PURPOSE: Malignant disease of the anus is rare. Abdominoperineal resection was formerly considered to be the treatment of choice. But, in recent, less ablative and more effective combined therapeutic modalities have been developed. METHODS: we analyzed 33 patients who were diagnosed and treated as anal cancers at the Department of Surgery, Gospel Hospital, Kosin Medical Collage, from July 1, 1988 to Nov. 30, 1997. RESULTS: The ratio of male to female was 1.4:1 and mean age was 56.7 years old. Twenty-two (84.8%) of these cancers were located in the anal canal and 5 (15.2%) in the anal margin. Three main histologic types of the anal cancers were identified: squamous cell carcinoma was the most common lesion, accounted for 17 cases (51.1%), adenocarcinoma accounted for 8 cases (24.2%), malignant melanoma accounted for 8 cases (24.2%). The overall 3-year survival rate and 5-year survival rate of anal cancer were 54.1%, 41.7%. Eleven patients with squamous cell carcinoma were treated curatively: 6 patients were treated with chemoradiotherapy, 3 patients with abdominoperineal resection, one patient with chemoradiotherapy and abdominoperineal resection, one patient with local excision. CONCLUSION: In survival rate, there were no significant differences between chemoradiotherapy group and surgical treatment group. In squamous cell carcinomas, chemoradiotherapy had anal sparing benefit without loss of survival. On univariate analysis, T, N, type of treatment, histologic type had no statistical significances on survival. On multivariate analysis, location of lesion and distant metastasis had statistical significances.
Adenocarcinoma ; Anal Canal ; Anus Neoplasms* ; Carcinoma, Squamous Cell ; Chemoradiotherapy ; Female ; Humans ; Male ; Melanoma ; Multivariate Analysis ; Neoplasm Metastasis ; Survival Rate

Gardner's syndrome is a familial disease consisting of gastrointestinal adenomatous polyposis, osteomas of the mandible, skull, and long bones, and a variety of sol tissue lesions, including sebaceous cysts, fibromas, lipomas, and desmoid tumors. The colon is the most common site for polyposis, but the stomach, duodenum, small bowel, and periampullary area may also be involved. The diagnostic evaluation, malignant potential, and management is identical to that for familial adenomatous polyposis. The extracolonic manifestations of Gardner's syndrome are frequent and varied. Gardner's syndrome is inherited as autosomal dominant traits. Authors experienced one case that is a 32 year old female patient who had colonic and duodenal multiple polyposis, desmoid tumor in abdominal wall and right mesocolon and odontoma on mandible.
Abdominal Wall ; Adenomatous Polyposis Coli ; Adult ; Colon ; Duodenum ; Epidermal Cyst ; Female ; Fibroma ; Fibromatosis, Aggressive ; Gardner Syndrome* ; Humans ; Lipoma ; Mandible ; Mesocolon ; Odontoma ; Osteoma ; Skull ; Stomach

No abstract available.
DNA* ; Ploidies* ; Stomach Neoplasms* ; Stomach*

Familial adenomatous polyposis (FAP) is an hereditary autosomal dominant disease characterized by development of hundreds to thousands of adenomatous polyps in the colon and rectum. The common symptoms are bloody stool, diarrhea, and abdominal pain. The average age at onset of symptoms is 33 years. Because of inevitable progression to malignancy, it is necessary to remove the entire colonic and rectal mucosa. Current surgical options are total proctocolectomy with permanent ileostomy, trans-abdominal colectomy with ileorectal anastomosis (IRA), and restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA). Recently IPAA can give optimum control of colorectal polyposis in FAP patients with an acceptable incidence of postoperative complications and satisfactory functional results. We experienced one case of FAP who had malignacy in the remained rectum after subtotal colectomy. IPAA was done and the result was satisfactory.
Abdominal Pain ; Adenomatous Polyposis Coli* ; Adenomatous Polyps ; Colectomy* ; Colon ; Diarrhea ; Humans ; Ileostomy ; Incidence ; Mucous Membrane ; Postoperative Complications ; Proctocolectomy, Restorative ; Rectum*

No abstract available.
Kidney Transplantation*

PURPOSE: Mechanical bowel preparation aims to eliminate solid stool in the colon prior to colonoscopy and colorectal surgery. During colorectal surgery, a clean bowel has advantages such as a lower bacterial load, reduced chance of spillage of fecal content, and easiery handling of the bowel. The aim of this prospective trial was to compare polyethylene glycol (PEG) and sodium phosphate solutions for colorectal surgery according to patient's tolerance, side effects, cleansing quality, and postoperative complication. METHODS: Eighty patients prospectively received either a standard 4 liter PEG solution or a 90 ml oral sodium phosphate solution. Patient's tolerance for solution was assessed with a detailed questionnaire. Before and after bowel preparation, we checked the patient's body weight, blood pressure, pulse, and biochemical parameters such as hematocrit, serum electrolyte, blood urea nitrogen, and creatinine levels. The cleansing quality was checked by the surgeon during the operation. Statistical analysis was performed using the chi-square test for patient's tolerance, body weight, blood pressure, pulse, and postoperative complication and using the paired t-test for biochemical parameters with SPSS 11.0 version. RESULTS: The PEG and sodium phosphate solutions were each administered to 40 patients, separately. Thirty-seven patients (92.5%) had colorectal cancer in each group. The other underlying diseases were benign tumor, multiple polyps, diverticulitis, and familiar adenomatous polyposis. In comparing tolerance, there was no significant difference in the rate of patients who complained of difficulty on the questionnaire for discomfort (P=0.954), nor in the rate of patients who complained of severe subjective symptoms such as nausea, vomiting, abdominal pain, dizziness and sleep loss. The cleansing quality, body weight, blood pressure, pulse change and postoperative complication rates were not significantly different. In the PEG group, hematocrit (P=0.008), serum magnesium (P=0.03), phosphorus (P= 0.004), and blood urea nitrogen (P=0.001) were decreased and serum chloride (P=0.001) was increased. In the sodium phosphate group, serum sodium (P=0.001) was increased and serum potassium (P=0.018) was decreased. There was no significant changes in serum calcium (P=0.086) and phosphate (P=0.191) in the sodium phosphate group. CONCLUSION: In both groups, there was no significant difference in patient's tolerance, cleansing quality and postoperative complication rate. Though there were some biochemical changes between the two groups, they were not significant clinically. Therefore, the sodium phosphate solution can be substituted for the PEG solution in preoperative bowel preparation.
Abdominal Pain ; Bacterial Load ; Blood Pressure ; Blood Urea Nitrogen ; Body Weight ; Calcium ; Colon ; Colonoscopy ; Colorectal Neoplasms ; Colorectal Surgery ; Creatinine ; Diverticulitis ; Dizziness ; Hematocrit ; Humans ; Magnesium ; Nausea ; Phosphorus ; Polyethylene Glycols* ; Polyethylene* ; Polyps ; Postoperative Complications ; Potassium ; Prospective Studies* ; Surveys and Questionnaires ; Sodium* ; Vomiting

PURPOSE: Preoperative chemoradiation therapy for rectal cancer seems to improve local control, anal sphincter preservation, resectability, and possibly survival in patients. However, there are several adverse effects, too. The aim of this study is to analyze the disadvantages of preoperative chemoradiation for rectal cancer. METHODS: We retrospectively reviewed 139 patients who were treated by using preoperative chemoradiation for an adenocarcinoma of the rectum between January 1995 and December 2004. All patients had fixed or locally advanced lesions, as determined by digital rectal examination. No distant metastasis was proven before preoperative chemoradiation. All of the patiedts received the full scheduled dose of radiation (range, 5,000~5,400 rad). Concurrent intravenous chemotherapy with 5-fluorouracil (425 mg/m2/day) and leucovorin (45 mg/day) was administered continuously on days 1~5 and 29~33. The mean interval between chemoradiation and surgery was 4~6 weeks. After preoperative chemoradiation, 117 patients underwent an operation. We reviewed the side effects of preoperative chemoradiation, postoperative complications, and distant metastases detected during the preoperative period after preoperative chemoradiation and during the operation. RESULTS: The side effects of preoperative chemoradiation were diarrhea (23%), radiation dermatitis (2.2%), fistula (0.7%), sepsis (0.7%), and rectal bleeding (0.7%). Two patients died from sepsis and rectal bleeding. The postoperative complications were bowel obstruction in 9 cases (7.7%), wound seroma in 8 cases (6.8%), wound infection in 5 cases (4.3%), anastomotic leakage in 5 cases (7.1%), rectovaginal fistula in 2 cases (2.8%), an enterocutaneous fistula in 2 cases (1.7%), and a vesicocutaneous fistula in 1 case (0.8%). Distant metastases were detected in 14 patients (10.1%) after preoperative chemoradiation. CONCLUSIONS: Although preoperative chemoradiation can be performed safely, careful management for the side effects of preoperative chemoradiation and for postoperative complications is necessary. We need a more sensitive study method for detecting distant metastasis of rectal cancer, especially during scheduled preoperative chemoradiation.
Adenocarcinoma ; Anal Canal ; Anastomotic Leak ; Dermatitis ; Diarrhea ; Digital Rectal Examination ; Drug Therapy ; Fistula ; Fluorouracil ; Hemorrhage ; Humans ; Intestinal Fistula ; Leucovorin ; Neoplasm Metastasis ; Postoperative Complications ; Preoperative Period ; Rectal Neoplasms* ; Rectovaginal Fistula ; Rectum ; Retrospective Studies ; Sepsis ; Seroma ; Wound Infection ; Wounds and Injuries

PURPOSE: Oxaliplatin is a recently developed active agent in colorectal cancer. Clinical observations have demonstrated synergistic effects of oxaliplatin with 5-fluorouracil (5- FU) and leucovorin (LV), even in 5-FU-resistant colorectal cancer. The purpose of this study was to determine response rates according to clinical factors after oxaliplatin, 5-FU and LV combination chemotherapy (FOLFOX 3) in metastatic colorectal cancer. METHODS: We reviewed 44 patients who had received FOLFOX 3 from Jan. 2000 to Dec. 2002. The combination chemotherapy consisted of oxaliplatin (85 mg/m2 on day 1) as a 2~6 hour infusion followed by continuous infusion of 5-FU (1500 mg/m2 on day 1, 2), concurrently with LV (45 mg on day 1, 2) as a 2 hour infusion. Cycles were repeated by 2-week intervals. We compared the response rates according to clinical factors such as primary sites, cycle, tumor differentiation, metastatic sites, serum CEA, and previous chemotherapy. RESULTS: Of the 44 patients who had received the combination chemotherapy with oxaliplatin, 5-FU, and LV, 19 cases were male, 25 cases were female. The median age was 50.7 years. The primary tumor sites were colon in 21 cases (47.7%), and rectum in 23 cases (52.3%). The metastatic sites were liver in 27 cases (61.4%), lung in 9 (20.5%), pelvis in 3, lymph node in 5, and peritoneum in 1. Thirty- five patients had received the combination chemotherapy as first line. Complete response was observed in 3 cases (6.8%). Partial response was in 7 cases (15.9%), stable disease status in 15 cases (34.1%), progressive disease status in 19 cases (43.2%), respectively. There were a no significant differences in response rates according to primary sites, tumor differentiation, serum CEA, and previous chemotherapy. However, with the metastatic sites, there were significant differences in response rates. Response rates were higher in lung (5/9), lymph node (3/4) metastases than any other metastatic sites (P <0.01). CONCLUSIONS: The objective response rate of FOLFOX 3 was 22.7% in metastatic colorectal cancers. The only significant clinical factor was metastatic sites. The lung and lymph node metastases showed better response than metastatses to liver, pelvis, and peritoneum. To evaluate the differences of response rates according to metastatic sites, we need further study.
Colon ; Colorectal Neoplasms* ; Drug Therapy ; Drug Therapy, Combination* ; Female ; Fluorouracil* ; Humans ; Leucovorin* ; Liver ; Lung ; Lymph Nodes ; Male ; Neoplasm Metastasis ; Pelvis ; Peritoneum ; Rectum

PURPOSE: Irinotecan is a recently developed active agent in colorectal cancer. The combination of irinotecan and 5-fluorouracil (5-FU)/lecovorin (LV), known as the FOLFIRI regimen, has been approved for patients with metastatic colorectal cancer. The purpose of this study was to assess the efficacy and toxicity of the FOLFIRI regimen in the treatment of metastatic colorectal cancer. METHODS: We reviewed the records of 65 patients who had received the FOLFIRI regimen from Jan. 2002 to Dec. 2005. The combination chemotherapy consisted of irinotecan (150~180 mg/m2 on day 1, 15) as a 2~6 hour infusion followed by bolus infusion of 5-FU (400 mg/m2) and continuous infusion of 5-FU (600 mg/m2 on days 1, 2, 15, 16), concurrently with LV (20 mg/m2 on day 1, 2, 15, 16) as a 2 hour infusion. Cycles were repeated in three-week intervals. RESULTS: Of the 65 patients who had received the FOLFIRI regimen, 34 were male and 31 cases female. The median age was 54.4 years. The primary tumor sites were the colon in 29 cases (44.6%) and the rectum in 36 cases (56.4%). The metastatic sites were the liver in 33 cases (50.8%), the peritoneum in 21 (32.3%), the lung in 14 (21.5%), a lymph node in 4, and the pelvis in 2. Twenty-seven patients (41.5%) had received the combination chemotherapy as the first line. Of the patients who received more than 3 cycles, complete response was none. Partial responses were 3 (7.1%), stable disease status in 25 cases (59.5%) and progressive disease status in 14 cases (33.3%). The rate of progressive disease status for patients who had received FOLFIRI as the 2nd or the 3rd line were much higher than that of those who had received it as the 1st line chemotherapy. Early stops (<3 cycles) of chemotherapy were due to toxicity, such as nausea, as diarrhea, in 15 of 19 cases (78.9%). CONCLUSIONS: The objective response rate of FOLFIRI was 7.1% in metastatic colorectal cancers. Nausea, vomiting, and diarrhea were the main causes of intolerance to the chemotherapy in most of the patients.
Colon ; Colorectal Neoplasms* ; Diarrhea ; Drug Therapy ; Drug Therapy, Combination* ; Female ; Fluorouracil* ; Humans ; Leucovorin* ; Liver ; Lung ; Lymph Nodes ; Male ; Nausea ; Pelvis ; Peritoneum ; Rectum ; Vomiting

OBJECTIVES: The purpose of this study is to evaluate feasibility and safety of simultaneous laparoscopy-assisted resection for synchronous colorectal and gastric cancer. METHODS: From January 2001 to December 2013, a total of 29 patients underwent simultaneous resection for synchronous colorectal and gastric cancers. Medical records were reviewed, retrospectively. RESULTS: Eight patients (5 male) underwent laparoscopy-assisted resection (LAP group) and twenty one patients (17 male) underwent open surgery (Open group). In the both group, the mean age (65.2 vs. 63.7 years, p =0.481), body mass index (22.6 vs. 22.3, p = 0.896) was comparable, respectively. In LAP group, laparoscopy-assisted distal gastrectomy was performed for all eight patients. In Open group, subtotal gastrectomy with billroth I gastroduodenostomy was most common procedure (66.7%). The operation time, blood loss volume was similar between the two groups. Gas out was earlier (3.0 vs. 4.6 days p = 0.106), postoperative hospital stay was shorter (12.0 vs. 18.3 days, p = 0.245) in LAP group. The postoperative complications were an ileus, a wound seroma and a bile leakage in LAP group, pneumonia (10.0%), wound bleeding (5.0%) and leakage (5.0%) in Open group. CONCLUSIONS: The simultaneous laparoscopy-assisted resection for synchronous colorectal cancer and gastric cancer is a feasible and safe procedure.
Bile ; Body Mass Index ; Colorectal Neoplasms ; Gastrectomy ; Gastroenterostomy ; Hemorrhage ; Humans ; Ileus ; Laparoscopy ; Length of Stay ; Medical Records ; Pneumonia ; Postoperative Complications ; Retrospective Studies ; Seroma ; Stomach Neoplasms* ; Wounds and Injuries