PURPOSE: Carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA 19-9) are the most frequently used tumor markers in the clinical setting of colorectal cancer (CRC). This study was designed to investigate the correlation between preoperative serum levels of CA 19-9 (pre-CA 19-9) and the clinicopathologic factors of patients with CRC. METHODS: A study was performed on 333 patients with histologically diagnosed colorectal adenocarcinoma between December 2008 and November 2011, based on prospective collected data. The clinical data such as age, sex, location of tumor, size of tumor, differentiation, depth of tumor (T), lymph node metastasis (N), distant metastasis (M), lymphatic invasion, venous invasion, perineural invasion, stage, and preoperative serum levels of CEA (pre-CEA) and pre-CA 19-9 were obtained. These patients were classified into two groups according to pre-CA 19-9 (CA 19-9 high: >39 U/mL, n = 61 [18.3%]; CA 19-9 normal: <39 U/mL, n = 272 [81.7%]). RESULTS: Sixty-one patients among 333 patients (18.3%) with CRC showed a high pre-CA 19-9. The elevation of pre-CA 19-9 was significantly associated with size of tumor (4.8 +/- 0.1 cm vs. 6.1 +/- 0.3 cm, P < 0.001), right colon cancer (P < 0.001), depth of tumor (P < 0.001), lymph node metastasis (P < 0.001), distant metastasis (P < 0.001), perineural invasion (P = 0.008), peritoneal seeding (P < 0.001), and stage (P < 0.001). On multivariate analysis, high pre-CA 19-9 was shown to be independently associated with high pre-CEA, lymph node metastasis, right colon cancer, large tumor size, and peritoneal seeding. There were twelve patients confirmed for peritoneal seeding among 333 patients (3.6%). CONCLUSION: High pre-CA 19-9 in advanced colorectal cancer might provide important information to predict the possibility of peritoneal seeding.
Adenocarcinoma ; Biomarkers, Tumor ; Carcinoembryonic Antigen ; Colonic Neoplasms ; Colorectal Neoplasms ; Humans ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Prospective Studies ; Seeds

PURPOSE: The aim of this study was to evaluate the interim oncologic outcome following a laparoscopic resection of colon cancer. METHODS: Prospectively collected data was obtained on 119 patients (M:F=60:59, mean age=56 years) undergoing a laparoscopic colon-cancer resection between January 2001 and May 2004. Fifty-nine tumors were in the sigmoid, 17 in the right colon, 15 in the transverse colon, 12 in the hepatic flexure, 12 in the left colon, 10 in the cecum, and 4 in the splenic flexure. RESULTS: The operative procedures included 51 sigmoidectomies, 48 right colectomies, 15 left colectomies, 3 transverse colectomies, and 2 total abdominal colectomies. The mean operative time was 186 minutes. The mean blood loss was 91 ml. Conversion to an open procedure was not required. TNM stages were 0 in 11 patients, I in 19, II in 55, III in 30, and IV in 4. The portion of T3 plus T4 was 73%. The mean number of resected lymph nodes was 27. The mean proximal and distal margins were 14 cm and 12 cm. The overall morbidity rate was 26% (15 wound seromas/ abscesses, 5 chylous leaks, 3 perianastomotic inflammations, 2 ileus, 2 intraabdominal bleedings, 1 anastomotic leak, 1 anastomotic obstruction, 1 intractable hiccup, 1 fungal peritonitis). There were no operative mortalities. The mean hospital stay was 10 days. Ninety eight patients were followed-up longer than 6 months (median 19 months, range 6~0 months) after the curative resection. Distant metastases occurred in 3 stage-IIIB and 3 stage-IIIC patients (6%): liver (2), liver & peritoneum (1), lung (1), paraaortic and iliac lymph nodes (1), and peritoneum (1). The mean time to recurrence was 10.3 months after the operation There were no local or port-site recurrences. CONCLUSIONS: In this study, Laparoscopic resections of colon cancer provided an acceptable morbidity rate and satisfactory early oncologic outcomes. Long-term follow-up is mandatory and ongoing.
Abscess ; Anastomotic Leak ; Cecum ; Colectomy ; Colon* ; Colon, Sigmoid ; Colon, Transverse ; Colonic Neoplasms* ; Conversion to Open Surgery ; Follow-Up Studies ; Hiccup ; Humans ; Ileus ; Inflammation ; Length of Stay ; Liver ; Lung ; Lymph Nodes ; Mortality ; Neoplasm Metastasis ; Operative Time ; Peritoneum ; Prospective Studies ; Recurrence ; Surgical Procedures, Operative ; Wounds and Injuries

PURPOSE: The aim of this study was to assess the recurrence pattern after a curative laparoscopic resection for colorectal cancer according to timing of recurrence and the location of the primary tumor. METHODS: Between July 1999 and December 2003, we included 318 patients who underwent a laparoscopic resection for stage I-III colorectal cancer and in whom recurrence had been detected within two postoperative years and who had been followed up for more than two years. The mean age was 57 (23~88) years. The median follow-up time was 36 (7~71) months. RESULTS: The number of rectal cancer patients was 214, and that of colon cancer patients was 104. The total recurrence rate was 15.4%, 7.7% among colon cancer patients and 19.2% among rectal cancer patients. Recurrence according to stage was as follows: stage I: 1.6%, stage II: 5.4%, stage III: 32.5%. Of the total recurrence, 79.6% occurred within two postoperative years. In patients with rectal cancer, local recurrence was more common than in patients with colon cancer. Other types of recurrence were not influenced by the location of the primary tumor. According to timing of recurrence, metastasis to distant lymph nodes developed proportionally after two postoperative years. CONSLUSIONS: Most of the recurrencs developed within two years after a laparoscopic resection for colorectal cancer. The recurrence pattern varied with the location of primary tumor and the timing of recurrence. The recurrence pattern after a laparoscopic resection for colorectal cancer was similar to that after open surgery for colorectal cancer.
Colonic Neoplasms ; Colorectal Neoplasms* ; Follow-Up Studies ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Rectal Neoplasms ; Recurrence*

PURPOSE: This study aimed to assess the oncologic outcomes after a laparoscopic resection in rectal cancer patients with minimum 2-year follow-up. METHODS: Among the 312 patients undergoing a laparoscopic rectal cancer resection between Jan. 2000 and Dec. 2004 at Hansol Hospital, 110 patients who had been followed-up for longer than 24 months (mean 33, range 24~56) after the curative resection were included in this study. Two patients (1.8%) received preoperative chemoradiation. Five patients (4.5%) received radiotherapy postoperatively. RESULTS: TNM stage was 0 in 5 patients, I in 25 (22.7%), II in 35 (31.8%), and III in 45 (40.9%). The T stage was as follows; Tis:T1:T2:T3:T4=4.5%:3.6%:25.5%:40.9%:25.5%. A protective ileostomy was performed in nine patients. The mean operative time was 208 minutes, and the mean blood loss was 179 ml. The mean number of removed lymph nodes was 18, and the mean distal margin was 3.0 cm. The radial margin was positive in one case. Conversion was required in three cases (2.7%). The overall morbidity rate was 17.2%. Anastomotic leak age occurred in five patients (5.5%). There was no operative mortality. During 33 months of mean follow-up, distant metastases and local recurrence were seen in 17 (15.5%) and 5 patients (4.5%), respectively. None had port-site recurrence. For the 94 patients with rectal cancer within 12 cm from the anal verge, the rate of local recurrence was 5.3%. The overall survival rate was 88.9% at 3 years (stage 0, I: 100.0%, stage II: 100.0%, stage III: 72.6%). The disease free survival rate was 78.8% at 3 years (stage 0, I: 100.0%, stage II: 88.6%, stage III: 56.9%). CONCLUSIONS: A laparoscopic resection of rectal cancer provides an acceptable safety profile. If the highly selective indications for radiotherapy (6.3%) and the rather high volume of advanced cancers (stage III 40.9%, T3/4 66.4%) of this study are considered, a 4.5% local recurrence rate is promising. Optimal surgery for rectal cancer by using a laparoscopic technique may reduce the need for radiotherapy.
Anastomotic Leak ; Disease-Free Survival ; Follow-Up Studies* ; Humans ; Ileostomy ; Lymph Nodes ; Mortality ; Neoplasm Metastasis ; Operative Time ; Radiotherapy ; Rectal Neoplasms* ; Recurrence ; Survival Rate

Colonic lipomas are rare diseases. Incidence of colonic lipomas is only 0.1~4.4%. However, after benign adenomatous polyp, they are the second most common benign disease of the colon. Most colonic lipomas do not require treatment. However, large colonic lipomas or those that cause symptoms require treatment (>2 cm). There are several options for treatment. For example, endoscopic removal, laparoscopic surgery, and open surgery can all be considered. We report on two cases of giant colonic lipomas that caused symptoms. Both were located at the splenic flexure colon, and were safely treated with laparoscopic surgery.
Adenomatous Polyps ; Colectomy ; Colon ; Colon, Transverse ; Incidence ; Laparoscopy ; Lipoma ; Rare Diseases

PURPOSE: Antithrombin (AT) is one of the most important natural inhibitor of coagulation, and patients with disseminated intravascular coagulation (DIC) almost invariably have an acquired deficiency of anti thrombin. The aim of our study is to evaluate the effect of replacement of antithrombin in patients with DIC and low plasma antithrombin levels after trauma or surgery. METHODS: We conducted a retrospective trial in patients with documented DIC. The patients received a loading dose of AT (1,000 IU) initially, followed by 2,000 IU per day for 2-5 days. The complete blood count, the DIC profiles (fibrinogen, FDP, PT, PTT), the AT level, and the biochemial and clinical responses were evaluated. RESULTS: A total of 19 patients with DIC due to trauma and/or postsurgical complications were enrolled. One patient received AT on two separate occasions, so a total of 20 episodes of AT infusion were evaluated. The ratio of males to females was 15:4, and the median age was 56 (range: 6-82). Compared to the initial laboratory findings, the levels of AT, PT, and PTT, as well as the platelet count were significantly improved after the infusion of AT. Biochemical response was achieved in 14 (70%) episodes, but a beneficial clinical effect was obtained in only 8 (40%) episodes. CONCLUSION: Antithrombin concentrate may improve the general status of patients with DIC after trauma and/or surgery. More, extensive clinical trials are required in order to confirm this.
Antithrombin III* ; Blood Cell Count ; Dacarbazine ; Disseminated Intravascular Coagulation ; Female ; Humans ; Male ; Plasma ; Platelet Count ; Retrospective Studies ; Thrombin

PURPOSE: The purpose of this study was to determine whether obesity increases the risk of performing a laparoscopic resection for colorectal cancer. METHODS: Prospectively collected data were obtained for 103 patients who had undergone laparoscopic resection for colorectal cancer from September 2001 to August 2002. Patients who had had a previous abdominal operation, a total colectomy or an additional surgical procedure at the time of colon resection were excluded from the analysis. The patients were divided into two groups based on body mass index (BMI kg/m2): the normal group (BMI <25) and the obesity group (BMI 25). Intraoperative blood loss, operative time, conversion, length of hospital stay and complications were analyzed. RESULTS: Nineteen patients (25%) were obese. Operation time (183.2 min vs 202.1 min) and the blood loss (98.2 ml vs 168.2 ml) were significantly increased in the obese patients, but hospital discharge after surgery (11.7 days vs 11.9 days) and the morbidity rate (8.5% vs 5.3%) were not different between the groups. Conversion to the an open precedure occurred with one obese patient, but that was not related to obesity. In the analysis of the low anterior resection, blood loss (94.6 ml vs 186.6 ml) was significantly higher in obese patients, but no statistically significant differences existed for other surgical outcomes between the two groups. CONCLUSIONS: A laparoscopic resection for colorectal cancer can be safely performed in obese patients.
Body Mass Index* ; Colectomy ; Colon ; Colorectal Neoplasms* ; Humans ; Length of Stay ; Obesity ; Operative Time ; Prospective Studies

PURPOSE: This study was prospectively carried out to determine the concordance between the immunohistochemical assay (IHC) and the enzyme immunoassay (EIA) assessing estrogen receptor (ER) and progesteron receptor (PR) in breast cancer tissues. MATERIALS AND METHODS: Breast carcinoma tissues were obtained from 36 patients. Hormonal receptors were determined by IHC assay using polyclonal antimouse antibody and by EIA. The concordance between two methods and the concordance according to in age, tumor size, stage, and lymph node metastasis of breast cancer patient were analyzed. RESULTS: The concordant rate of ER status was 88.9% between IHC and EIA. ER-IHC(+)/EIA(-) were 3 cases and ER-IHC(-)/EIA(+) was 1 cases. ER-positive was 63.9% in IHC and 53.8% in EIA. The concordant rate of PR status was 86.1% between IHC an EIA. PR-IHC(+)/EIA(-) were 4 cases and PR-IHC(-)/EIA(+) was 1 cases. PR-positive was 61.1% in IHC and 52.8% in EIA. There was high concordance (76.2-100%) in age, tumor size, stage, and lymph node metastasis. CONCLUSIONS: There was high concordance between immunohistochemical assay and enzymeimmunoassay determining estrogen and progesteron receptors in the breast cancer. The IHC assay appears to be a resonable substitute for the EIA to determine hormonal receptors.
Breast Neoplasms* ; Breast* ; Estrogens ; Humans ; Immunoenzyme Techniques ; Lymph Nodes ; Neoplasm Metastasis ; Prospective Studies

PURPOSE: A heterotopic pancreas is defined as one for which pancreatic tissue is present outside its usual or habitual location and without an anatomic relation either of continuity or of vascularization with the pancreas proper. Most heterotopic pancreases are incidentally encountered during surgery, and on rare occasions, epigastric pain, weight loss, hemorrhage, gastric outlet obstruction, and intussusception have been directly attributable to the presence of a heterotopic pancreas. The purpose of this article is to report the clinical characteristics of the heterotopic pancreas. METHOD: We retrospectively observed 24 patients, who had been pathologically proven to have a heterotopic pancreas, at the Department of Surgery, Korea University Hospital, from Jan. 1990 to Dec. 1998. RESULTS: 16 of the 24 cases were found incidentally during operations due to by other primary diseases; 8 cases were symptomatic. The ratio of males to females was 1.18:1 and most common sites were the stomach and the duodenum (71%). The mean size of the lesion was 1.26 cm, and the sizes in symptomatic cases were larger (mean 1.89 cm) than those in cases where the lesions were found incidentally (mean 0.94 cm). We experienced a case of a ductal adenocarcinoma originating from the heterotopic pancreas in the jejunum of a 73 year old man. CONCLUSION: A heterotopic pancreas should be considered in the differential diagnosis of submucosal tumors, polyps, ulceration, and intestinal tumors, When suspected, an intraoperative frozen section is recommended, and the range and the method of the operation should be decided based on the results of the frozen section.
Adenocarcinoma ; Aged ; Diagnosis, Differential ; Duodenum ; Female ; Frozen Sections ; Gastric Outlet Obstruction ; Hemorrhage ; Humans ; Intussusception ; Jejunum ; Korea ; Male ; Pancreas* ; Polyps ; Retrospective Studies ; Stomach ; Ulcer ; Weight Loss

PURPOSE: Splenic artery aneurysm is uncommon, but the increased frequency in use of arteriography, computed tomography, and ultrasonography has resulted in increasing clinical recognition of these lesions. This paper relates our experience in the outcome and management of aneurysms of the splenic artery. METHODS: From January 1992 to October 1999, 12 patients were diagnosed with splenic artery aneurysms. They were retrospectively analyzed. RESULTS: The male to female ratio was 1:4 and the mean age was 46.3 years. The mean of pregnancy history of all women was 3.0 and there were no pregnant women during operation. The associated diseases that might have caused the aneurysms were pancreatitis in 5 patients, portal hypertension in 1, operative trauma in 1, and ill defined pathogenesis in 5 patients. The size of the aneurysms was larger than 2 cm in all patients. The splenic artery aneurysms was located at distal in 9 patients, mid in 1, and proximal in 2 patients. 7 patients were treated surgically (aneurysmectomy without splenectomy in 1 patient, aneurysmectomy with splenectomy in 6 patients). Transcatheter embolization was used in 4 patients. One of them was treated with distal pancreatectomy after two months because of pancreatic pseudocyst. One patient without treatment died 2 years after diagnosis. CONCLUSION: Although surgery remains necessary in splenic artery aneurysms larger than 2 cm, transcatheter embolization is effective in initial treatment of the high risk group in splenic artery aneurysms.
Aneurysm* ; Angiography ; Diagnosis ; Female ; Humans ; Hypertension, Portal ; Male ; Pancreatectomy ; Pancreatic Pseudocyst ; Pancreatitis ; Pregnant Women ; Reproductive History ; Retrospective Studies ; Splenectomy ; Splenic Artery* ; Ultrasonography