China ; epidemiology ; Colonic Neoplasms ; epidemiology ; mortality ; Female ; Humans ; Incidence ; Male

PURPOSE: Although the cancer of the right side colon is usually managed by primary anastomosis following resection, but the optimal management of obstructing left side colon cancer is controversial. So, we performed this study to evaluate the feasibility and safety of subtotal or total colectomy as a method of one-stage operation in malignant obstruction of left side colon. METHODS: We analyzed retrospectively 35 patients with obstructing left side colon cancer among 74 cases of obstructing colorectal carcinoma who were treated surgically at the Wallace Memorial Baptist Hospital from January 1989 to December 1998. RESULTS: One-stage operation was performed in 16 patients (subtotal colectomy in 13, total colectomy in 3). Staged operation was performed in 15 patients (two-stage operation in 10, three-stage operation in 5). Palliative colostomy was performed in 4 patients. Postoperative complications had been developed in 6 patients (37.5%) with subtotal or total colectomy group and in 7 patients (46.7%) with staged operation group. The postoperative frequent bowel movement was shown in 13 patients (81.2%) with subtotal or total colectomy group and in 7 patients (70.0%) with staged operation group. Frequent bowel movement was improved with antidiarrheal medications within 3 months. Operative mortality was 6.3% (1 patient) in subtotal or total colectomy group and 13.3% (2 patients) in staged operation group. There was no significant difference in morbidity and mortality statistically between two groups. CONCLUSIONS: We believe that subtotal or total colectomy as a method of one-stage operation can be performed with acceptable morbidity and mortality in selected patients with obstructing left side colon cancer.
Colectomy* ; Colon* ; Colonic Neoplasms* ; Colorectal Neoplasms ; Colostomy ; Humans ; Mortality ; Postoperative Complications ; Protestantism ; Retrospective Studies

PURPOSE: There have been many different kinds of operations for obstructing left colon (distal to splenic flexure) cancer and rectal cancer because immediate resection and anastomosis was known to cause many complications. We performed this study to analyse operative cases and evaluate which procedure had the better result. METHODS: Thirty-six cases of left colon cancer and rectal cancer with complete obstruction were analysed from April 1990 to January 2001 and those cases were divided into two groups, the group of staged procedure and the group of primary resection. 28 cases were curative operations and 8 cases were palliative operations. RESULTS: The group of staged procedures had 17 cases of curative operations with 1st. stage-colostomy and 2nd. stage-cancer resection. And the group of primary resection had 11 cases of curative operations, 6 cases of Hartmann's procedures, 2 cases with intraoperative colonic lavage and resection and 3 cases with cancer resection, anastomosis and proximal colostomy. There were no differences in the distribution of age and cancer stage between two groups. In both groups, the sigmoid colon was the most prevalent obstruction site. The staged procedure group had higher operative mortality (25%) than the primary resection group (8%). And 5-year survival rate of the primary resection group was higher than that of the staged procedure group (45%: 33%), but there was no statistical significance. CONCLUSIONS: We think that the primary resection is the better surgical procedure because of shorter hospital stay and fewer operations in the treatment of obstructing left colon and rectal cancer.
Colon* ; Colon, Sigmoid ; Colonic Neoplasms ; Colostomy ; Length of Stay ; Mortality ; Rectal Neoplasms ; Rectum* ; Survival Rate ; Therapeutic Irrigation

Although the obstruction of the right colon is usually handled by primary anastomosis following resection, fear of the increased incidence of septic complication, especially anastomotic leakage with sepsis has turned surgeons away from doing anastomosis in the face of acute obstruction of the left colon. However, from recent reports, enough experiences have been accumulated to show that primary anastomosis is associated with minimum morbidity and mortality in the acute obstruction of the left colon. We experienced 54 cases of colon cancer obstruction at Holy Family Hospital from January 1988 to December 1997. Twenty six cases of them were right colon cancers, 24 cases were left colon cancers and 4 cases were rectal cancers. We reviewed these three groups for evaluation of the safety of one-stage resection and anastomosis of left colon cancer obstruction. The postoperative complication rate was 18% in right colon obstruction versus 38% in left colon obstruction. The most common complication was wound infection(43%). In using of primary resection and anastomosis, complication of right colon revealed 15% and left colon was 29%. But in a method of primary resection and anastomosis with decompression, complication of right colon was 17% and left colon was 13%. Especially on the left colon, primary resection and anastomosis with decompression revealed lower complication(13%) than that without decompression(67%). The mortality of colon cancer obstruction was 2% but this was a patient who had a poor general condition and took a primary resection and anastomosis without decompression. In cases of left colon cancer obstruction primary resection and anastomosis with decompression of left colon cancer obstruction can be a safe operation method with low morbidity and mortality.
Anastomotic Leak ; Colon* ; Colonic Neoplasms* ; Decompression ; Humans ; Incidence ; Mortality ; Postoperative Complications ; Rectal Neoplasms ; Sepsis ; Wounds and Injuries

BACKGROUND: There have been growing interests in harmful effects of dust particles on human health. It has been reported that dust particles negatively affected respiratory and cardiovascular systems. Relationship of dust particles and lung cancer incidence was also investigated. However, there is a lack of studies regarding the relationship between dust particles and cancers except for lung cancer. Therefore, this study aimed to determine the relationship of dust particle concentration and cancer mortality in Korea. METHODS: Average concentration of coarse dust particles (particulate matter 10, PM₁₀) of 2008-2014 were obtained from AirKorea website and cancer mortality was found in Statistics Korea for 2008-2014. Correlation analyses using PM₁₀ and cancer mortality were performed. Age-adjusted death rate (AADR) was used for correlation analysis because a number of death and mortality rate do not reflect population and age of death. Regional annual PM₁₀ was matched with AADR of identical area. Correlation between two variables was presented in scatter plots and Pearson's correlation analysis was performed. RESULTS: PM₁₀ concentration was positively correlated with AADR of malignant neoplasm, lung cancer, stomach cancer, colon cancer, uterus cancer, and leukemia. PM₁₀ concentration was significantly correlated with AADR of malignant neoplasm (r=0.247, P=0.009), lung cancer (r=0.277, P=0.003), stomach cancer (r=0.434, P=0.000), colon cancer (r=0.377, P=0.000), and uterus cancer (r=0.226, P=0.017). CONCLUSION: This study suggested that cancer patients or high-risk group for cancer should pay attention to PM₁₀ concentration. Large-scale studies should investigate the relationship of PM10 concentration and cancer incidence including cancer mortality to extend understanding of this cross-section study.
Cardiovascular System ; Colonic Neoplasms ; Dust ; Humans ; Incidence ; Korea ; Leukemia ; Lung Neoplasms ; Mortality* ; Particulate Matter* ; Statistics as Topic ; Stomach Neoplasms ; Uterine Neoplasms

PURPOSE: The prognosis following colonic perforation is generally regarded as worse than it is for upper gastrointestinal perforation. Moreover, the increasing incidence of colon cancer associated perforation is another reason for the present study of colonic perforation in the present study. We reviewed and analyzed various types of colonic perforations to determine which prognostic factors were still useful for the treatment of colonic perforation. METHODS: Thirty six patients (mean age, 51.5; 24 males) with generalized peritonitis secondary to a colonic perforation were studied retrospectively. All the patients had undergone an exploratory laparotomy. The severity of the clinical condition was recorded according to the APACHE III scoring system for all the patients when they were first seen. Mortality and morbidity were analyzed for possible prognostic factors, such as age, type of operation, association with malignancy, and APACHE-III score. RESULTS: Penetrating trauma was the leading cause of perforation (27.8%), and iatrogenic perforations accounted for 19.4% of the total. Among nontraumatic perforations, malignancy was the major pathology (25.0%). The sigmoid colon was the most frequent site of perforation. Types of surgical treatment varied according to the general conditions of the patients. In 22 patients, the operation was finished with primary closure alone. A colonic resection was performed in 14 patients, and a proximal diversion was performed in 19 patients (after either a resection or primary closure). Analysis of the various clinical variables showed that old age (>60), underlying malignancy, and the APACHE III score were significant prognostic factors for the surgical outcome. CONCLUSIONS: These results suggest that penetrating injuries are still the main cause of colonic perforation and that iatrogenic and malignancy-related perforations are increasing. Among other variables, old age, underlying malignancy and the APACHE III score are significant prognostic factors for the surgical outcome.
APACHE ; Colon* ; Colon, Sigmoid ; Colonic Neoplasms ; Humans ; Incidence ; Laparotomy ; Mortality ; Pathology ; Peritonitis* ; Prognosis ; Retrospective Studies

Thrombotic thrombocytopenic purpura (TTP), a fatal disease, is mostly idiopathic but can occur secondary to cancer, infection, transplantation, pregnancy, surgery, or drugs. The mechanism of TTP is still unknown, however, and detection is difficult because of unclear diagnosis criteria. Colonic stent insertion is commonly used in management of malignant colon obstruction. This is a very safe procedure with a low procedure-related mortality rate, but serious complications can develop. The authors first experienced a patient with TTP when the phenomenon occurred after stent insertion for palliation of obstructive colon cancer and therefore would like to report the case.
Colon ; Colonic Neoplasms* ; Diagnosis ; Humans ; Mortality ; Pregnancy ; Purpura, Thrombotic Thrombocytopenic* ; Stents*

Acute colonic obstruction secondary to left-colonic malignancy remains a common emergency condition. Traditional management is emergency surgery and has high morbidity and mortality. Self expandable metallic stents (SEMS) promised to improve morbidity and mortality, stoma rates and hospital stay. SEMS use in the potentially curative setting, as a bridge to surgery, is associated with an improved stoma rate and morbidity, but has no mortality benefit. There are concerns about oncological safety with higher local recurrence rates, thus SEMS is not recommended in this setting unless the patient has increased surgical risk and would benefit from a period of recovery prior to surgery. SEMS has a definite role in the palliative setting, for both patients with incurable disease or those with a high surgical risk. SEMS is associated with improved morbidity, mortality, and stoma rates. The technique for SEMS insertion is now well established but it is still unclear whether covered or uncovered stents are better.
Colon* ; Colonic Neoplasms* ; Emergencies ; Humans ; Intestinal Obstruction ; Length of Stay ; Mortality ; Recurrence ; Self Expandable Metallic Stents ; Stents*

PURPOSE: After the final report of Clinical Outcomes of Surgical Therapy (COST) study group, the application of laparoscopic surgery in colon cancer a spread widely. However, laparoscopic surgery in the rectum is still regarded as a complicated procedure to start due to technical difficulties and a steep learning curve. The aim of this study was to show the safety and technical feasibility of a laparoscopic low anterior resection at an early time on the learning curve in comparison with open low anterior resection. METHODS: The learning curves of one colorectal surgeon in open and laparoscopic low anterior resections were retrospectively compared. The compared factors were clinicopathologic characteristics, operation time, and the factors associated with postoperative recovery, morbidity and mortality. RESULTS: There were no significant differences in age or sex between two groups. The operation time was significantly longer in the laparoscopy group (P<0.001) In the view point of postoperative recovery, the laparoscopy group showed significant advantages in hospital stay (P<0.001), the passage of flatus (P<0.001), the number of analgesics used (P=0.03), and the removal of foley catheter (P=0.001). There were no conversions in the laparoscopy group, and the complication rate was lower in the laparoscopy group (10.7% vs. 17.6%). There was no postoperative mortality in either group. CONCLUSIONS: Even though the operation time was significantly longer in the laparoscopy group, a laparoscopic low anterior resection appears to have some benefits in postoperative recovery and morbidity. In terms of surgical outcomes, a laparoscopic low anterior resection can be performed safely even in early times on the learning curve.
Analgesics ; Catheters ; Colonic Neoplasms ; Flatulence ; Laparoscopy ; Learning Curve* ; Learning* ; Length of Stay ; Mortality ; Rectum ; Retrospective Studies

PURPOSE: The purpose of this study was to compare the efficacy of curative emergency surgery for complicated colon cancer in terms of tumor recurrence and survival compared with that of elective surgery. METHODS: A total of 238 primary surgeries for colon cancer were performed. All patients were deemed to have undergone a curative resection. Patients were classified into an emergency surgery group for complicated colon cancers (n=40) and an elective surgery group for uncomplicated colon cancers (n=198). RESULTS: Emergency colonic cancers present at a more advanced stage (P=0.002). The postoperative mortality rate in the emergency group was significantly higher than it was in the elective group (15.0% vs. 2.5%, P= 0.004). There were differences between the two groups in tumor recurrence (32.5% vs. 13.1%, P=0.003), overall survival (52.5% vs. 71.7%, P=0.017), and disease-free survival (50.0% vs. 69.7%, P=0.016). However, after the patients were stratified according to tumor stage, no statistical differences were observed. CONCLUSIONS: When compared with uncomplicated colon cancers, complicated colon cancers present at a more advanced stage with a higher postoperative mortality and an overall worse prognosis. However, the difference decreases when patients are stratified according to the tumor stage. The negative prognostic efficacy of emergency surgery for complicated colon cancers appears to be confined to the perioperative period. Despite the more advanced stage of tumors in patients undergoing emergency surgery, the aim of the surgeon should be to offer a curative resection for better survival, if possible.
Colon* ; Colonic Neoplasms* ; Disease-Free Survival ; Emergencies* ; Humans ; Mortality ; Perioperative Period ; Prognosis ; Recurrence