PURPOSE: Oral UFT is known to be a safe and effective antineoplastic regimen for adjuvant chemotherapy of colorectal cancer. As it sometimes produces upper gastrointestinal symptoms such as anorexia, nausea, vomiting and abdominal pain, medication should be stopped transiently or dosage reduced. UFT-E, an enteric coated granule of UFT was introduced to reduce UGI toxicity. We analyzed the toxicity of UFT and UFT-E prospectively for the purpose of comparison between the two types. METHODS: The toxicity of UFT and UFT-E were evaluated in 83 patients (UFT; 45, UFT-E; 38) with colorectal cancer who underwent curative surgery according to the WHO toxicity criteria. All patients were selected consecutively with patients' approval and by the "Institutional Review Board, Asan Medical Center". RESULTS: The toxicity incidence in UFT-E group was slightly less than that in UFT group without statistical significance. The severity of toxicity seemed to be mild within grade 1 or 2 and most of them toxicity self-limiting. The regimen was completely interrupted in 9 patients (20%) in the UFT group, 3 patients (7.9%) in the UFT-E group due to severe UGI symptoms, prolonged leukopenia, derrangement of liver function and skin rash. CONCLUSIONS: Toxicity rate of UFT-E was not higher than that of UFT. But we cannot prove superiority of UFT-E on UGI toxicity. Oral UFT-E can be administered safely on an outpatient basis without lethal toxicity requiring hospitalization.
Abdominal Pain ; Anorexia ; Chemotherapy, Adjuvant ; Chungcheongnam-do ; Colorectal Neoplasms* ; Exanthema ; Hospitalization ; Humans ; Incidence ; Leukopenia ; Liver ; Nausea ; Outpatients ; Prospective Studies ; Vomiting

Sigmoid colon cancer occasionally attaches to the adjacent viscera. It is estimated that such attachment occurs in 6% to 12% of all patients with colon carcinoma without distant metastases. This study was performed to identify the parameters to distinguish direct tumor invasion to adjacent organs from simple inflammatory adhesion in sigmoid colon cancer and to clarify the difference of survival and recurrence pattern between two groups. METHODS: Between 1989 and 1998, 415 patients underwent resection of sigmoid colon cancer in our clinic. Of these, 46 had tumors adherent to adjacent organs and confirmed as tumor direct invasion or simple inflammatory adhesion by pathologic examination. The mean age of 46 cases was 54.2+/-12.8 (mean+/-SD) years and median follow up was 21 (3~53) months. RESULTS: Among the clinical and pathologic parameters such as symptoms and laboratory findings presenting bowel obstruction, serum CEA levels, preoperative radiological findings, tumor size, differentiation, and stage, there was no specific one that was correlated with direct tumor invasion or inflammatory adhesion. Almost all cases with adhesion to adjacent organ were treated by an en bloc resection including mutivisceral resection. The group with direct invasion had inferior disease free survival rate and overall survival rate comparing with simple inflammatory adhesion group. CONCLUSIONS: In the situation that there was no valuable parameter suggesting direct tumor invasion, en bloc resection or multivisceral resection involving one tumor-free plane may be beneficial to the patients with sigmoid colon cancer adherent to adjacent organ.
Colon ; Colon, Sigmoid* ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Neoplasm Metastasis ; Recurrence ; Sigmoid Neoplasms* ; Survival Rate ; Viscera

INTRODUCTION: Stapled anastomosis in the rectal cancer surgery has been already proven as a safe technique, maintaing secure suture and saving times compared to handsewn anastomosis. With the advancement of stapling device, the incidence of anastomotic leakage has decreased significantly. However, developement of anastomotic stricture has become a major postoperative complication. PURPOSE: An analysis of the clinical features and the predisposing factors of anastomotic stricture was made to identify its pathogenesis and to determine adequate procedure. METHODS: We analyzed 49 patients (8.1%) with the rectal stricture among 608 patients, undergone stapled anastomosis for the rectal cancer surgery at Asan Medical Center from Jan 1993 to Dec 1998. Rectal stricture was defined when index finger or colonoscope could not pass the anastomotic site (high grade), or could pass with difficulty(low grade). RESULTS: Underlying general diseases, e.g., DM, hypertension and cardiovascular disease was associated more frequently in patients with anastomotic stricture (20.4%) than patients without (10.8%) (P<0.05). The rate of postoperative major complications in patients with stricture was 22.4%, while that of anastomotic leakage was 6.1%. Development of anastomotic stricture was not associated with operative methods, age, anastomosis level, and postoperative radiotherapy. In patients with stricture, 34 patients (69.4%) were asymptomatic, and 15 patients were symptomatic. In treating symptomatic rectal stricture, only five patients performed dilation manually or by the Hegar dilator. CONCLUSIONS: Rectal stricture after stapled anastomosis might be associated with underlying diseases, and correlated with prolonged sanguinous drainage and ileus. Meticulous management of underlying disease and complete hemostasis during operation appear to be important to reduce the rate of rectal stricture.
Anastomotic Leak ; Cardiovascular Diseases ; Causality ; Chungcheongnam-do ; Colonoscopes ; Constriction, Pathologic* ; Drainage ; Fingers ; Hemostasis ; Humans ; Hypertension ; Ileus ; Incidence ; Postoperative Complications ; Radiotherapy ; Rectal Neoplasms ; Sutures

PURPOSE: The standard treatment for sigmoid volvulus has been considered as a resection of involved segment after nonoperative decompression. This study was performed to investigate the clinical characteristics and compare the results of managements in patients with sigmoid volvulus. METHODS: We recruited twelve patients with sigmoid volvulus registered and treated at Asan Medical Center during 1989 and 1999. The medical records were reviewed retrospectively. Telephone inerviews were performed to inquire recent status. We analyzed clinical variables including symptoms on admission, physical findings, findings of radiologic studies, managements and their outcomes. The median age was 64 years (range:45 to 84 years). The median follow-up period was 46 months (range:2 to 94). RESULTS: Nine patients among twelve were male. Presenting symptoms were abdominal pain (92%), abdominal distension (67%), constipation (50%) and hematochezia. The diagnostic modalities utilized included plain film of the abdomen, CT scan and sigmoidoscopy. Nine cases (75%) were correctly diagnosed prior to operation, of which eight (67%) were diagnosed by plain film. The remaining three cases were by operation. In these cases, preoperative diagnoses were ischemic colitis and obstruction due to colonic malignancy. In seven cases, only nonoperative managements were employed. Nonoperative management included decompression by nasogastric tube or rectal tube insertion and use of bulk forming agents and stool softner afterwards to improve bowel habits. Five patients underwent anterior resection. We couldn't perform surgery in seven cases because of high operative risk due to underlying serious medical conditions such as bronchial asthma, malignancies and refusal by the patients after clinical improvement in 4 and 3cases, respectively. Three of them were died of underlying disease or sepsis. Recurrence occurred in two patients (50%) who underwent nonoperative management only and none in patients who underwent surgical intervention. CONCLUSIONS: In patients with sigmoid volvulus, elective surgery after appropriate nonoperative management is mandatory to prevent recurrence and fatal outcome, especially in good surgical risk patients. Considerable patients, however, did not undergo surgery due to poor physical status or refusal of surgery.
Abdomen ; Abdominal Pain ; Asthma ; Chungcheongnam-do ; Colitis, Ischemic ; Colon ; Colon, Sigmoid* ; Constipation ; Decompression ; Diagnosis ; Disulfiram ; Fatal Outcome ; Follow-Up Studies ; Gastrointestinal Hemorrhage ; Humans ; Intestinal Volvulus* ; Male ; Medical Records ; Recurrence ; Retrospective Studies ; Sepsis ; Sigmoidoscopy ; Telephone ; Tomography, X-Ray Computed

PURPOSE: The complication after colostomy formation may place undue hardship and emotional trauma on the ostomates. The purpose of this study was to find the effect of preoperative stoma site marking on postoperative stoma related complication. METHODS: We recruited 127 colostomy patients who underwent sigmoid or descending end colostomy, by elective operation. Transverse colostomy, loop colostomy, and emergency operation were excluded in this study. We divided the patients into two groups according to pre-operative stoma site marking by an enterostomal therapist. Postoperative stoma related complications were compared and analysed prospectively using chi-square test and paired t-test. Significance was assigned to a P value of < 0.05. RESULTS: Among 127 patients, 49 were marked preoperatively (marking group) while 78 were not marked (non- marking group). Overall stoma related complications were developed in 32 (25%) cases. Major complications including prolapse, parastomal hernia, stenosis were developed in 10 (8%) cases and minor complications including peristomal dermatitis and wound infection were developed in 22 (17%) cases. Stoma related complications were developed in 7 (14%) cases in the marking group and 25 (32%) cases in the non-marking group (P<0.05). Major complications were developed in 2 (4%) cases in the marking group and 8 (10%) cases in the non-marking group. Minor complications were developed in 5 (10%) cases in the marking group and 17 (22%) cases in the non-marking group. However, the difference in major and minor complications between the groups was not statistically significant. Of minor complications in the non-marking group, 9 (53%) cases due solely to postoperative frequent stool leakage caused by inappropriate location of the stoma. However, in the marking group, postoperative stool leakage was not observed. CONCLUSIONS: Preoperative stoma site marking by an enterostomal therapist may reduce postoperative stoma related complication. All elective procedure that result in stoma formation should be assessed and marked preoperatively.
Colon, Sigmoid ; Colostomy ; Constriction, Pathologic ; Dermatitis ; Emergencies ; Hernia ; Humans ; Prolapse ; Prospective Studies ; Wound Infection

PURPOSE: In Asia including Korea, colonic diverticulosis is a relatively uncommon disease. Recently, the incidences of left colonic diverticulosis in Korea has been increasing, mainly due to a westernized diet and life-style. This study was performed to analyze the clinical manifestations and surgical outcomes of patients with colonic diverticulosis. METHODS: We retrospectively reviewed the medical records of 39 patients with colonic diverticulosis who underwent surgery at Asan Medical Center during July 1989 and December 2001. RESULTS: The male to female ratio was 30:9, and the mean age was 52 (26~78) years. The most prevalent age group was people in fifth decade (13 cases, 33%). Twenty-three cases (59%) were in the right colon, 14 cases (36%) in the left and 2 cases (5%) were bilateral. The relative incidence of left colonic diverticulosis was higher in the elderly patients group (>or=50 years old) (57% vs 15%; P=0.002). Of the three diagnostic tools, the barium enema showed a 63% accuracy, the colonofiberscopy 62% and the abdomen-pelvic CT scan 59%. Bowel perforation (19 cases, 49%) and recurrent abdominal pain (10 cases, 16%) were the common surgical indications. Among 11 cases with bowel perforation accompanying the left colonic diverticulosis, two cases (18%), which underwent one-stage operation, developed complications, while 3 cases (27%) among the other 9 that underwent multi-staged operations, did so. CONCLUSION: The incidences of left colonic diverticulosis were relatively high (36%), especially in the elderly patients (P= 0.002). This study indicates that a tailored surgical procedure, depending on the severity of inflammation, is important in reducing postoperative complications.
Abdominal Pain ; Aged ; Asia ; Barium ; Chungcheongnam-do ; Colon* ; Diet ; Diverticulosis, Colonic* ; Diverticulum ; Enema ; Female ; Humans ; Incidence ; Inflammation ; Korea ; Male ; Medical Records ; Postoperative Complications ; Retrospective Studies ; Tomography, X-Ray Computed

Metastases to the liver from carcinoma of the colon and rectum occur as many as 80% of cases. As resection of metastases is proven to enhance survival and to reduce hepatic recurrence, the criteria for selection of patients and surgery type appear to be indispensable. Purpose: The aim of this study was to assess the prognostic factors after hepatic resection for metastatic colorectal cancer and propose the optimal surgical principles for resection of metastatic colorectal cancer. Methods: Sixty-three patients who underwent initial hepatic resection for liver metastases from colorectal cancer between 1989 and 1998 were analyzed regarding clinical and pathologic parameters. Results: Overall 5-year survival rate was 32%. Preoperative serum CEA level and resection margin of metastatic tumors were found to be significant predictors for poor long-term outcome. Resection margin of greater than 5 mm was closely associated with better survival. In multivariate analysis, resection margin alone was an independent prognostic factor. Conclusions: Preoperative serum CEA level and surgical resection margin may affect the outcome for the patients who underwent hepatic resection for metastatic colorectal cancer. Surgical resection margin must be kept enough to avoid re-recurrence or metastasis during hepatic resection for metastatic colorectal cancer.
Colon ; Colorectal Neoplasms* ; Humans ; Liver ; Multivariate Analysis ; Neoplasm Metastasis ; Rectum ; Recurrence ; Survival Rate

BACKGROUND/AIMS: Recent Korean studies performed over the past few decades have shown diminishing efficacy and unacceptability of clarithromycin-based triple therapy as first-line eradication therapy for Helicobacter pylori infection, based on evidence of a declining eradication rate. Triple therapy continues to be used as first-line eradication therapy despite concerns regarding high clarithromycin resistance among Koreans. Patient compliance and acid suppression are important factors associated with the H. pylori eradication rate. We investigated whether regular administration of a proton pump inhibitor (PPI) 30 minutes before a meal can improve the eradication rate. MATERIALS AND METHODS: We retrospectively analyzed the data of 316 patients who were treated with first-line triple therapy (PPI, amoxicillin, and clarithromycin) for H. pylori infection between January 2012 and September 2017. Patients were divided into 2 groups based on the time of administration of the PPI (group A: before a meal, group B: after a meal). The urea breath test was performed 4~6 weeks after eradication of infection. RESULTS: Notably, 249 patients (78.8%, 249/316) showed successful eradication. The eradication rates in groups A and B were 87.5% (49/56 patients) and 76.9% (200/260 patients), respectively. We observed that regular administration of PPI before meals improved the eradication rate (P=0.079). CONCLUSIONS: We observed that although clarithromycin-based triple therapy was associated with an overall eradication rate <80%, regular PPI administration before meals improved the eradication rate. Regular PPI administration before meals and effective education to improve patient compliance could improve the eradication rate through maximal acid suppression.
Amoxicillin ; Breath Tests ; Clarithromycin ; Education ; Helicobacter pylori ; Helicobacter ; Humans ; Meals ; Patient Compliance ; Proton Pump Inhibitors ; Proton Pumps ; Protons ; Retrospective Studies ; Urea

Background/Aims: Combination of midazolam and opioids is used widely for endoscopic sedation. Compared with meperidine, fentanyl is reportedly associated with rapid recovery, turnover rate of endoscopy room, and quality of endoscopy. We compared fentanyl with meperidine when combined with midazolam for sedative colonoscopy. Methods: A retrospective, cross-sectional, 1:2 matching study was conducted. Induction and recovery time were compared as the primary outcomes. Moreover, cecal intubation time, withdrawal time, total procedure time of colonoscopy, paradoxical reaction, adenoma detection rate, and adverse effect of midazolam or opioids were assessed as the secondary outcomes. Results: A total of 129 subjects (43 fentanyl vs. 86 meperidine) were included in the analysis. The fentanyl group showed significantly more rapid induction time (4.5±2.7 min vs. 7.5±4.7 min, p<0.001), but longer recovery time (59.5±25.6 min vs. 50.3±10.9 min, p=0.030) than the meperidine group. In multivariate analysis, the induction time of the fentanyl group was 3.40 min faster (p<0.001), but the recovery time was 6.38 min longer (p=0.046) than that of the meperidine group. There was no difference in withdrawal time and adenoma detection rate between the two groups. Conclusions The fentanyl group had more rapid sedation induction time but longer recovery time than the meperidine group.