Adenomatous Polyposis Coli ; genetics ; pathology ; Colonic Neoplasms ; classification ; genetics ; pathology ; Colorectal Neoplasms, Hereditary Nonpolyposis ; diagnosis ; genetics ; DNA Glycosylases ; metabolism ; Humans ; Intestinal Polyps ; pathology ; Lymphatic Metastasis ; Neoplasm Staging ; Neuroendocrine Tumors ; classification ; pathology ; Precancerous Conditions ; pathology ; Rectal Neoplasms ; classification ; genetics ; pathology ; World Health Organization

Humans ; Intestinal Polyps ; Colonic Polyps/surgery* ; Intestinal Polyposis ; Colorectal Neoplasms

Acute lower gastrointestinal obstruction due to colorectal neoplasm is a common clinical problem, which frequently requires emergency operation. Morbidity and mortality associated with emergency operation is relatively high, and almost all requires a multi-stage operation. Recently flexible rectal stent has been emerged as an alternative for the management of acute lower gastrointestinal obstruction due to colorectal neoplasm. Thus we analyzed the results of flexible rectal stent treatment for acute lower gastrointestinal obstruction due to colorectal neoplasm. METHODS: From June 1996 to May 1999 47 patients with acute malignant lower gastrointestinal obstruction were included in this study, medical records of these patients were reviewed retrospectively. RESULTS: Of 47 patients 19 were male and 28 were women, with a mean age of 57.3 years (33~77 years). Male to female ratio was 1:1.47. Causes of acute intestinal obstruction were as follows: rectal cancer, 17 patients; sigmoid colon cancer, 18 patients; descending colon cancer, 3 patients; ascending colon cancer, 1 patient; stomach cancer, 5 patients; gall bladder cancer, 1 patient; and uterine cervix cancer, 1 patient; and ovarian cancer, 1 patient. Stent insertion was indicated as palliative treatment in 22 patients and preoperative decompression in 25 patients. Successful stent insertions were achieved in 40 patients (85.1%). Stent insertion was successful in 20 patients (91.0%) among the 22 patients treated for palliation. Stent insertion was successfully achieved in 20 patients (80.0%) among the 25 patients. Stent insertion failure was observed in 7 patients (14.9%). Stent failed due to the complete obstruction, 3 patients; long segmental lesion, 1 patient; anatomic abnormality, 1 patient; multiple lesions, 1 patient, and ultra-low rectal lesion, 1 patient. Colonoscopy-assisted stent insertion was performed in 5 patients. Post-stent complications occurred in 12 patients among the 40 patients (30.0%): stent migration, 8 patients; expansion failure, 2 patients; fecal incontinence, 1 patient; and malposition, 1 patient. The interval between stent insertion and operation was from 1 to 30 days with a median of 7 days. Elective operations were performed as follows: anterior resection, 6 patients; low anterior resection, 7 patients; Miles' operation, 3 patients; sigmoid colostomy, 3 patients; and transverse colostomy, 1 patient. Mean distal resection margin of specimen was 2.3 cm. No postoperative complication was seen. CONCLUSIONS: Multi-stage operation can be avoided with flexible rectal stent without increasing postoperative complications. Complication rate was relatively high in patients whom stent were inserted for palliative intent. Combined colonoscopy increased the successful rate in difficult cases. Immediate operation should be considered for the patients with long segmental lesion, multiple lesions, ultra-low rectal lesion, and when perforation is suspected.
Cervix Uteri ; Colon* ; Colon, Ascending ; Colon, Descending ; Colon, Sigmoid ; Colonic Neoplasms* ; Colonoscopy ; Colorectal Neoplasms ; Colostomy ; Decompression ; Emergencies ; Fecal Incontinence ; Female ; Gallbladder Neoplasms ; Humans ; Intestinal Obstruction ; Male ; Medical Records ; Mortality ; Ovarian Neoplasms ; Palliative Care ; Postoperative Complications ; Rectal Neoplasms ; Retrospective Studies ; Sigmoid Neoplasms ; Stents* ; Stomach Neoplasms

PURPOSE: It has been reported that in colorectal cancer, the positive rate of the cytological examination of ascites is low and that the cytologically positive result of the cancer cell influences its prognosis; nonetheless, not many studies on the correlation of the formation of peritoneal effusion and cancer have been done yet. Thus, this study on the correlation of clinico-pathological findings with peritoneal effusion was initiated. METHODS: The study population, includes a total of 191 patients who underwent an operation for colon cancer and rectal cancer from May 1, 2004, to December 31, 2005. Peritoneal effusion considered to be present in cases with more than 10 cc of body fluid retained in the Douglas pouch, and a cytological test was performed on patients whose retained fluid was more than 50 cc. In all patients, the correlation of the clinico-pathological findings with peritoneal effusion was analyzed, and the volume of effusion and the positive result of peritoneal cytology were compared. RESULTS: Among the 191 patients, patients without peritoneal effusion numbered 133 (69.6%) and patients with peritoneal effusion numbered 58 (30.4%). Between the two groups, the presence of intestinal obstruction due to cancer (P<0.001), perineural involvement (P=0.025), lymph node metastasis (P=0.004), lymph-node stage (P=0.001), distal metastasis (P=0.012), macroscopic peritoneal dissemination, and stage (P=0.017) were statistically significantly different. In the multivariate analysis, only the presence of intestinal obstruction and lymph-node disease stage correlated statistically significantly to the formation of peritoneal effusion (P=0.009, 0.004). Twenty patients (34.5%) had peritoneal effusion of more than 50 cc, and among them, malignant cells were detected in 3 patients (15%). Based on 50-cc peritoneal effusion, more or less effusion and the detection of malignant cells by peritoneal cytology did not correlate with the clinico- pathological outcomes (P>0.05). CONCLUSIONS: For colorectal cancer patients with peritoneal effusion, but without co-morbid medical diseases inducing such peritoneal effusion, by regarding peritoneal effusion itself as meaningful, the range of lymphadenectomies, adjuvant chemotherapy, and other additional therapy should be considered.
Ascites ; Ascitic Fluid* ; Body Fluids ; Chemotherapy, Adjuvant ; Colonic Neoplasms ; Colorectal Neoplasms* ; Douglas' Pouch ; Humans ; Intestinal Obstruction ; Lymph Node Excision ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Rectal Neoplasms

Acolonic polyp is a circumscribed mass of tissue that projects above the surface of the intestinal mucosa, which may be classified as either pedunculated or sessile, depending on whether or not it contains a discrete stalk, and according to the size and type. It has been believed that colorectal cancer evolves from a precursor lesion, the adenomatous polyp. The introduction of colonoscopy in the early 1970s, followed by the demonstration of the feasibility of colonoscopic polypectomy, provided the technology for the application of this concept to clinical practice. Colorectal cancer can be prevented through examination of the entire colon and identification of a polyp to be resected. According to the National Polyp Study in the USA, the incidence of colorectal cancer is reduced by 76~90% following colonoscopic polypectomy. Colonoscopy and polypectomy, when performed by adequately trained physicians, is a safe and effective procedure that can decrease deaths resulting from colorectal cancer.
Adenomatous Polyps ; Colon ; Colonic Neoplasms ; Colonic Polyps ; Colonoscopy ; Colorectal Neoplasms ; Diagnosis* ; Incidence ; Intestinal Mucosa ; Polyps*

Irinotecan (CPT-11) is a chemotherapeutic agent that inhibits topoisomerase I and has shown efficacy against advanced colorectal cancer. Diarrhea is the most common toxicity that has been reported to be as high as 87% in patients treated with irinotecan. However, the serious complications including acute hemorrhagic colitis, intestinal ulceration, and intestinal perforation may be uncommon events with irinotecan therapy. We report the first Korean case of acute hemorrhagic colitis induced by irinotecan administration in the patient with advanced colon cancer.
Colitis* ; Colonic Neoplasms ; Colorectal Neoplasms ; Diarrhea ; DNA Topoisomerases, Type I ; Humans ; Intestinal Perforation ; Ulcer

The use of colonoscopy is important to prevent colon cancer. Despite the safety of the colonoscopy procedure, the most common complication of a colonoscopy is perforation, which occurs with a rate of approximately 0.3% during diagnostic colonoscopy and occurs with a rate of approximately 1.1% with the use of therapeutic colonoscopy. Surgery is the treatment of choice for most cases of colonic perforation. With the development of endoscopic devices and techniques, conservative treatment of colonic perforation has been reported by the use of endoscopic clipping. We report here a patient with iatrogenic perforation of the sigmoid colon that was caused by diagnostic colonoscopy. The perforation presented as pneumoretroperitoneum, which was successfully treated with endoscopic clipping.
Colon ; Colon, Sigmoid ; Colonic Neoplasms ; Colonoscopy ; Humans ; Intestinal Perforation ; Retropneumoperitoneum

Hereditary syndromes cause approximately 5 to 15% of overall colorectal cancer (CRC) cases. Hereditary CRC is conventionally divided into two major categories: hereditary non-polyposis colorectal cancer (HNPCC) and those related to polyposis syndromes including familial adenomatous polyposis (FAP), Peutz-Jegher syndrome (PJS), and juvenile polyposis (JP). The screening for the cancer and methods of treatment applied to patients with hereditary CRC are quite different from those applied to the general population. The genes responsible for these syndromes has recently identified, as a result, genetic testing has become the most important determining factor in clinical decisions. Germ-line mutation of the APC gene induces FAP, an autosomal dominant disorder, characterized by the development of hundreds to thousands of colonic adenomas. CRC appears in almost all affected individuals by the time they are 50 years of age. An affected individual should undergo colectomy by his/her late teens. Furthermore, according to the findings of genetic testing, at-risk family members also need endoscopic surveillance and surgery. Recently, a mutation on the MYH gene is increasingly being investigated in patients with multiple polyps, and autosomal recessive MYH polyposis is considered to be a new category of polyposis. More common than FAP, HNPCC is caused by germ-line mutations in DNA mismatch repair genes, mainly MLH1 and MSH2. Although there is no polyposis, polyps seem to be more villous and dysplastic and appear to grow rapidly into CRCs. The aggregate lifetime risk of CRC is about 80% for mutation carriers. The risk for other types of cancer, such as endometrial, ovarian, small bowel, and transitional cell cancer, is also increased. The Amsterdam criteria and Bethesda guidelines are the best-known tools for diagnosis and genetic testing, and colectomy followed by endoscopic follow-up is the standard treatment. PJS and JP are reported to be characterized by hamartomatous polyps throughout the GI tract and germ-line mutations in the STK11 gene (PJS) and the DPC4/BMPR1A gene (JP).
Adenomatous Polyposis Coli/*genetics ; Colorectal Neoplasms, Hereditary Nonpolyposis/diagnosis/*genetics ; Genetic Predisposition to Disease ; Germ-Line Mutation ; Humans ; Intestinal Polyposis/diagnosis/*genetics ; Peutz-Jeghers Syndrome/diagnosis/*genetics

Adenomatous Polyps ; pathology ; Colonic Polyps ; pathology ; Colorectal Neoplasms ; pathology ; Diagnosis, Differential ; Hamartoma Syndrome, Multiple ; pathology ; Humans ; Intestinal Polyposis ; pathology ; Intestinal Polyps ; pathology ; Peutz-Jeghers Syndrome ; pathology ; Rectal Diseases ; pathology

Colonic Polyps/surgery* ; Colonoscopy ; Colorectal Neoplasms/surgery* ; Humans ; Intestinal Polyposis ; Microsurgery ; Treatment Outcome