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Anoplasty for the treatment of anal stenosis.

Myoung Woo CHO ; Eung Bum PARK

Journal of the Korean Society of Coloproctology.1993;9(1):1-8.

No abstract available.
Constriction, Pathologic*

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Signal Transduction Pathways in Colorectal Cancer Carcinogenesis and Metastasis.

Moo Jun BAEK

Journal of the Korean Society of Coloproctology.2005;21(6):433-444.

Cell proliferation and differentiation are regulated by a number of hormones, growth factors. These molecules interact with cellular receptors and communicate with the nucleus of the cell through a network of intracellular signal transduction pathways. A great deal of recent work has defined signal transduction pathways that distinguish malignant from normal cells, and hence identified potential targets for cancer therapy. In colorectal cancer cells, key components of these pathways may be altered by oncogenes through overexpression or mutation, leading to dysregulated cell signaling, inhibition of apoptosis, metastasis, and cell proliferation. The molecular mechanisms and signaling pathways that regulate cell proliferation and survival are receiving considerable attention as potential targets for anticancer strategies. This article was reviewed the role of signal transduction in colorectal cancer, introduce promising molecular targets, and outline therapeutic approaches under development.
Apoptosis ; Carcinogenesis* ; Cell Proliferation ; Colorectal Neoplasms* ; Intercellular Signaling Peptides and Proteins ; Neoplasm Metastasis* ; Oncogenes ; Signal Transduction*

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Hematologic and Non-hematologic Toxicity after Intravenous Adjuvant 5-Fluorouracil and Leucovorin Treatment of Colorectal Cancer: A Prospective Study.

Kyu Jae LEE ; Sun Mi MOON ; Dae Yong HWANG

Journal of the Korean Society of Coloproctology.2005;21(6):426-432.

PURPOSE: Although large clinical trials have been performed attempting to find an optimal 5-fluorouracil (5-FU)-based regimen on the basis of activity and toxicity, there have been few data reporting the toxicity. We experienced a less severe toxicity than previous reports, so we undertook an analysis of the toxicity profiles of 5-FU-based chemotherapy on colorectal cancer patients. METHODS: Forty-two patients were consecutively enrolled in this study from Sep. 2002 to Sep. 2003. The primary endpoints were the incidences of anorexia, nausea, vomiting, diarrhea, constipation, headache, stomatitis, alopecia, and leukopenia, as recorded with the standard National Cancer Institute- Common Toxicity Criteria (NCI-CTC). The regimen used in this study was intravenous infusion of 5-FU, 500 mg/m2, plus leucovorin (LV), 20 mg, daily for 5 days every 4 weeks for 6 cycles. Information on toxic profiles was obtained by questionnaire and blood test data during each cycle of treatment. RESULTS: Of the patients, 73.8% experienced at least one type of toxicity. There were no clinical grade 3/4 toxicities. Toxicites (grade 1/2) were as follows: anorexia (51.2%), nausea (50.4%), constipation (24.6%), headache (11.5%), vomiting (4.0%), diarrhea (2.4%), alopecia (2.0%), stomatitis (0.4%), and leukopenia (4.0%). The most common adverse event was gastrointestinal toxicity (16.6%). There were no deaths attributed to non-hematologic toxicity. There was no dose reduction during any cycle of treatment. In a comparison of the incidence of toxicity by age (<65 and > or =65), gender, and TNM stage, univariate analysis found no statistical differences. CONCLUSIONS: Our data would seem to confirm that Korean patients experienced less incidence and severity of toxicity than Western patients. We believe that the accumulated data provide sufficient evidence that colorectal patients in Korea actually experience a less severe toxicity of 5-FU-based chemotherapy when they are treated on this schedule. Considering this study, a race-specific dose determination for a colorectal cancer adjuvant chemotherapeutic setting is warranted.
Alopecia ; Anorexia ; Appointments and Schedules ; Colorectal Neoplasms* ; Constipation ; Diarrhea ; Drug Therapy ; Fluorouracil* ; Headache ; Hematologic Tests ; Humans ; Incidence ; Infusions, Intravenous ; Korea ; Leucovorin* ; Leukopenia ; Nausea ; Prospective Studies* ; Surveys and Questionnaires ; Research Design ; Stomatitis ; Vomiting

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Functional and Oncologic Outcome of Coloanal Anastomosis in Low Lying Rectal Cancer.

Sang Lim WON ; Ik Yong KIM ; Seong Hoon SUNG ; Dae Sung KIM

Journal of the Korean Society of Coloproctology.2005;21(6):419-425.

PURPOSE: Sphincter preservation is one of the main goal in the treatment of rectal cancer, but surgical management of cancer of the lower third of the rectum continues to evolve. The aim of this study was to evaluate the oncologic safety and to assess the functional results of coloanal anastomosis following ultra low anterior resection (CAA/ uLAR) in distal rectal cancer. METHODS: Thirty-six patients underwent coloanal anastomosis following ultralow anterior resection between January 2000 and February 2005. Main operative techniques were total mesorectal excision with autonomic nerve preservation. Colonic J pouch was made 6 cm in length. All patients were followed up for fecal incontinence and frequency of bowel movement after diverting ileostomy closure. All patients were evaluated for local or systemic recurrences. RESULTS: The mean age of the patients was 58.7 (34~82) years. The median follow-up period was 24.5 (6~55) months. The types of anastomosis were straight anastomosis (n=25), colonic J pouch formation (n=10) and coloplasty (n=1). The twenty-nine patients of thirty-one patients underwent diverting ileostomy were performed ileostomy repair. The twenty-two patients had frequency after ileostomy repair. There is no statistical correlation of reservoir type and frequency (P=0.604). But the relationship between adjuvant radiation and frequency is statistically correlated (P=0.012). Postoperative complications were anastomotic leakage (n=5), but mostly radiological minor leakage, transient paralytic ileus (n=2), and anastomotic stenosis (n=1). The local recurrence rate is 3% and systemic recurrence occurred in 5 patients (14%), most patients were in Astler-Coller stage C. CONCLUSIONS: Ultralow anterior resection and coloanal anastomosis in low lying rectal cancer did not seem to affect recurrence. This procedure has poor functional outcome in early period but normal continence and acceptable frequency of bowel movements can be obtained at 1 year after operation.
Anastomotic Leak ; Autonomic Pathways ; Colon ; Colonic Pouches ; Constriction, Pathologic ; Deception* ; Fecal Incontinence ; Follow-Up Studies ; Humans ; Ileostomy ; Intestinal Pseudo-Obstruction ; Postoperative Complications ; Rectal Neoplasms* ; Rectum ; Recurrence

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Synchronous Lesions in Colorectal Cancer.

Young Jin PARK

Journal of the Korean Society of Coloproctology.2005;21(6):413-418.

PURPOSE: The detection and removal of synchronous cancer and polyps in colorectal surgery is important to prevent the future development of metachronous cancer. However, it is occasionally impossible to evaluate the entire colon with colonoscopy preoperatively due to luminal obstruction by tumors. The aim of this study is to evaluate the incidence of synchronous colorectal tumors and to emphasize the importance of their peri-operative detection through vigorous application of colonoscopy. METHODS: Three hundreds two patients underwent a potentially curative resection for colorectal cancer in Ilsan Paik Hospital from January 2000 to March 2005. Colonoscopy was performed preoperatively or intraoperatively. All the synchronous polyps detected by colonoscopy and contained in the surgical specimen were included in the analysis. The data on synchronous cancer and polyps were collected through medical records and colonoscopic databases. The incidence, the risk factors, and the effects of synchronous polyps on surgery were analyzed. RESULTS: A total of 268 polyps were detected in 112 patients (37%) when all types of polyp were included whereas true adenomatous polyps were present in 78 patients (26%) among 302 patients. Synchronous cancers were found in 14 patients (4.6%). The detection of polyps on preoperative colonoscopy changed the surgical strategy in 30 out of the 223 patients (13.5%) who had completed preoperative colonoscopy. Neither the age and the gender of the patient, the location and the stage of the tumor, nor the family history were related with increased risk of synchronous polyps. Seventeen among 46 intraoperative colonoscopy cases had synchronous lesions which were not known on preoperative evaluation. Another bowel resection was needed to remove the lesions in nine of them. CONCLUSIONS: Synchronous colorectal polyps or cancer is frequent, and preoperative detection is important. Intraoperative colonoscopy can provide valid information if a preoperative colonoscopic evaluation is not available.
Adenomatous Polyps ; Colon ; Colonoscopy ; Colorectal Neoplasms* ; Colorectal Surgery ; Humans ; Incidence ; Medical Records ; Phenobarbital ; Polyps ; Risk Factors

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Decision of Salvage Treatment after Transanal Endoscopic Microsurgery: Clinical Experience on 36 Cases of Rectal Cancer.

Suk Hee SHIN ; Sang Ah HAN ; Chi Min PARK ; Seong Hyeon YUN ; Woo Yong LEE ; Dong Wook CHOI ; Hokyung CHUN

Journal of the Korean Society of Coloproctology.2005;21(6):406-412.

PURPOSE: Local excision, including transanal endoscopic microsurgery (TEM), has become an alternative to the classic radical operation for early rectal cancer. However, radical resection for rectal cancer is necessary for advanced tumor, poor differentiation, a narrow resection margin, and positive lymphovascular invasion. This study presents the factors related to recurrence in patients who required secondary radical surgery after TEM, but did not undergo the operation. METHODS: From November 1994 to December 2004, 167 patients underwent TEM for rectal cancer. Thirty-six of those patients were included in this study. Inclusion criteria were poor differentiation, a mucinous carcinoma, invasion to a proper muscle layer, lymphovascular invasion, and a positive resection margin. RESULTS: Twelve of the 36 patients underwent a secondary radical operation, but 24 of them did not due to poor general condition or refusal. One of 12 patients (8.3%) who underwent a secondary radical operation had a systemic recurrence. Five of 24 patients (20.8%) who did not receive surgery had recurrences; 3 of 5 were local recurrence, and the others were distant metastases. Among the 24 patients who did not undergo a secondary radical operation, there were no recurrences in 2 cases of poor differentiation or mucinous carcinoma and in 2 cases of positive resection margin. There were 2 cases of recurrences in the 7 patients (25.0%) who had lymphovascular invasion, 1 case in the 1 patient (100%) who had a T3 lesion, 3 cases in the 17 patients (12.5%) who had T2 lesions. CONCLUSIONS: In high-risk patients, TEM followed by radical surgery is most beneficial in preventing local recurrence. A radical operation is strongly recommended especially if pathologic results after TEM shows T3 lesions or lymphovascular invasion.
Adenocarcinoma, Mucinous ; Disulfiram ; Humans ; Microsurgery* ; Neoplasm Metastasis ; Rectal Neoplasms* ; Recurrence

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Brain Metastases Developed in Advanced Colorectal Cancer Patients who Underwent Multi-drug Chemotherapy.

Yong Keun PARK ; Sang Lim LEE ; Kwang Wook SUH

Journal of the Korean Society of Coloproctology.2005;21(6):401-405.

PURPOSE: Brain metastasis from colorectal cancer is a rare clinical condition. We have experienced five cases of brain metastases in a relatively short period of time during extensive chemotherapy for advanced colorectal cancer. To examine whether this phenomenon is a simple coincidence or there is a correlation with prolongation of life span in patients with stage IV colorectal cancer, we analysed five patients with brain metastases. METHODS: The case histories of 47 patients with unresectable systemic metastases who had undergone sequential chemotherapy (FOLFOX and FOLFIRI) in Ajou University Hospital from August 2002 to December 2004 were reviewed and analyzed for clinical characteristics. The sites of unresectable metastases were the liver (n=28), the lung (n=28), and the paraaortic nodes (N=6). Diagnostic criteria of unresectable metastasis were multiple or bilobar lesions in hepatic metastasis and multilobar involvement in pulmonary metastasis. RESULTS: There was no complete remission. Partial remission was noted in 31.9% of the patients and stable disease in 8.5%. Sequential chemotherapy showed no effect in 59.6% of the patients. Brain metastases occurred in five patients (10.6%). Accompanying metastases were found in the lung (n=4), the liver (n=3), the paralortic lymph nodes (n=2), and bone (n=1). Four patient (21.0%) were noted in the response group. The mean interval from primary cancer surgery to the diagnosis of brain metastasis was 27.5 (20~44) months. From the start of chemotherapy, brain metastasis was diagnosed at an average of 10.5 (8~16) months. Metastasectomies were performed in three patients, and stereotaxic radiosurgery was performed in two patients. One patient died with the disease, and four patients have been alive with the disease for more than six months. CONCLUSIONS: It is still unclear whether the increasing incidence of brain metastasis is related with prolongation of life expectancy in patients with stage IV colorectal cancer. However, about half of the stage IV colorectal cancer patients were found to obtain meaningful survival benefits by sequential chemotherapy, and 20% of chemo- responders showed brain metastases. Therefore, we conclude that the increasing incidence of brain metastasis seems to correlate with prolongation of life expectancy in stage IV colorectal cancer.
Brain* ; Colorectal Neoplasms* ; Diagnosis ; Drug Therapy* ; Humans ; Incidence ; Life Support Care ; Liver ; Lung ; Lymph Nodes ; Metastasectomy ; Neoplasm Metastasis* ; Radiosurgery

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Safety and Feasibility of Laparoscopic Low Anterior Resection in Early Learning Curve.

Jeong Hyun KANG ; Yoon Ah PARK ; Seung Hyuk BAIK ; Kang Young LEE ; Nam Kyu KIM ; Seung Kook SOHN ; Chang Hwan CHO

Journal of the Korean Society of Coloproctology.2005;21(6):396-400.

PURPOSE: After the final report of Clinical Outcomes of Surgical Therapy (COST) study group, the application of laparoscopic surgery in colon cancer a spread widely. However, laparoscopic surgery in the rectum is still regarded as a complicated procedure to start due to technical difficulties and a steep learning curve. The aim of this study was to show the safety and technical feasibility of a laparoscopic low anterior resection at an early time on the learning curve in comparison with open low anterior resection. METHODS: The learning curves of one colorectal surgeon in open and laparoscopic low anterior resections were retrospectively compared. The compared factors were clinicopathologic characteristics, operation time, and the factors associated with postoperative recovery, morbidity and mortality. RESULTS: There were no significant differences in age or sex between two groups. The operation time was significantly longer in the laparoscopy group (P<0.001) In the view point of postoperative recovery, the laparoscopy group showed significant advantages in hospital stay (P<0.001), the passage of flatus (P<0.001), the number of analgesics used (P=0.03), and the removal of foley catheter (P=0.001). There were no conversions in the laparoscopy group, and the complication rate was lower in the laparoscopy group (10.7% vs. 17.6%). There was no postoperative mortality in either group. CONCLUSIONS: Even though the operation time was significantly longer in the laparoscopy group, a laparoscopic low anterior resection appears to have some benefits in postoperative recovery and morbidity. In terms of surgical outcomes, a laparoscopic low anterior resection can be performed safely even in early times on the learning curve.
Analgesics ; Catheters ; Colonic Neoplasms ; Flatulence ; Laparoscopy ; Learning Curve* ; Learning* ; Length of Stay ; Mortality ; Rectum ; Retrospective Studies

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Step-by-step Management and Treatment Outcome of Bleeding Control for Anastomosis Site after Low Anterior Resection with Double Stapling Technique.

Hyuk Mun KIM ; Eung Jin SHIN ; Ok Pyung SONG ; Jae Joon KIM ; Yong Seok JANG ; Rae Kyung PARK ; Moo Joon BAEK

Journal of the Korean Society of Coloproctology.2005;21(6):390-395.

PURPOSE: This study reviews our experience with a step- by-step management approach of increasing aggressiveness and evaluates the treatment outcome for intraluminal hemorrhage. METHODS: The study group was comprised of patients who had experienced intraluminal hemorrhage after a low anterior resection with the double stapling technique from 1999 to 2003. The choice of management was selected according to our step-by-step management protocol, and the outcomes were evaluated for each step, lincluding mortality and complications. RESULTS: Nine patients (6 males and 3 females, mean age 55 years) were identified, the mean volume of packed RBC transfusion was 2 pints, and the mean distance of the anastomotic site from the anal verge was 6 cm. The median stapler size was 31 mm. The first step was cold saline irrigation and drainage; four of 9 patients were controlled. The second step was retention enema with topical hemostatics; one of remaining 5 patients stopped bleeding. The third step was colonoscopic hypertonic saline injection around the bleeding site with direct colonoscopic electrocauterization, two of remaining 4 patients were controlled. The last step was suturing the bleeding site through the anus, the remaining 2 patients stopped bleeding. One of the 9 patients developed leakage from the anastomotic site after the last step management, three of the 9 patients had long standing ileus, and one of the 9 patients developed acute renal failure after a massive transfusion. There were no postoperative deaths. CONCLUSIONS: It is safer and easier to control bleeding with step-by-step management system of increasing aggressiveness.
Acute Kidney Injury ; Anal Canal ; Drainage ; Enema ; Female ; Hemorrhage* ; Hemostatics ; Humans ; Ileus ; Male ; Mortality ; Rectal Neoplasms ; Treatment Outcome*

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Safety of Conservative Treatment of Colonoscopic Perforation.

Eun Jong NA ; Kyung Jong KIM ; Young Don MIN

Journal of the Korean Society of Coloproctology.2005;21(6):384-389.

PURPOSE: Colonoscopy is a relatively safe procedure. However, various complications, such as hemorrhage or perforation, can occur, and among them, perforation can lead to death. This study was designed to evaluate the clinical characteristics and the treatment of colonoscopic perforation, as well as the availability of conservative treatment as the initial management. METHODS: We reviewed the medical records of the 11 patients who had been treated for colonoscopic perforation from May 2003 to April 2005. RESULTS: Six perforations were related to diagnostic colonoscopy whereas five occurred from therapeutic colonoscopy. The sigmoid colon was the most common perforation site (6 patients), followed by the cecum 2 patients and the transverse colon, splenic flexure, and the rectum 1 patient each. Five patients were diagnosed during colonoscopy. Six patients were diagnosed 12~48 hours after the colonoscopy. Three patients who showed definite signs of peritonitis underwent emergency operations. A conservative treatment was done in eight patients; among them, one patient had an operation on the 3rd. day after the perforation. The remaining seven patients underwent conservative treatment and were followed for up to 1 month without complications. Among these patients, one patient had a recurrent perforation on the 33rd day after the initial perforation, and an operation was done. CONCLUSIONS: These results suggest that conservative treatment in patients with colon perforations is safe and effective unless there are obvious signs of generalized peritonitis.
Cecum ; Colon ; Colon, Sigmoid ; Colon, Transverse ; Colonoscopy ; Emergencies ; Hemorrhage ; Humans ; Medical Records ; Peritonitis ; Rectum

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