No abstract available.

Despite a recent trend toward increased screening and public awareness for colorectal cancer, 30% of patients present with incurable disease. This study was designed to identify objective criteria that might help surgeons decide which patients with incurable colorectal cancer will benefit from palliative resection. Among 33 patients considered incurable colorectal cancer, twenty one patients underwent palliative resection and twelve patients had bypass surgery. Incidence of postoperative complication after palliative resection was 61.9%(13 cases), and after bypass surgery was 58.3%(7 cases). Among patients treated by palliative resection, one patient required reoperation for postoperative bleeding. The operative mortality after palliative resection was 19%(4 cases), and after bypass surgery was 25%(3 cases). The median survival was 11.4 months for patients treated by palliative resection, and was 9.7 months for patients treated by bypass surgery. These results show that palliative resection can be done safely and effectively in patients with incurable colorectal cancer. We believe this approach improved the quality of the remaining life in these patients.
Colorectal Neoplasms* ; Hemorrhage ; Humans ; Incidence ; Mass Screening ; Mortality ; Postoperative Complications ; Reoperation

The management of malignant left colon obstruction remains a difficult problem. Conventional surgical treatment is muti-staged and each stage carries its own morbidity and mortality. The purpose of this study is to identify the feasibility and safety of one stage operation in patients presenting with acute obstruction of the left colon. From January 1991 to June 1996, 29 patients received one stage resection for acutely obstructed carcinoma of the left colon at Soonchunhyang University Chunan Hospital. Subtotal colectomies were performed in 9 patients(31.0%), left hemicolectomies in 6(20.7%), low anterior resection in 6(20.7%), sigmoid colectomy in 4(13.8%), anterior resection in 4 patients(13.8%). Subtotal colectomy was performed in patients with massively distended colon of dubious viability and to contain ischemic lesions at proximal colon. Total operative mortality was 6.9%: 5% in the immediate resection with anastomosis group, 11.1% in subtotal colectomy group. Complications included wound infection(4), fecal incontinence(2), intestinal obstruction(2), anastomotic leakage(1), upper G-I bleeding(1), postoperative bleeding(1), pulmonary complication(1). Our results suggest that resection and primary anastomosis can be performed with acceptable morbidity and mortality in patients with acute malignant obstruction of the left colon.
Chungcheongnam-do ; Colectomy ; Colon* ; Colon, Sigmoid ; Humans ; Mortality ; Wounds and Injuries

Although many improvements have been made in surgical technique, as well as preoperative and postoperative care, the pancreaticoduodenectomy remains a technically difficult procedure attended by relatively high morbidity and mortality rates. This study concerns a total of 43 patients that underwent a pancreaticojejunostomy using a polyethylene stent by the Dunking method in a pancreaticoduodenectomy at Soon Chun Hyang University Hospital from January 1990 to December 1996. The results obtained are as follows:1) In our study, there were 13 patients with pancreatic head cancer, 11 patients with ampulla of Vater cancer, 5 patients with distal common bile duct cancer, 4 patients with duodenal cancer, 3 patients with chronic pancreatitis, 3 patients with trauma, 3 patients with a choledochal cyst, 1 patient with stomach cancer. 2) There were 23 men (53.5%) and 20 women (46.5%). 3) Postoperative complications developed in 25 patients (58.1%). Of the complications, bleeding was the most commonly observed, after which, in order of frequency, wound infection, leakage at the anastomotic site, intestinal obstruction, and intraabdominal abscess were also observed. 4) The overall operative mortality was 13.9% (excluding emergency cases, mortality was 7.5 %). Four patients died of intraabdominal or gastrointestinal bleeding, one patient died of pancreatic leakage, and one of hepatic failure. 5) Transfusion during the operation (above 5 pints) was significantly correlated with operative morbidity. Preoperative percutaneous transhepatic biliary drainage (PTBD) with serum bilirubin greater than 10 mg/dl significantly decreased the operative morbidity. 6) A prothrombin time more than 13.9 second, serum albumin less than 3.0 g/dl, and an emergency operation were significantly correlated with operative mortality.
Abscess ; Ampulla of Vater ; Bilirubin ; Choledochal Cyst ; Common Bile Duct ; Drainage ; Duodenal Neoplasms ; Emergencies ; Female ; Head and Neck Neoplasms ; Hemorrhage ; Humans ; Intestinal Obstruction ; Liver Failure ; Male ; Mortality* ; Pancreaticoduodenectomy* ; Pancreaticojejunostomy* ; Pancreatitis, Chronic ; Polyethylene ; Postoperative Care ; Postoperative Complications ; Prothrombin Time ; Serum Albumin ; Stents* ; Stomach Neoplasms ; Wound Infection

PURPOSE: This research was performed to investigate the relationship between CD44 and cancer cell invasion depth, histologic differentiation, tumor size and lymph node metastasis in the gastric carcinoma. MATERIALS AND METHODS: In 20 cases of early gastric cancer and 40 cases of advanced gastric cancer, the immunohistochemical staining for CD44v3 and CD44v5 was performed. RESULTS: 1. In all 60 cases, the positive rates for CD44v3 and CD44v5 were 18.3% and 71.7% respectively. 2. CD44v5 was expressed in 45% of early gastric cancer and 85% of advanced gastric cancer. 3. Larger tumor exhibited higher positive rates for CD44v5. 4. There were 28 cases of lymph node metastases out of 43 cases of CD44v5-positive primary gastric carcinoma (65.1%), and were 4 cases of lymph node metastases out of 17 CD44v5-negative cases (23.5%). 5. The 5 year survival rate was low in CD44v5- positive cases (p-value=0.039). CONCLUSION: The tumors that exhibit deep invasion and have large size and lymph node metastases tend to have more frequent expression of CD44v3 and CD44v5. In especially CD44v5. We found a good correlation between he expression of CD44v5 and the established prognostic factors. Actually we can use the CD44v5 rather than CD44v3 as a prognostic factor in advanced gastric cancer.
Lymph Nodes ; Neoplasm Metastasis ; Stomach Neoplasms* ; Survival Rate

BACKGROUND: The optimum surgical treatment for rectal prolapse is controversial, and many different operations have been described. The aim of this study is to evaluate the results of a perineal procedure for the treatment of rectal prolapse. METHODS: Between February 1990 and March 1997, 16 consecutive patients underwent perineal rectosigmoidectomy for a complete rectal prolapse. One patient was lost to follow up. The remaining 15 patients were followed up for an average of 58.4 (9~94) months, and clinical and functional outcomes were evaluated. RESULTS: There were 8 males and 7 females, and ages ranged from 18 to 65 years. The mean prolapse duration was 10.7 (0.25~30) years. There were no postoperative deaths. Two patients developed postoperative complications (one wound infection and the other wound hematoma). Five patients had fecal incontinence prior to surgery. Three of the five patients had improved fecal incontinence after the procedure. There were three recurrences (recurrence rate of 20%): one of them underwent a Delorme operation at our institution and others had no treatment. CONCLUSION: A perineal rectosigmoidectomy is a safe and effective operation for the primary treatment of rectal prolapse and has low mortality and morbidity.
Fecal Incontinence ; Female ; Humans ; Lost to Follow-Up ; Male ; Mortality ; Postoperative Complications ; Prolapse ; Rectal Prolapse* ; Recurrence ; Wound Infection ; Wounds and Injuries

The Roux-en-Y esophagojejunostomy is one of the most common means of reconstructive surgery after a total gastrectomy. While these Roux operations work well in the majority of patients, approximately 30% of individuals undergoing them develop the so-called Roux stasis syndrome, consisting of chronic abdominal pain, nausea, vomiting, and postprandial bloating. The Roux stasis syndrome is thought to result from the jejunal transsection performed during the construction of a conventional Roux limb. The aim of this study was to review a new type of uncut Roux procedure, in which staple lines and loop ligation maintain myoneural continuity and prevent the Roux stasis syndrome between the proximal jejunum and the Roux limb. At the same time, a jejunojejunostomy provides distal diversion of pancreaticobiliary secretions. The postoperative courses of 23 cases of the uncut Roux procedure with staples after a total gastrectomy were compared with those of 18 cases of afferent proximal loop ligation with hand-sewn sutures, the procedures having been performed between May 1995 and January 1997. Passage of contrast media through the ligated afferent jejunal loop was identified in 34.8% of cases and occluded staple lines was identified in 38.9% of cases. It was found that the uncut Roux procedure prevents the Roux stasis syndrome and that the current technique has a high incidence of dehiscence of the staple lines and the loop ligation with subsequent reflux esophagitis. Because of the results reported here, other techniques, which maintain enteric myoneural continuity to an uncut Roux limb while providing complete and permanent diversion of the alkaline secretions distally from the esophagus, need to be developed before this type of anatomic reconstruction can be recommended.
Abdominal Pain ; Contrast Media ; Esophagitis, Peptic ; Esophagus ; Extremities ; Gastrectomy* ; Humans ; Incidence ; Jejunum ; Ligation ; Nausea ; Sutures ; Vomiting

BACKGROUND : The purpose of this study was to determine whether the Billroth I method using an EEA stapler is safe, reliable, and easy-to-use for treatment of gastric cancer compared with a distal gastrectomy with conventional manual anastomosis. METHODS : A prospective comparative study was performed between forty patients with EEA stapling and thirty patients with manual suturing during gastroduodenostomies performed during the past three years with respect to operation time, diameter of anastomosis, postoperative clinical course, and post operative complications. RESULTS : The operation time was significantly shortened by about 50 minutes on the average, in the cases where the EEA stapler was used (p<0.001). On postoperative hypotonic duodenography, the diameter of the anastomosis was significantly larger in the cases where the EEA stapler was used (p< 0.001). However, the postoperative clinical course showed no difference between the two groups. Complications, such as anastomotic stenosis and anastomotic leak age were noted only in the cases where manual suturing was used. CONCLUSIONS : A gastroduodenostomy using the EEA stapler might be a faster, simpler and safer pro cedure compared with the gastroduodenostomy using the conventional manual anastomosis.
Anastomotic Leak ; Bezafibrate ; Constriction, Pathologic ; Gastrectomy* ; Gastroenterostomy* ; Humans ; Prospective Studies ; Stomach Neoplasms ; Stomach*

An annular pancreas is a rare congenital variant of the pancreatic anatomy, which may cause symptoms of gastric outlet obstruction and recurrent pancreatitis, and is often hard to diagnose before operation. The case of an annular pancreas with intermittent abdominal pain in a 38-year-old alcoholic man is described. A duodenal obstruction with consecutive ulcers was the clinical manifestation in this patient. The annular pancreas was diagnosed by using hypertonic duodenography followed by pancreatic angiography. The duodenoscopy revealed stenosis of the pancreas. A duodeno-duodenostomy relieved the symptoms. The patient had an uneventful recovery following a operation.
Abdominal Pain ; Adult* ; Alcoholics ; Angiography ; Constriction, Pathologic ; Duodenal Obstruction ; Duodenoscopy ; Gastric Outlet Obstruction ; Humans ; Pancreas* ; Pancreatitis ; Ulcer

This report is a retrospective clinical analysis fo 84 cases more than 65 years of colorectal carcinoma treated surgically by the Department of General Surgery, College of Medicine, Soon Chun Hyang University from January 1991 to December 1995. The average age was 71.3 years; 49 patients were male and 35 were female. Tumor location was as follows; rectum 39(46.4%), sigmoid 22(26.2), ascending colon 12(14.3%), descending colon 8(9.5%), transverse colon 3(3.6%). The most frequent symptom in colorectal cancer was abdominal pain. The patients whose clinical symptom had been for less than 1 month before the hospitalization was about 31.0%. The rate of curative resection was 88.1%, Emergency operation was performed about 19.0%(16 cases). By Astler Coller classification, there were stage A 2 cases(2.5%), Bl 13 cases(16.5%), B2 28 cases(35.4%), Cl 2 cases(2.5%), C2 24 cases(30.4%), D 10 cases(12.7%). The average size of mass was 4.41 on. The most common pathologic type was moderately differentiated adenocarcinoma. Postoperative mortality rate was 4.7%(4 cases). The 5 year cumulative survival rate was 42.9%. In conclusion, the postoperative mortality and survival rates obtained in this study encourage us not to consider age as a limiting factor for curative surgical treatment. Early detection of colorectal cancer, adequate management of preoperative underlying disease and aggresive curative resection are improving outcome in the surgery of old aged patients with colorectal cancer.
Abdominal Pain ; Adenocarcinoma ; Aged* ; Classification ; Colon, Ascending ; Colon, Descending ; Colon, Sigmoid ; Colon, Transverse ; Colorectal Neoplasms* ; Emergencies ; Female ; Hospitalization ; Humans ; Male ; Mortality ; Rectum ; Retrospective Studies ; Survival Rate