Kyung Uk Jung

Recurrence Pattern Depends on the Location of Colon Cancer in the Patients with Synchronous Colorectal Liver Metastasis

AbstractBackgroundnThe veins from the lower rectum drain into the systemic venous system, while those from other parts of the colon drain into the portal venous system. The aim of this study was to investigate recurrence pattern and survival according to the anatomical differences in patients with colorectal liver metastases (CRLM).MethodsnFrom October 1994 to December 2009, synchronous CRLM patients who underwent surgery were identified from our prospectively collected database. The patients were excluded if there had been extrahepatic metastases. The patients were divided into two groups according to the location of the primary colorectal cancer: lower rectal cancer (group 1) and upper rectal or colon cancer (group 2). The recurrence patterns and survival were investigated.ResultsA total of 316 patients were included: 53 patients in group 1 and 263 patients in group 2. After a median follow-up of 37xa0months, the extrahepatic recurrence curve of group 1 was superior to that of group 2 (Pxa0<xa00.001), although there was no difference between the hepatic recurrence curves (Pxa0=xa00.93). The disease-free and overall survival curves of group 1 were inferior to those of group 2 (Pxa0=xa00.004) (Pxa0<xa00.001). Lower rectal cancer was a significant risk factor for extrahepatic recurrence in Cox proportional hazard model analysis (hazard ratioxa0=xa01.7, Pxa0=xa00.04).ConclusionsThe extrahepatic recurrence rate is high in lower rectal cancer patients after surgical treatment for synchronous CRLM.

Single incision and reduced port laparoscopic low anterior resection for rectal cancer: initial experience in 96 cases.

Although a single incision laparoscopic (SIL) technique has been used increasingly in colorectal surgery, there are only a few reports on the clinical availability of this approach coupled with low anterior resection (SIL–LAR) for colorectal cancers. We report here 96 consecutive cases of SIL–LAR and reduced port LAR cases, of which the initial approach was SIL.

Age Over 80 is a Possible Risk Factor for Postoperative Morbidity After a Laparoscopic Resection of Colorectal Cancer.

Purpose With extended life expectancy, the mean age of patients at the time of diagnosis of colorectal cancer and its treatment, including radical resection, is increasing gradually. We aimed to evaluate the impact of age on postoperative clinical outcomes after a laparoscopic resection of colorectal cancers. Methods This is a retrospective review of prospectively collected data. Patients with primary colorectal malignancies or premalignant lesions who underwent laparoscopic colectomies between January 2009 and April 2013 were identified. Patients were divided into 6 groups by age using 70, 75, and 80 years as cutoffs: younger than 70, 70 or older, younger than 75, 75 or older, younger than 80, and 80 or older. Demographics, pathological parameters, and postoperative clinical outcomes, including postoperative morbidity, were compared between the younger and the older age groups. Results All 578 patients underwent a laparoscopic colorectal resection. The overall postoperative complication rate was 21.1% (n = 122). There were 4 cases of operative mortality (0.7%). Postoperative complication rates were consistently higher in the older groups at all three cutoffs; however, only the comparison with a cutoff at 80 years showed a statistically significant difference between the younger and the older groups. Conclusion Age over 80 is a possible risk factor for postoperative morbidity after a laparoscopic resection of colorectal cancer.

Adjuvant chemotherapy after neoadjuvant chemoradiation and curative resection for rectal cancer: is it necessary for all patients?

The benefit of adjuvant chemotherapy for patients with locally advanced rectal cancer who have received neoadjuvant concurrent chemoradiation therapy (CCRT) and undergone curative resection remains unclear.

Prospective analysis of delayed colorectal post-polypectomy bleeding

Backgrounds/aimsAlthough post-polypectomy bleeding is the most frequent complication after colonoscopic polypectomy, only few studies have investigated the incidence of bleeding prospectively. The aim of this study was to investigate the incidence of delayed post-polypectomy bleeding and its associated risk factors prospectively.MethodsPatients who underwent colonoscopic polypectomy at Kangbuk Samsung Hospital from January 2013 to December 2014 were prospectively enrolled in this study. Trained nurses contacted patients via telephone 7 and 30xa0days after polypectomy and completed a standardized questionnaire regarding the development of bleeding. Delayed post-polypectomy bleeding was categorized as minor or major and early or late bleeding. Major delayed bleeding was defined as au2009>u20092-g/dL drop in the hemoglobin level, requiring hospitalization for control of bleeding or blood transfusion; late delayed bleeding was defined as bleeding occurring later than 24xa0h after polypectomy.ResultsA total of 8175 colonoscopic polypectomies were performed in 3887 patients. Overall, 133 (3.4%) patients developed delayed post-polypectomy bleeding. Among them, 90 (2.3%) and 43 (1.1%) patients developed minor and major delayed bleeding, respectively, and 39 (1.0%) patients developed late delayed bleeding. In the polyp-based multivariate analysis, young age (<u200950 years; odds ratio [OR] 2.10; 95% confidence interval [CI] 1.18–3.68), aspirin use (OR 2.78; 95% CI 1.23–6.31), and polyp size of >u200910xa0mm (OR 2.45; 95% CI 1.38–4.36) were significant risk factors for major delayed bleeding, while young age (<u200950xa0years; OR 2.6; 95% CI 1.35–5.12) and immediate bleeding (OR 3.3; 95% CI 1.49–7.30) were significant risk factors for late delayed bleeding.ConclusionsYoung age, aspirin use, polyp size, and immediate bleeding were found to be independent risk factors for delayed post-polypectomy bleeding.

Scoring Systems Used to Predict Bladder Dysfunction After Laparoscopic Rectal Cancer Surgery

BackgroundPostoperative bladder dysfunction often occurs after rectal cancer surgery, necessitating long-term urinary catheter drainage. The aim of this study was to evaluate the feasibility of early catheter removal and to propose scoring systems that may predict urinary dysfunction after laparoscopic rectal cancer surgery.MethodsA total of 110 patients who underwent elective laparoscopic rectal cancer surgery were included in this prospective observational study. The urinary catheter was removed on the first postoperative day.ResultsThe overall incidence of bladder dysfunction was 29.1xa0% (32/110). The incidence of bladder dysfunction was significantly higher in patients with an age of 65xa0years or older, male gender, and anastomosis levels from the anal verge of 6xa0cm or below (Pxa0=xa00.03, 0.002, and 0.03, respectively). By setting a cut-off of two of the risk factors, this simple scoring system can predict postoperative bladder dysfunction with sensitivity of 96.9xa0%, specificity of 50.0xa0%, and accuracy of 63.6xa0%. A scoring system based on regression coefficients was also conducted according to the following formula: bladder dysfunction predicting scorexa0=xa018 (1 for male or 0 for female)xa0+0.5 (age, years)xa0−2 (anastomosis level, cm). With this method, a cut-off value of 35+xa0points predicts postoperative bladder dysfunction with a sensitivity of 81.3xa0%, specificity of 71.8xa0%, and accuracy of 74.5xa0%.ConclusionsBladder dysfunction after laparoscopic rectal cancer surgery following early catheter removal occurred in 29.1xa0% of patients. Two scoring systems using three risk factors (age, male gender, and anastomosis level) may predict postoperative bladder dysfunction.

Obstructive Left Colon Cancer Should Be Managed by Using a Subtotal Colectomy Instead of Colonic Stenting

Purpose This study compared a subtotal colectomy to self-expandable metallic stent (SEMS) insertion as a bridge to surgery for patients with left colon-cancer obstruction. Methods Ninety-four consecutive patients with left colon-cancer obstruction underwent an emergency subtotal colectomy or elective SEMS insertion between January 2007 and August 2014. Using prospectively collected data, we performed a retrospective comparative analysis on an intention-to-treat basis. Results A subtotal colectomy and SEMS insertion were attempted in 24 and 70 patients, respectively. SEMS insertion technically failed in 5 patients (7.1%). The mean age and rate of obstruction in the descending colon were higher in the subtotal colectomy group than the SEMS group. Sex, underlying disease, American Society of Anesthesiologists physical status, and pathological stage showed no statistical difference. Laparoscopic surgery was performed more frequently in patients in the SEMS group (62 of 70, 88.6%) than in patients in the subtotal colectomy group (4 of 24, 16.7%). The overall rate of postoperative morbidity was higher in the SEMS group. No Clavien-Dindo grade III or IV complications occurred in the subtotal colectomy group, but 2 patients (2.9%) died from septic complications in the SEMS group. One patient (4.2%) in the subtotal colectomy group had synchronous cancer. The total hospital stay was shorter in the subtotal colectomy group. The median number of bowel movements in the subtotal colectomy group was twice per day at postoperative 3–6 months. Conclusion A subtotal colectomy for patients with obstructive left-colon cancer is a clinically and oncologically safer, 1-stage, surgical strategy compared to SEMS insertion as a bridge to surgery.

Microsatellite Instability Status of Interval Colorectal Cancers in a Korean Population.

Background/Aims A subset of patients may develop colorectal cancer after a colonoscopy that is negative for malignancy. These missed or de novo lesions are referred to as interval cancers. The aim of this study was to determine whether interval colon cancers are more likely to result from the loss of function of mismatch repair genes than sporadic cancers and to demonstrate microsatellite instability (MSI). Methods Interval cancer was defined as a cancer that was diagnosed within 5 years of a negative colonoscopy. Among the patients who underwent an operation for colorectal cancer from January 2013 to December 2014, archived cancer specimens were evaluated for MSI by sequencing microsatellite loci. Results Of the 286 colon cancers diagnosed during the study period, 25 (8.7%) represented interval cancer. MSI was found in eight of the 25 patients (32%) that presented interval cancers compared with 22 of the 261 patients (8.4%) that presented sporadic cancers (p=0.002). In the multivariable logistic regression model, MSI was associated with interval cancer (OR, 3.91; 95% confidence interval, 1.38 to 11.05). Conclusions Interval cancers were approximately four times more likely to show high MSI than sporadic cancers. Our findings indicate that certain interval cancers may occur because of distinct biological features.

Robotic transverse colectomy for mid-transverse colon cancer: surgical techniques and oncologic outcomes

Robot-assisted surgery for colon cancer has been reported in many studies, most of which worked on right and/or sigmoid colectomy. The aim of this study was to report our experience of robotic transverse colectomy with an intracorporeal anastomosis, provide details of the surgical technique, and present the theoretical benefits of the procedure. This is a retrospective review of prospectively collected data of robotic surgery for colorectal cancer performed by a single surgeon between May 2007 and February 2011. Out of 162 consecutive cases, we identified three robotic transverse colectomies, using a hand-sewn intracorporeal anastomosis. Two males and one female underwent transverse colectomies for malignant or premalignant disease. The mean docking time, time spent using the robot, and total operative time were 5, 268, and 307xa0min, respectively. There were no conversions to open or conventional laparoscopic technique. The mean length of specimen and number of lymph nodes retrieved were 14.1xa0cm and 6.7, respectively. One patient suffered from a wound seroma and recovered with conservative management. The mean hospital stay was 8.7xa0days. After a median follow-up of 72xa0months, there were no local or systemic recurrences. Robotic transverse colectomy seems to be a safe and feasible technique. It may minimize the necessity of mobilizing both colonic flexures, with facilitated intracorporeal hand-sewn anastomosis. However, further prospective studies with a larger number of patients are required to draw firm conclusions.

Reduced Port Laparoscopic Abdominoperineal Resection

In the past decade, single-incision laparoscopic surgery (SILS) has shown acceptable results in a number of surgical interventions including colorectal procedures for benign and malignant diseases. However, the acceptance of SILS in the lower rectum has been hampered by its technical difficulties and concern over oncological outcome. More recently, increased experience, safety, and feasibility of SILS for rectal lesions in short-term outcomes have started to be reported. Many of them adopted an additional port for traction or transection of the rectum in the case of a very low rectal lesion, which is generally called “reduced port laparoscopic surgery.” SILS or reduced port laparoscopic abdominoperineal resection (RPLAPR) is a relatively new technique in the minimally invasive surgery era, and there are only a few reports on this topic. In this chapter, we introduce the surgical technique of SILS or RPLAPR in our center and short-term outcomes with a literature review.