Hong Young Moon

The Prognostic Significance of E-Cadherin and Liver Intestine-Cadherin Expression in Colorectal Cancer

PurposeThe significance of liver intestine-cadherin as a potential marker has been growing in the field of oncology, because of its unique features compared with classic cadherins. We investigated the coexpression patterns of E-cadherin and liver intestine-cadherin in colorectal cancer, and determined whether differences in expression patterns were associated with clinicopathologic parameters and also which relationship between these two adhesion molecules existed in colorectal cancer.MethodsExpression pattern of E-cadherin and liver intestine-cadherin was investigated immunohistochemically in 207 colorectal cancers along with clinicopathologic parameters.ResultsReduced expression of liver intestine-cadherin was detected in 51 percent (n--05) of tumors. Such expression was found to be associated with tumoral dedifferentiation (P--.015) and in a multivariate analysis was associated with a significant worse overall survival after adjustment for tumor stage, differentiation, and E-cadherin status (hazard ratio, 1.951; 95 percent confidence interval, 1.06-.592; P--.032). Fifteen percent (n--2) of tumors showed reduced expression of E-cadherin and had relationship with tumoral dedifferentiation (P-lt;-.001), lymph node metastasis (P--.004), and advanced stage (P--.029). Reduced expression of E-cadherin was associated with short overall survival (P--.028); however, in a multivariate analysis, it was not statistically significant.ConclusionsReduced expression of liver intestine-cadherin had a significant correlation with tumoral dedifferentiation and short overall survival in this series. In addition, early and frequent loss of liver intestine-cadherin expression might be a more sensitive indicator than E-cadherin to predict more aggressive tumoral behavior.

Lymph node ratio as determined by the 7th edition of the American Joint Committee on Cancer staging system predicts survival in stage III colon cancer

The aim of this study was to evaluate the prognostic usefulness of the lymph node ratio (LNR) in stage III colon cancer using the 7th edition of the American Joint Committee on Cancer (AJCC) staging system.

Relationship between meat and cereal consumption and colorectal cancer in Korea and Japan

Background and Aim:  The incidence of colorectal cancer in Asian countries is increasing. The change to a more westernized diet is known to be related to these increases, and there are reports on the relationship between meat consumption and colorectal cancer in Japan. The aim of this study was to investigate the relationship between dietary change and colorectal cancer in Korea and Japan.

The First Case of Primary Retroperitoneal Mucinous Cystadenoma in Korea: A Case Report

Primary mucinous cystic cystadenomas of the retroperitoneum are very rarely encountered, and there have been only about 30 cases reported in the literature. The histogenesis of primary mucinous cystadenomas is unclear. Most authors suggested that it develops through mucinous metaplasia in a pre-existing mesothelium-lined cyst. Complete surgical excision is the only treatment and it is required for the final diagnosis and cure. We present here a case report of a 38-year-old Korean woman with primary retroperitoneal cystadenoma. It was a thin-walled, multilocular cyst with a dominant loculus that measured 10.0×7.5×5.5 cm3 in size, and to the best of our knowledge, this is the first such case to be reported in in Korea.

The Role of Laparoscopic Approach for Anastomotic Leakage After Minimally Invasive Surgery for Colorectal Cancer

OBJECTIVES The objectives of this study were to evaluate the feasibility and safety of a re-laparoscopic approach to manage anastomotic leakage after minimally invasive colorectal resection and to compare its clinical outcomes with those obtained using an open approach. METHODS We retrospectively reviewed clinical data from 1714 patients who underwent colorectal cancer resection from September 2006 to August 2009 at the Korea University Medical Center. Clinical data from a total of 57 surgery patients who developed anastomotic leakage were analyzed. RESULTS Twenty-six leakage cases were managed laparoscopically, whereas the remaining 31 leakage cases were managed using an open approach. There were no significant differences in age, sex, or other clinical features between patients in the two groups. The total operation time was shorter in the laparoscopic group (107.3 ± 68.1 minutes) than in the open group (126.5 ± 50.1 minutes), but this difference was not statistically significant (P = .230). Six cases in each group required additional procedures such as reoperation or percutaneous intervention (P = .126). There was one case of postoperative mortality in the open group. Median (quartiles 25%-75%) number of days required to resume a soft diet tended to be shorter in the laparoscopic group than the open group (5 [3-7] versus 6 [5-10] days; P = .057). Patients in both groups showed similar postoperative complications including intraabdominal abscess; however, the incidence of wound infection was significantly lower in the laparoscopic group than the open group (3.8% versus 25.8%; P = .031). CONCLUSIONS Compared with conventional open treatment of anastomotic leakage, the laparoscopic approach resulted in fewer wound complications and tendency of early recovery of bowel movement without an increase in adverse outcomes. Using a laparoscopic approach, all the advantages of minimally invasive surgery can be realized in patients who develop anastomotic leakage after minimally invasive surgery.

Malignant extragastrointestinal stromal tumor of retroperitoneum.

A 32-year-old man was admitted to our department due to dysuria that was associated with an intraadominal mass. Ultrasonography revealed a normal bladder, a lobulated mixed echoic mass in the retroperitoneum and small quantity of pelvic ascites. Preoperative magnetic resonance imaging (MRI) revealed that the largest tumor was slightly hypointense relative to the muscle on the T1-weighted image, hyperintense relative to the muscle on the T2-weighted image, and heterogeneously enhanced with some cystic components (Figure 1). The patient underwent a complete gross excision of the mass combined with a low anterior resection. At surgery, the tumor was found adhered to the wall of the rectum and could not be dissected without causing injury. There were several retroperitoneal nodules that proved to be a metastasis, which was confirmed by a frozen histological evaluation. Grossly, the tumor measured 13.3 (CC) /10.2 (AP) /9.4 (W) cm. It was encapsulated, and cut sections showed fleshy, reddish and some myxoid tissue. Histologically, the tumor cells consisted of spindle cells and relatively uniform medium size round epitheloid cells. There was marked nuclear pleomorphism and high mitotic activity (60/10 High power field). The tumor cells tested strongly immunohistochemically positive for c-kit (CD 117), CD34, and vimentin, but negative for desmin, a-smooth muscle actin, and the S-100 protein (Figure 2). After an uneventful postoperative course, the patient was discharged 14 days after surgery and has since been treated with imatinib mesylate (Gleevec†, Novartis Pharma, Basel, Switzerland). There was no recurrence of the tumor at the 6-months follow-up examination.

Rectal Diverticular Perforation Complicating Diagnostic Colonoscopy: A Case Report and Review of the Literature

Abstract The presence of retroperitoneal, mediastinal, and subcutaneous emphysema due to rectal diverticular perforation during diagnostic colonoscopy has not been reported. Further, the management of colonoscopic perforation remains a controversial issue. In this case report, the authors discuss the importance of recognizing this rare complication after colonoscopy and its response to conservative treatment.

Significance of Follow-up in Detection of Pulmonary Metastasis of Colorectal Cancer.

Purpose This study was performed to evaluate the effectiveness of conventional chest radiography, carcinoembrionic antigen (CEA) level and abdominal computed tomography (CT) or chest CT for early detection of pulmonary metastasis after a curative resection of colorectal cancer. Methods We retrospectively reviewed 84 cases of pulmonary metastasis from a group of colorectal cancer patients who had a curative surgical resection from 2000 to 2006 at the Korea University Medical Center. Results Stage I tumors were detected in 4 patients, stage II tumors in 18, stage III tumors in 43 and stage IV tumors in 19. The detection rates for pulmonary metastasis were 28.5% by conventional chest radiography, 40.5% by increased CEA level and 28.5% by abdominal CT or chest CT. Among them, fourteen patients underwent a radical pneumonectomy. After detection of pulmonary metastasis, the survival outcome for the patients who underwent a resection of the lung was superior to the survival outcome of the patients who did not undergo a resection of the lung (43.7 months vs. 17.4 months, P = 0.001). For patients who underwent resections of the lung, pulmonary metastasis was detected by conventional chest radiography in 2 (14%) patients, by elevated CEA level in 6 (42%) patients, and by abdominal CT or chest CT in 6 (42%) patients. Conclusion Conventional chest radiography is no more useful in detecting early pulmonary metastasis after a curative colorectal surgery than a routine chest CT. Thus, we propose the use of routine chest CT for screening for lung metastasis.

The efficacy of oral tegafur-uracil as maintenance therapy following intravenous 5-fluorouracil chemotherapy in stage III colon cancer.

BACKGROUND/AIMS The aim of this study was to evaluate the impact on disease-free survival (DFS) of adding oral tegafur-uracil (UFT) to intravenous 5-fluorouracil (5-FU) as surgical adjuvant chemotherapy for stage II and III colon cancer. METHODOLOGY The authors retrospectively analyzed 148 patients treated from 2000 through 2005 with pathologically confirmed stage II or III colon cancer. Forty seven patients were treated with 6 cycles of 5-FU+leucovorin (5-FU group) and the other 101 patients were treated with same above regimen followed by an additional 12 cycles of UFT+leucovorin (LV) for 28 days with a 7-day rest period (5-FU+UFT group). RESULTS The median follow-up time was 64.9 months (range 15.3-95.2 months) and mean age was 58.8±10.8. The clinical characteristics of the 5-FU+UFT and 5-FU groups were similar. Furthermore, for all study subjects and stage II patients, 3-year DFS rates were not significantly different between two groups. However, for stage III patients, 3-year DFS rates were 80.0% and 60.7% in the 5-FU+UFT and 5-FU groups, respectively (HR=0.32; p=0.01; 95% CI=0.13-0.76). CONCLUSIONS The addition of UFT to 5-FU was found that significantly improve DFS in patients with stage III colon cancer. The authors cautiously suggest UFT as a maintenance therapy following 5-FU chemotherapy could be another option in stage III colon cancer patients.

Endoscopic Obstruction in Rectal Cancers: Survival and Recurrence Patterns Following Curative Surgery

BACKGROUND It is controversial whether preoperative obstruction in rectal cancers can affect prognosis or influence recurrence patterns. We investigated the association between endoscopic obstruction with survival and recurrence patterns in patients with locally advanced rectal cancers. MATERIALS AND METHODS An observational study and multivariate analysis were conducted to identify determinants of survival and to compare recurrence patterns between patients with obstructive or nonobstructive tumors after curative resection. Endoscopic obstruction was defined as a luminal obstruction of the rectum severe enough to prevent the colonoscope from passing beyond the tumor. RESULTS Cancer was obstructive in 91 patients (16.8%) and nonobstructive in 452 (83.2%). Median follow-up was 50 (range, 3-161) months. Local recurrence occurred in 17 patients (14 nonobstructed [5.4%] and 3obstructed [5.5%]; P=1.0) and systemic recurrence in 83 (62 nonobstructed [23.8%] and 21 obstructed [38.2%]; P=.042]). Endoscopic obstruction was a significant prognostic factor in stage III rectal cancers (P=.001) but not in stage II tumors. The multivariate analysis showed that endoscopic obstruction was an independent prognostic factor for overall survival, but not for disease-free survival, in patients with stage III rectal cancers. Endoscopic obstruction was associated with multiple-site systemic recurrence that was unsalvageable (salvageable surgery, 24 nonobstructed [40%] and 2 obstructed [10%]; P=.014). CONCLUSIONS Endoscopic obstruction in patients with stage III rectal cancer predicted worse overall survival and was associated with multiple-site systemic recurrence.