Jun Won Um

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.

Expression of estrogen receptors in gastric cancer and their clinical significance.

The male predominance of gastric cancer suggests that female sex hormones may have a protective effect against gastric cancer. We evaluated the expression of estrogen receptors in gastric cancer tissue and cells and the clinical significance of ER‐β expression in gastric cancer.

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.

Voiding Dysfunction after Total Mesorectal Excision in Rectal Cancer

Purpose The aim of this study was to assess the voiding dysfunction after rectal cancer surgery with total mesorectal excision (TME). Methods This was part of a prospective study done in the rectal cancer patients who underwent surgery with TME between November 2006 and June 2008. Consecutive uroflowmetry, post-voided residual volume, and a voiding questionnaire were performed at preoperatively and postoperatively. Results A total of 50 patients were recruited in this study, including 28 male and 22 female. In the comparison of the preoperative data with the postoperative 3-month data, a significant decrease in mean maximal flow rate, voided volume, and post-voided residual volume were found. In the comparison with the postoperative 6-month data, however only the maximal flow rate was decreased with statistical significance (P=0.02). In the comparison between surgical methods, abdominoperineal resection patients showed delayed recovery of maximal flow rate, voided volume, and post-voided residual volume. There was no significant difference in uroflowmetry parameters with advances in rectal cancer stage. Conclusions Voiding dysfunction is common after rectal cancer surgery but can be recovered in 6 months after surgery or earlier. Abdominoperineal resection was shown to be an unfavorable factor for postoperative voiding. Larger prospective study is needed to determine the long-term effect of rectal cancer surgery in relation to male and female baseline voiding condition.

Acquired Omental Cystic Lymphangioma after Subtotal Gastrectomy: A Case Report

We herein describe a case of cystic lymphangioma in the greater omentum of the remnant stomach, which is thought it to be related with subtotal gastrectomy 10 yr ago for early gastric cancer. A 76-yr-old man was admitted to our department with postprandial abdominal discomfort and bowel habit change. Intraabdominal multilocular cystic mass was detected by ultrasonography and computed tomography. We performed a complete En-bloc tumor resection including spleen and distal pancreas, and histological examination confirmed cystic lymphangioma originated from the greater omentum of the remnant stomach. Although the etiology of omental lymphangioma remains largely unclear, these findings suggested strongly that obstruction of the lymphatic vessels after gastric resection for gastric carcinoma might be the most plausible cause. The surgical extirpation with resection of organs involved appears to be a treatment of choice for such unusual case.

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.

Transanal rectal foreign body removal using a SILS port.

Rectal foreign bodies are being detected more frequently, and their textures, sizes, shapes, and locations are critical considerations when removal and deciding on management plans. Many removal techniques have been described and various theories have been put forward to explain procedural mechanics. Here the authors report a case in which a transanal technique using a SILS port was successfully used.

Risk factors causing structural sequelae after anastomotic leakage in mid to low rectal cancer

AIM To investigate the risk factors causing structural sequelae after anastomotic leakage in patients with mid to low rectal cancer. METHODS Prospectively collected data of consecutive subjects who had anastomotic leakage after surgical resection for rectal cancer from March 2006 to May 2013 at Korea University Anam Hospital were retrospectively analyzed. Two subgroup analyses were performed. The patients were initially divided into the sequelae (stricture, fistula, or sinus) and no sequelae groups and then divided into the permanent stoma (PS) and no PS groups. Univariate and multivariate analyses were performed to identify the risk factors of structural sequelae after anastomotic leakage. RESULTS Structural sequelae after anastomotic leakage were identified in 29 patients (39.7%). Multivariate analysis revealed that diversion ileostomy at the first operation increases the risk of structural sequelae [odds ratio (OR) = 6.741; P = 0.017]. Fourteen patients (17.7%) had permanent stoma during the follow-up period (median, 37 mo). Multivariate analysis showed that the tumor level from the dentate line was associated with the risk of permanent stoma (OR = 0.751; P = 0.045). CONCLUSION Diversion ileostomy at the first operation increased the risk of structural sequelae of the anastomosis, while lower tumor location was associated with the risk of permanent stoma in the management of anastomotic leakage.