopic Missing Rate of Colorectal Polyps / 대한소화기내시경학회지

BACKGROUND/AIM: Colonoscopy has been known as the best diagnostic and therapeutic modality for colorectal polyps. However, it has been difficult to assess its accuracy. METHODS: We studied the data from patients who had colonoscopic polypectomy within 30 days after the initial examination. RESULTS: From 218 patients, a total of 362 polyps were found, 51 (14.1%) of which were missed. There were 17 patients with missed polyps among 59 patients who had two or more polyps on the initial examination. According to the location, the missing rates were variable: the splenic and hepatic flexure had the highest missing rates, and the sigmoid colon had the lowest missing rate. In our study, there was no difference of missing rate according to the size and shape. CONCLUSIONS: There is a significant colonoscopic missing rate for colorectal polyps in routine clinical practice, especially in patients with multiple colonic polyps and at the site of the colonic flexure.

Impact of Body Mass Index on Surgical Outcomes of Laparoscopic Colorectal Cancer Resection

PURPOSE: The purpose of this study was to determine whether obesity increases the risk of performing a laparoscopic resection for colorectal cancer. METHODS: Prospectively collected data were obtained for 103 patients who had undergone laparoscopic resection for colorectal cancer from September 2001 to August 2002. Patients who had had a previous abdominal operation, a total colectomy or an additional surgical procedure at the time of colon resection were excluded from the analysis. The patients were divided into two groups based on body mass index (BMI kg/m2): the normal group (BMI <25) and the obesity group (BMI 25). Intraoperative blood loss, operative time, conversion, length of hospital stay and complications were analyzed. RESULTS: Nineteen patients (25%) were obese. Operation time (183.2 min vs 202.1 min) and the blood loss (98.2 ml vs 168.2 ml) were significantly increased in the obese patients, but hospital discharge after surgery (11.7 days vs 11.9 days) and the morbidity rate (8.5% vs 5.3%) were not different between the groups. Conversion to the an open precedure occurred with one obese patient, but that was not related to obesity. In the analysis of the low anterior resection, blood loss (94.6 ml vs 186.6 ml) was significantly higher in obese patients, but no statistically significant differences existed for other surgical outcomes between the two groups. CONCLUSIONS: A laparoscopic resection for colorectal cancer can be safely performed in obese patients.

Laparoscopic Anterior Resection for Rectal Cancer: an Analysis of Early Experiences

PURPOSE: Regarding laparoscopic colon cancer resection, the surgical society is currently waiting for the long-term oncologic result of multi-center randomized trials with over thousands patients. For rectal cancer surgery, however, laparoscopic approach is in much debate. The aim of this study was to evaluate the feasibility and safety of laparoscopic anterior resection for rectal cancer, based on the early results of our initial experiences. METHODS: Nineteen patients (M:F=10:9, median age 55 years) underwent laparoscopic anterior resection for rectal cancer among the 71 malignant neoplasms of the colon and rectum resected laparoscopically between October 1997 and February 2001. All clinical data were prospectively collected. During the initial period, rectosigmoid lesion was the only indication. With the development of a new roticulating stapler for distal rectal transection, the indication was extended to the lesions of the upper and middle third of the rectum. The operation parameters (operation time, blood loss), tumor parameters (stage, resection margins, and number of resected lymph nodes), and postoperative clinical course (bowel function recovery, hospital stay, and complication) were evaluated. RESULTS: The tumors located in the rectosigmoid (n=13), upper third of the rectum (n=4), and the middle third of the rectum (n=2). Four cases were converted to an open procedure. The reasons for conversion were bladder invasion (1), tumor located too low (1), inappropriate distal resection margin (1), and tumor fixation to the sacrum (1). Median operation time was 210 minutes. Median blood loss was 400 ml. Median times to passage of flatus and oral feeding were 2 days and 3 days after surgery, respectively. Median length of the distal resection margin was 3 cm. Median number of harvested lymph nodes were 22. TNM stages were as follows; 0:I:II:III:IV=1:2:6:9:1. Two anastomotic leaks occurred in the converted patients. There were no major postoperative complications in other patients. There was no operative mortality. Median time to hospital discharge was 13 days. During a median follow-up period of 15 months, one patient developed distant metastases. There were no local/port sites recurrences. CONCLUSIONS: Laparoscopic anterior resection is a safe alternative to conventional surgery for rectal cancer. Long- term follow-up is mandatory to evaluate the oncologic safety.

The Effects of Combined Spinal Epidural Anesthesia on Subarachnoid Block for Lower Extremity Surgery / 대한마취과학회지

BACKGROUND: Combined spinal epidural anesthesia (CSE) often produces a more extensive spinal block than expected. This study was designed to evaluate the effects of CSE on subarachnoid block in patients undergoing lower extremity surgery. METHODS: Thirty-three patients who undergone lower extremity surgeries were randomly allocated to three groups of 11 patients each. Using needle through needle technique, all patients received a subarachnoid injection of hyperbaric 0.5% bupivacaine 1.6~2.0 ml through a 25G Whitacre spinal needle. Group 1 received no extradural injection for 25min, but group 2 and 3 received extradural saline 10 ml and bupivacaine 10 ml 5min after the subarachnoid injection, respectively. Levels of sensory and motor block were assessed at 4, 6, 8, 10, 15, 20, and 25 min after subarachnoid injection. RESULTS: The median values of maximum sensory block level were T7 in all groups. Levels of sensory blockade and the time to onset of maximum sensory blockade were similar among the three groups. There was no significant difference in the degree of motor block among three groups. CONCLUSIONS: This study suggests that extradural saline 10 ml or 0.5% bupivacaine 10 ml which injected 5min after subarachnoid injection does not significantly influence the level of subarachnoid block in lower extremity surgical patients. However, further study is required to declare the safety or optimal dose of extradural injection during CSE.

Effect of High-dose Fentanyl Versus Propofol-Fentanyl Anesthesia on Functional Recovery of Stunned Myocardium in Dogs / 대한마취과학회지

BACKGROUND: The purpose of this study was to evaluate the effects of propofol-fentanyl anesthesia in comparison with fentanyl alone on the functional recovery of postischemic reperfused myocardium and on the incidence of ischemia-reperfusion arrhythmia in an open-chest canine model. METHODS: Dogs were subjected to 15 minutes of left anterior descending coronary artery (LAD) occlusion followed by 3 hour of reperfusion during fentanyl (n=12) or propofol plus fentanyl (n=11) anesthesia. Regional myocardial contractility was evaluated using systolic shortening (%SS), the preload recruitable stroke work slope (Mw), intramyocardial pressure (IMPs), and regional stroke work area (RSWA). RESULTS: Dogs anesthetized with propofol-fentanyl had a significantly lower regional (%SS, Mw, IMPs, and RSWA) and global myocardial contractility (cardiac index, mean aortic pressure and left ventricular dP/dt) than fentanyl anesthetized dogs during pre-occlusion baseline. LAD occlusion produced a significant reduction in the regional contractile functions (%SS, Mw, IMPs, and RSWA) in both groups. During reperfusion, gradual return of the regional contractile functions (%SS, Mw, IMPs, RSWA) toward their respective baselines were observed without any differences between the groups. However, ventricular fibrillation associated with LAD occlusion was lower in the propofol-fentanyl group than in the fentanyl group (zero vs 33%, p<0.05). CONCLUSIONS: Propofol supplementation over moderate-dose fentanyl reduces reperfusion arrhythmia during coronary occlusion and subsequent reperfusion but does not improve functional recovery of post-ischemic, reperfused myocardium compared with high-dose fentanyl anesthesia in dogs.