PURPOSE: The TNM classification for carcinoma of the colon and the rectum provides more detail than other staging systems. This study was performed to evaluate the effectiveness of AJCC staging system (5th ed., 1997) for the colorectal cancer in predicting prognosis. METHODS: We analyzed a data base of 1,233 colorectal cancer patients (M:F=673:560) who underwent surgery in Asan Medical Center during July 1989-December 1996. Survival analysis was performed between the stages and the subgroups in same stage by using Kaplan-Meier method and log rank test. Borderline subgroup comparison between the stages was performed, also. Significance was assigned to a P value of <0.05. RESULTS: Mean age of the patients was 57 (19-90) years old. Median follow-up period was 42 (6-129) months. The number of patients in each stage were 0: 15, I: 152, II: 390, III: 465, IV: 199. The 5 year overall & disease free survival rates of each stage were 100%, 100% (in stage 0), 96.4%, 93.6% (in stage I), 82.7%, 82.2% (in stage II), 59.9%, 55.3% (in stage III), and 7.3%, 24.9% (in stage IV), respectively (P=0.000). Subgroup analysis in stage I (T1N0 vs. T2N0) and II (T3N0 vs. T4N0) revealed no differences. However, in stage III, N1 (n=246) group showed better survival than N2 (n=219) group (70.3%, 65.5% vs. 49.2%, 44.6%: P=0.000). Borderline survival analysis between stage I and II (T2N0 vs. T3N0) was significantly different (96.6%, 95.7% vs 82.7%, 82.3%: P=0.006). However, between stage II and III (T4N0 vs. T1N1), appropriate analysis was impossible due to small number of cases. CONCLUSIONS: AJCC staging system for colorectal cancer was reliable and effective in predicting prognosis. However, substages are needed in stage III.
Chungcheongnam-do ; Classification ; Colon ; Colorectal Neoplasms* ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Prognosis ; Rectum

Although the treatment strategy for colorectal trauma has advanced during the last part of the twentieth century and the result has improved, compared to other injuries, problems, such as high septic complication rates and mortality rates, still exist, so standard management for colorectal trauma is still a controversial issue. For that reason, we designed this article to address current recommendations for management of colorectal injuries based on a review of literature. According to the reviewed data, although sufficient evidence exists for primary repair being the treatment of choice in most cases of nondestructive colon injuries, many surgeons are still concerned about anastomotic leakage or failure, and prefer to perform a diverting colostomy. Recently, some reports have shown that primary repair or resection and anastomosis, is better than a diverting colostomy even in cases of destructive colon injuries, but it has not fully established as the standard treatment. The same guideline as that for colonic injury is applied in cases of intraperitoneal rectal injuries, and, diversion, primary repair, and presacral drainage are regarded as the standards for the management of extraperitoneal rectal injuries. However, some reports state that primary repair without a diverting colostomy has benefit in the treatment of extraperitoneal rectal injury, and presacral drainage is still controversial. In conclusion, ideally an individual management strategy would be developed for each patient suffering from colorectal injury. To do this, an evidence-based treatment plan should be carefully developed.
Abdominal Injuries ; Anastomotic Leak ; Colon ; Colorectal Surgery ; Colostomy ; Drainage ; Humans ; Stress, Psychological ; Wounds, Nonpenetrating ; Wounds, Penetrating

No abstract available.
Constipation ; Quality of Life

No abstract available.
Colostomy ; Heel

Liver metastases in colorectal cancer are a frequent and lethal complication. Although hepatic resection is an effective treatment for patients with liver metastases in colorectal cancer, only 10-20% of the patients with liver metastases in colorectal cancer are indicated on hepatic resection. However, over the past several decades, liver resection has evolved as a safe and potentially curative treatment for liver metastases in colorectal cancer. Currently the absolute number of patients amenable to resection is large and is growing with better imaging, better surgery, and improvements in systemic therapies to reduce the risk of both intrahepatic and extrahepatic recurrences. The development of active chemotherapy and molecular targeted therapies, together with newer modalities like radiofrequency ablation, have expanded the indications for hepatic resection and improved survival. Also, although initially unresectable, a hepatic resection of colorectal liver metastases after down-sizing by using the above mentioned treatment modalities and chemotherapy can provide a hope for long-term survival that is similar to that of primarily resectable patients. To achieve this objective, for patients with liver metastases, a multidisciplinary team approach has become mandatory, with routine re-evaluation of patients and with adequate timing for each treatment.
Colorectal Neoplasms ; Humans ; Liver ; Molecular Targeted Therapy ; Neoplasm Metastasis ; Recurrence

We performed single port transumbilical appendectomy and cholecystectomy using the TriPort (R-port, Advanced Surgical Concepts, Wicklow, Ireland), inserted through a transumbilical incision in a cadaver model. A articulating instrument, Autonomy(TM) (Cambridge Endo, MA, USA) in right hand was used for retraction in addition to a standard laparoscopic instrument in left hand for dissection and coagulation. Both procedures were technically successful. In conclusion, single port surgery may be performed safely. And in the near future, more complex procedures could be performed through single port in accordance with the advancement of the instruments.
Appendectomy ; Cadaver ; Cholecystectomy ; Hand ; Laparoscopy

Colonoscopy is a frequently performed procedure used for colorectal cancer screening. Most frequent complication is colonic perforation and bleeding. Other visceral injuries are very rare, but injuries to the spleen and liver have been described. We report on 66-yr-old female who presented with abdominal pain after uneventful colonoscopy. Abdominal CT scan revealed a band at previous hysterectomy site and dilated small bowel suggesting strangulated loop. A broad based knowledge of the different complication is necessary to decrease the risk of associated morbidity and mortality.
Abdominal Pain ; Colon ; Colonoscopy ; Colorectal Neoplasms ; Female ; Hemorrhage ; Humans ; Hysterectomy ; Intestinal Obstruction ; Liver ; Mass Screening ; Spleen

Klippel-Trenaunay syndrome (KTS) is a rare congenital disorder and is essentially a disorder of capillary, venous, and lymphatic malformations. Hematochezia is the most common symptom associated with intestinal hemangiomatosis and remains one of the life-threatening emergencies in KTS. We reported one patient of KTS presented with rectal bleeding and severe anemia who was successfully managed by sphincter-saving operation.
Anemia ; Capillaries ; Congenital, Hereditary, and Neonatal Diseases and Abnormalities ; Emergencies ; Gastrointestinal Hemorrhage ; Hemorrhage ; Humans ; Klippel-Trenaunay-Weber Syndrome

PURPOSE: The aim of this study was to review our experience with neuroendocrine carcinoma (NEC) of the colon and rectum to highlight the clinical and pathological characteristics in this relatively uncommon malignancy. METHODS: From December 1995 to December 2006, 11 patients with NEC were identified from our database of 6,143 colorectal cancer patients (0.18%), which does not include carcinoid tumors. The pathology was retrospectively reviewed and the tumors were categorized as pure NEC, including well-differentiated NEC (n=3), poorly-differentiated (n=3) and mixed endocrine/exocrine tumor (n=5) on the basis of the histology and immunohistochemical findings. RESULTS: The mean age of the patients was 57 yr (range, 37 to 69 yr). The tumors were located as follows: 8 in the colon and 3 in the rectum. The diagnosis of NEC was suggested preoperatively from the tissue biopsy in 2 of 9 patients (22.2%). The tumors were advanced at the time of diagnosis, with American Joint Committee on Cancer Stage III (n=7) and Stage IV disease (n=4). Most tumors stained positive by immunohistochemistry for neuroendocrine markers, including synaptophysin (7/9, 77.8%); however, chromogranin was expressed in 4 of 9 NEC tumors (44.4%). Metastatic disease was detected at the time of diagnosis in 36.4% (4/11) of the patients. The median survival for NEC was 16 mo (3.6-67.4 mo), and for pure NEC and mixed endocrine/exocrine tumor was 4.1 mo and 23.6 mo, respectively. CONCLUSION: NEC had distinctive cytoarchitectural features and was often immunoreactive for neuroendocrine markers. Our findings showed that pure NEC had aggressive behavior and a poor prognosis.
Biopsy ; Carcinoid Tumor ; Carcinoma, Neuroendocrine ; Colon ; Colorectal Neoplasms ; Humans ; Immunohistochemistry ; Joints ; Prognosis ; Rectum ; Retrospective Studies ; Synaptophysin

PURPOSE: Recently, a self-expandable metallic stent has allowed an elective single-stage resection avoiding the risk of emergency operation and stoma formation in patients with obstructive colorectal cancer (CRC). But, forceful expansion of stent may increase the possibility of tumor cell exfoliation and dissemination through bowel lumen, lymphatic and blood vessels. Aim of study is to evaluate the short-term outcome of curative resection for obstructive colorectal cancer followed by stent in terms of oncologic safety. METHODS: Twenty-seven patients who underwent curative resection for obstructive CRC followed by stent insertion were included in 'stent group' and control group included 87 patients who underwent surgery for non-obstructive CRC. The clinicopathologic characteristics and prognosis were compared between two groups. RESULTS: There was no significant difference in clinicopathologic characteristics between two groups. No difference was found in postoperative complications between two groups. Overall survival rate of two groups showed no statistically significant differences (P=0.1254). Stage-matched survival rates (stage II & III) were also showed no differences between two groups. CONCLUSION: Stent insertion itself does not compromise the survival of patients with obstructive CRC. Oncologic safety of stent insertion for obstructive CRC is acceptable. A further large-scaled prospective study and long-term follow-up is necessary to evaluate the oncologic safety of stent insertion in obstructive CRC.
Blood Vessels ; Colorectal Neoplasms ; Emergencies ; Follow-Up Studies ; Humans ; Postoperative Complications ; Prognosis ; Stents ; Survival Rate