No abstract available.
Abdominal Pain*

No abstract available.
Colon* ; Diverticulum*

No abstract available.
Colon* ; Diverticulum*

The effect of perioperative blood transfusion on the survival rate of patients of colorectal cancer was studied. From January 1990 to December 1995, 533 patients with colorectal cancer underwent surgical treatment in the department of surgery, Kangbuk Samsung Medical Center. In these patients, 430 patients with Dukes stages A, B, and C carcinoma were divided into two groups: those who received perioperative blood transfusion and those who did not. Overall survival curves were constructed using Kaplan-Meier method and the differences between curves were tested by using the log-rank test. Comparison of variables between the transfused and nontransfused groups were evaluated with the Student t test and Chi-square test with SPSS program. Two hundred and three patients (47.2%) received transfusions within the perioperative period. The transfused group included patients with tumors of more advanced stage such as Dukes C(60.1% vs. 44.5%, p< 0.05) and more rectal cancer(88.2% vs. 55.5%, p< 0.05). In the other variables such as age distribution, sex difference, histologic grade and perioperative hemoglobin level, there was no significant difference between the transfused and non-transfused group. Although the 5-year overall survival rate was significantly lower in the transfused group than non-transfused(61% vs. 74.2%, p< 0.05), subgroup analysis according to the tumor location and Dukes stage showed no statiscally significant difference in survival in each location and stage between the two groups. It is postulated that the possible adverse influence of blood transfusion on the survival of patients with colorectal cancer is linked to other prognostic features rather than to the immunologic sequelae of the transfusion itself.
Age Distribution ; Blood Transfusion ; Colorectal Neoplasms ; Humans ; Perioperative Period ; Prognosis* ; Sex Characteristics ; Survival Rate

PURPOSE: To review the current standards of pancreaticoduodectomies and show that excellent results can be achieved by a single surgeon. METHODS: A case series of consecutive patients, operated on during the period March 1999 to February 2003, were retrospectively evaluated. The patients' medical records were abstracted for demographic data, clinical presentation, operative indication, operative time, amount of transfusion, perioperative morbidity, mortality and other operative records. RESULTS: The average age was 57.5 years, ranging from 35 to 78. Jaundice was the main presenting symptom (68.3%) and preoperative PTBD was performed at 34 cases (56.7%). The most common indication for this procedure was cancer of the ampulla of Vater (28 cases, 47.3%) and the second was pancreatic head cancer (14 cases, 23.6%). A total of 60 patients underwent a pancreaticoduodectomy during the 4 year period. Fifty-three patients underwent a pylorus- preserving pancreaticoduodectomy (PPPD) and 5 a classical Whipple procedure. The operation lasted an average of 367 minutes, ranging from 250 to 555. The mean operative blood loss was 750 ml, ranging from 180 to 2400. About seventy- two percent of patients had no major complications, 28% had one or two more major complications and there was only one operative mortality (1.7%). The major morbidity was leakage of the pancreaticojejunostomy (5 cases, 8.3%). Delayed gastric emptying occurred in 6 patients. CONCLUSION: The above study demonstrates that a complicated procedure, such as the Whipple pancreaticoduodectomy, can be performed with excellent results by a single surgeon with sufficient experience. The most important prerequisite is that the surgeon be adequately trained in the procedure. In low-volume hospitals, the case load should be restricted to a minimal number of trained surgeons in order to concentrate the experience.
Ampulla of Vater ; Gastric Emptying ; Head and Neck Neoplasms ; Hospitals, Low-Volume ; Humans ; Jaundice ; Medical Records ; Mortality ; Operative Time ; Pancreaticoduodenectomy ; Pancreaticojejunostomy ; Retrospective Studies

No abstract available.
Tongue Neoplasms* ; Tongue*

PURPOSE: This study was designed to evaluate the clinical charateristics, surgical treatment and outcome of carcinoid tumors of the rectum. METHODS: A retrospective review of the charts of all patients treated for rectal carcinoid tumors at Kangbuk Samsung Medical Center between Jan 1989 and April 1998. Thirteen patients with rectal carcinoids tumors were treated. Follow-up data, histopathological information and surgical procedures were obtained from case notes. RESULTS: There were 10 men and 3 women. The ages ranged from 28 to 60 years (mean 41.1 years for all, 43.8 years for men and 32 years for women). Eight patients (61.5%) had no symptoms. Of the five patients, four complained of rectal bleeding (30.8%), and one complained of defecational difficulty (7.7%). Size of rectal carcinoid tumor was less than 1 cm in 7 patients (53.8%), between 1 cm and 2 cm in 2 patients (15.4%), in four patients (30.8%) larger than 2 cm. Three patients were treated in Abdominoperineal resection. Two patients underwent stapled low anterior resection. The remaining 8 patients underwent conservative resection (3 colonoscopic polypectomy and electrocauterization, 2 colonoscopic snaring biopsy, 2 transanal resection and one Mason's operation). The depth of invasion was contained within sutmucosa in 3 patients. Liver metastasis was found in 2 patients. Average follow-up time was 35.6 months. Two patients died of mutiple mestastasis (liver, bone, peritoneum) 9 and 30months later. CONCLUSION: We concluded that tumors smaller than 1 cm could be managed by local treatment whereas larger than 2 cm should be managed by radical treatment.
Biopsy ; Carcinoid Tumor* ; Female ; Follow-Up Studies ; Hemorrhage ; Humans ; Liver ; Male ; Neoplasm Metastasis ; Rectum ; Retrospective Studies ; SNARE Proteins

This study was undertaken to identify the causative factors that predispose to early postoperative intestinal obstructions after the radical resection due to colorectal cancer, and to determine their preventive operative techniques. The records of 722 patients that had undergone radical resection due to colorectal cancer at the Department of General Surgery, Kangbuk Samsung Hospital, between January 1, 1986 and December 31, 1995, were reviewed. Among them, operative treatments due to early postoperative intestinal obstructions were performed in 39 patients(5.4%). The most common cause of intestinal obstruction in early postoperative period was bowel adhesion, that was developed in 20 cases(51.3%), and next common cause was internal herniation of bowel into the space between colostomy loop and lateral peritoneal wall(3 cases, 7.7%), incarcerated herniation of small bowel into the reperitonealized pelvic cavity(3 cases, 7.7%), pelvic abscess(1 case, 2.6%), and unknown causes(9 cases, 23.1%) in descending frequency. Use of closed suction drains was responsible to development of the 3rd and 4th causes. As a result, during the radical resection due to colorectal cancer, meticulous manupulation of bowels not to injure the bowel serosa, reperitonealization of pelvic floor at narrow interval with inversion of its dissected edge, complete closure of the space between colostomy loop and lateral wall of peritoneum, and adequate alternative use of closed suction drain and natural drain according to the operative condition, should be considered. In conclusion, surgeons should pay more attention to the operating procedures to lower the incidence of early postoperative intestinal obstruction.
Colorectal Neoplasms ; Colostomy ; Humans ; Incidence ; Intestinal Obstruction* ; Pelvic Floor ; Peritoneum ; Postoperative Period ; Serous Membrane ; Suction

We examined the interrelationships of depth of penetration, tumor size, and the number of positive lymph nodes in Dukes'c colorectal cancer. This report contains a retrospective study of 256 cases of colorectal cancer that underwent treatment from Jan. 1985 to Dec. 1994 at the Department of Surgery, Kangbuk Samsung Hospital. The most of the patients were on the 6th decades and male to female ratio was 1.27 : 1. By modified Astler-Coller classification, there were stage Cl 29 cases(11.3%), C2 227 cases(88.7%). Eighty patients with colon cancer(31.4%) and 176 patients with carcinoma of the rectum(68.6%) were available for analysis. Utilizing cumulative frequency distributions of tumor size, depth of invasion and the number of positive lymph nodes, comparisons were carried out among three factors. The results indicate that there was no correlation between the longest diameter of the tumor and other two factors but the number of positive lymph node was closely related to depth of invasion. In conclusion, the number of positive lymph node and depth of invasion are very important prognostic factor. But tumor size as a single factor does not correlated with prognosis in Dukes' C colorectal cancer.
Classification ; Colon ; Colorectal Neoplasms ; Female ; Humans ; Lymph Nodes ; Male ; Prognosis ; Retrospective Studies

PURPOSE: Little is known about local recurrence following proximal gastrectomy in patients with upper third gastric cancer. We performed this study to evaluate the long-term results of a proximal gastrectomy, and to analyze the risk factors of local recurrence affecting survival in these patients. MATERIALS AND METHODS: We undertook a retrospective study of 63 patients who underwent potentially curative proximal gastrectomy between 1990 and 1999, with special reference to local recurrence. RESULTS: During a median follow-up period of 37 months, 25 of the 63 patients (39.7%) developed a recurrence of cancer, with local recurrence in 15 patients (23.8%), the majority of these occurring at the remnant stomach or anastomosis. The median time to local recurrence was 38 months (8~78 months). Univariate analysis of risk factors for local recurrence revealed an infiltrative or diffuse gross type, with a tumor sizes>5 cm, a distal resection margin Diagnosis ; Follow-Up Studies ; Gastrectomy* ; Gastric Stump ; Humans ; Prognosis ; Recurrence* ; Reoperation ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms*