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Journal of the Korean Society of Coloproctology.2009;25(5):356-362. doi:10.3393/jksc.2009.25.5.356

Colorectal cancer has been rapidly increasing in Korea during the past decades, which was known as low risk area. The age-standardized mortality rates increased from 3.0 to 14.5 in 100,000 for men and from 2.3 to 7.9 in 100,000 for women between 1983 and 2008. According to the National Cancer Registry, the age-standardized incidence rates of total colorectal cancer were increased by 7.3% and 5.5% for men and women, respectively, between 1999 and 2005, while the incidence rates of the most prevalent cancers in Korea, such as stomach, liver, and cervical cancers, have decreased during the same period. Westernized dietary and lifestyle-related factors seem to be closely related to the increased risk of colorectal cancer. Higher intakes of red and processed meat, a lack of physical activity, obesity, and alcohol drinking have been suggested to be risk factors for colorectal cancer in the numerous epidemiologic studies, while higher intakes of dietary fiber, green leafy vegetables, some micronutrients abundant in vegetables and fruits, such as folate, and calcium were reported to be protective factors. Since many of the diet and lifestyle-related factors for colorectal cancer are modifiable, it is urgently needed to set up comprehensive primary prevention program against colorectal cancer to effectively cope with the rapidly increasing cancer in Korea.
Alcohol Drinking ; Calcium ; Colorectal Neoplasms ; Diet ; Dietary Fiber ; Female ; Folic Acid ; Fruit ; Humans ; Incidence ; Korea ; Liver ; Male ; Meat ; Micronutrients ; Motor Activity ; Obesity ; Phosphatidylethanolamines ; Primary Prevention ; Risk Factors ; Vegetables

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Laparoscopic Management of Appendiceal Intussusception Caused by Fecaliths.

Dong Baek KANG ; Seung Ho KIM ; Jung Taek OH ; Kang Deuk KIM ; Hyang Jeong JO ; Jeong Kyun LEE ; Won Cheol PARK

Journal of the Korean Society of Coloproctology.2009;25(5):352-355. doi:10.3393/jksc.2009.25.5.352

Appendiceal intussusception is a rare condition of abdominal pain. It develops as a result of various anatomic or pathologic conditions, such as polyps, worms, carcinomas, mucoceles, or fecaliths. Furthermore, an accurate preoperative diagnosis of appendiceal intussusception may be difficult. However, recently developed radiologic modalities, such as multidetector CT and laparoscopy, can considerably aid preoperative diagnosis and provide a means of adopting optimal minimally invasive surgery. Here, the authors describe the case of a 30-yr-old woman with the clinical features of acute appendicitis, who was preoperatively diagnosed as having appendiceal intussusception with fecaliths and who was managed by using a laparoscopic partial cecectomy.
Abdominal Pain ; Appendicitis ; Fecal Impaction ; Female ; Humans ; Intussusception ; Laparoscopy ; Mucocele ; Polyps

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A Case of Successful Percutaneous Drainage of a Pelvic Abscess Complicating Colonoscopy.

Youn SI ; Shin Young KIM ; Seung Bong CHOI ; Hyung Jin KIM ; Yoon Suk LEE ; Hyun Min CHO ; Jun Gi KIM ; Seung Tack OH ; In Kyu LEE

Journal of the Korean Society of Coloproctology.2009;25(5):347-351. doi:10.3393/jksc.2009.25.5.347

Perforations that occur during colonoscopy are usually managed by surgical repair. When the patient's symptoms are mild and laboratory findings show minor abnormalities, a conservative treatment can be considered. Although an operation is the treatment of choice in patients with generalized peritonitis, in some selected patients, percutaneous abscess drainage can be an alternative to surgical intervention for drainage of deep-infected fluid collections or can act as a temporary measure until the patient becomes sufficiently stable for surgery. We report here on a 53-yr-old male patient who developed signs of localized peritonitis and had a pelvic abscess due to a colonic perforation after colonoscopy and was treated successfully by using percutaneous abscess drainage.
Abscess ; Colon ; Colonoscopy ; Drainage ; Humans ; Male ; Peritonitis

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Analysis of Anastomotic Leakage after an Anterior Resection for Rectal Cancer.

Hey Won PARK ; Chang Nam KIM ; Jin Seok PARK ; Yoon Jung KANG ; Byung Sun CHO ; Min Koo LEE ; Young Jin CHOI ; Joo Seung PARK

Journal of the Korean Society of Coloproctology.2009;25(5):340-346. doi:10.3393/jksc.2009.25.5.340

PURPOSE: The aim of our study was to identify risk factors associated with anastomotic leakage (AL) after an anterior resection (high anterior resection+low anterior resection) for rectal cancer. METHODS: Between January 1998 and December 2007, 356 patients underwent an anterior resection for rectal cancer. Early anastomotic leakage (EAL) was defined as leakage identified during hospitalization. Late anastomotic leakage (LAL) was defined as leakage identified in outpatients. RESULTS: AL (EAL+LAL) occurred in 30 patients (8.4%, mean time: 15.4 days). Among of them, EAL occurred in 20 patients (5.6%, mean time: 5.1 days), and LAL occurred in 10 patients (2.8%, mean time: 36.0 days). In the univariate analysis, the size of the tumor, the tumor level from the anal verge, and the level of anastomosis were significantly associated with AL. In EAL, the size of the tumor, the tumor level from the anal verge, the level of anastomosis, the operation type, and the value of serum albumin on day 3 after the operation were risk factors. In LAL, the tumor level from the anal verge and the level of anastomosis were risk factors. In the multivariate analysis, tumor size >7 cm (AL: P<0.001, EAL: P<0.001) and tumor level from the anal verge < or =8 cm (AL: P=0.014, EAL: P=0.001) were independent risk factors. CONCLUSION: AL and EAL after an anterior resection for rectal cancer were related to the size of the tumor and the level of the tumor from the anal verge.
Anastomotic Leak ; Hospitalization ; Humans ; Multivariate Analysis ; Outpatients ; Rectal Neoplasms ; Risk Factors ; Serum Albumin

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Expression of Alpha-catenin/E-cadherin and Clinical Significance of Metastatic Factors in Stage III Advanced Colon Cancer.

Seung Hun CHAE ; Han Sun KIM ; Jae Man KIM ; Sang Hee LEE ; Sung Ook JO ; Mi Keung LEE ; Wan Jo JUNG ; Ho Jun LEE

Journal of the Korean Society of Coloproctology.2009;25(5):334-339. doi:10.3393/jksc.2009.25.5.334

PURPOSE: Among the cell adhesion molecules, alpha-catenin and E-cadherin play an important part in maintaining normal cell structure. The change in expression of cell adhesion molecules affects the invasion and metastasis of a tumor and the prognosis for patients. In this study, we evaluated the relationship between the expression of cell adhesion molecules and the histopathologic characteristics of stage III colon cancer. METHODS: The relationship between the immunohistochemical expression of cell adhesion molecules and tumor progression were statistically analyzed in 40 patients with stage III colon cancer. RESULTS: There were no statistically significant correlations between loss of membranous alpha-catenin and E-cadherin expressions and such variables as histologic differentiation and lymph node disease based on the criteria of the American Joint Committee on Cancer (AJCC). A significant correlation, however, existed between depth of mural invasion and loss of expressions of both alpha-catenin and E-cadherin (P=0.001 and P=0.002, respectively). Expressions of both alpha-catenin and E-cadherin were also significantly decreased in patients showing liver metastases during follow-up (P=0.019 and P=0.015, respectively). CONCLUSION: Immunohistochemical analyses of alpha-catenin and E-cadherin expressions may be available as predictors for distant metastasis, especially in stage III colon cancer. Such analyses may also help to identify appropriate therapeutic strategies and the need for intensive follow-up in patients with stage III colon cancer.
alpha Catenin ; Cadherins ; Cell Adhesion Molecules ; Colon ; Colonic Neoplasms ; Follow-Up Studies ; Humans ; Joints ; Liver ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis

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Clinicopathologic Analysis of Gastrointestinal Stromal Tumors of the Colon and Rectum.

Sung Hoon CHOI ; Seo Jeon KIM ; Yun Jung CHOI ; Byung So MIN ; Jin Su KIM ; Seung Hyuk BAIK ; Nam Kyu KIM ; Jung Gu KANG

Journal of the Korean Society of Coloproctology.2009;25(5):323-333. doi:10.3393/jksc.2009.25.5.323

PURPOSE: This study's aim is to investigate the clinicopathologic characteristics of colorectal gastrointestinal stromal tumors (GISTs) and to evaluate the result of those tumors. METHODS: We retrospectively reviewed 22 patients who had been diagnosed with primary colorectal GISTs and who had undergone a surgical resection between October 1996 and July 2008. RESULTS: Colorectal GISTs accounted for 0.28% of all colorectal malignancies and 7.7% of all GISTs. Rectal GISTs (19, 86.4%) were more common than colonic GISTs (3, 13.6%). According to the National Institute of Health's (NIH) grading system, there were 1 (4.5%) very low, 5 (22.7%) low, 4 (18.2%) intermediate, and 12 (54.6%) high-risk tumors. The disease recurred in 7 patients (1 with intermediate risk and 6 with high risk). Recurrence sites were the liver (42.9%), the peritoneum (71.5%), and the lymph nodes (14.3%). Adjuvant imatinib therapy and/or radiation therapy were done for patients with microscopically positive margins of resection and high risk, of which one experienced a recurrence at 95 months after surgery. The five-year recurrence rates were 0% in the very-low-grade and low-grade groups, 33.3% in the intermediate-grade group, and 37.5% in the high-grade group. The five-year overall survival rates were 100% in the very-low-grade and low-grade groups, 66.7% in the intermediate-grade group, and 62.5% in the high-grade group. CONCLUSION: Poor prognosis of colorectal GISTs was closely related to the tumor's histologic grade and size. Integrating surgery, molecular therapy, and radiation therapy might improve outcomes, but further study with more cases is needed.
Benzamides ; Colon ; Gastrointestinal Stromal Tumors ; Humans ; Imatinib Mesylate ; Liver ; Lymph Nodes ; Peritoneum ; Piperazines ; Prognosis ; Pyrimidines ; Rectum ; Recurrence ; Retrospective Studies ; Survival Rate

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Gastrointestinal Stromal Tumors of the Colon and Rectum.

Ok Joo PAEK ; Young Bae KIM ; Seung Yeop OH ; Kwang Wook SUH

Journal of the Korean Society of Coloproctology.2009;25(5):318-322. doi:10.3393/jksc.2009.25.5.318

PURPOSE: This study was designed to review the clinical characteristics of gastrointestinal stromal tumors (GISTs) of the colon and rectum and to evaluate their immunohistochemical and pathologic features based on the current National Institutes of Health criteria. METHODS: Patient and disease characteristics, pathologic features, surgical or endoscopic management, and clinical outcomes of 11 patients with GISTs diagnosed and primarily treated at our institution between March 1995 and February 2009 were evaluated. RESULTS: Colorectal GISTs accounted for 4.4% of all GISTs. The primary location was the rectum (8 cases). Four patients had high-risk GISTs, 4 patients had low-risk GISTs, and 3 patients had very low-risk GISTs. All tumors were c-kit positive. Four patients underwent a radical resection, whereas 7 patients underwent an endoscopic resection (n=3) or a transanal excision (n=4). Two high-risk patients without adjuvant Imatinib mesylate therapy developed metastases, but the other high-risk patients with adjuvant Imatinib mesylate therapy didn't. CONCLUSION: Colorectal GISTs occurred predominantly in the rectum. Because GISTs do not metastasize through the lymphatics, small GISTs that are amenable to local excision or endoscopic resection can be treated by either of these techniques as long as negative microscopic margins are obtained around the primary tumor. Patients with high-risk GISTs should be considered for the use of Imatinib mesylate as adjuvant therapy.
Benzamides ; Colon ; Gastrointestinal Stromal Tumors ; Humans ; Imatinib Mesylate ; Mesylates ; National Institutes of Health (U.S.) ; Neoplasm Metastasis ; Piperazines ; Pyrimidines ; Rectum

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The Initial Experience with a Single Incision Laparoscopic Appendectomy.

Jong Won KIM ; Jun Seok PARK ; In Taik CHANG ; Yoo Shin CHOI ; Hyung Jun SONG ; Beom Gyu KIM

Journal of the Korean Society of Coloproctology.2009;25(5):312-317. doi:10.3393/jksc.2009.25.5.312

PURPOSE: A laparoscopic appendectomy (LA) is becoming popular for the treatment of acute and perforated appendicitis. Since it was first described, the LA has been modified many times. We present the result for a new technique of LA, in which the LA is conducted through a single umbilical incision without exteriorizing the appendix to perform the operation. METHODS: A single incision laparoscopic appendectomy was attempted in 25 patients (17 men, 8 women). Under general anesthesia, a wound retractor was inserted through the umbilicus. The appendix was grasped and dissected from surrounding tissues with a single flexible dissector or grasper. After mesenteric dissection with ultrasonic shear, the base of the appendix was ligated with an Endoloop. The appendix was withdrawn into the wound protector and extracted from the abdomen. RESULTS: A single incision laparoscopic appendectomy was completed in 25 patients. No major intraoperative or postoperative complications were encountered. The average duration of the procedure was 50.3+/-21.3 min. The average hospital stay was 4.1+/-2.4 days. CONCLUSION: This new technique, a single incision laparoscopic appendectomy, further improves the minimal invasiveness of a LA because a single incision is used. This procedure is a safe, very minimally invasive procedure with excellent cosmetic results.
Abdomen ; Anesthesia, General ; Appendectomy ; Appendicitis ; Appendix ; Cosmetics ; Hand Strength ; Humans ; Length of Stay ; Male ; Postoperative Complications ; Ultrasonics ; Umbilicus

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The Impacts of Obesity on a Laparoscopic Low Anterior Resection.

Jin Hee WOO ; Ki Jae PARK ; Hong Jo CHOI

Journal of the Korean Society of Coloproctology.2009;25(5):306-311. doi:10.3393/jksc.2009.25.5.306

PURPOSE: Obese patients are generally believed to be at increased risk for surgery compared to those who are not obese. It was the purpose of this study to compare the short-term outcomes of a laparoscopic low anterior resection (LAR) in obese and non-obese patients. METHODS: We retrospectively reviewed 79 patients who had undergone a laparoscopic LAR for rectal cancer between September 2002 and January 2008. The degree of obesity was based on the Body Mass Index (BMI, kg/m2). We divided the 79 patients into two groups: the high BMI (BMI> or =25) and the low BMI (BMI <25) groups. The parameters analyzed included age, gender, American Society of Anesthesiologists classification score, operative time, estimated blood loss, conversion rate, postoperative complications, hospital stay, and oncologic characteristics. Statistics included the t-test and Fisher's exact test. Statistical significance was assessed at the 5% level (P<0.05 being statistically significant). RESULTS: There were no significant differences between the low BMI (n=55) and the high BMI (n=24) groups in age and gender. The high BMI group had significantly more conversion to an open procedure (20.8% vs. 3.6%, P=0.0244). The high BMI group and the low BMI group had no differences in blood loss, complications, hospital stay, and oncologic characteristics, but the high BMI group had a longer operative time (244.2 min vs. 212.0 min, P=0.0035). CONCLUSION: A laparoscopic LAR in obese patients had a higher conversion rate and a longer operative time, but there were no differences in postoperative complications and oncologic characteristics. A further study based on many experiences is needed to clarify the influence of the surgeon's experience on the operative time and the conversion rate, and long-term follow-up is necessary to evaluate the oncologic safety of a laparoscopic LAR in obese patients.
Body Mass Index ; Conversion to Open Surgery ; Follow-Up Studies ; Humans ; Length of Stay ; Obesity ; Operative Time ; Postoperative Complications ; Rectal Neoplasms ; Retrospective Studies

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The Characteristics of Crohn's Disease in Korea According to the Montreal Classification.

Beom KIM ; Soon Do PARK ; Sung Il CHOI ; Suk Hwan LEE ; Kil Yeon LEE

Journal of the Korean Society of Coloproctology.2009;25(5):300-305. doi:10.3393/jksc.2009.25.5.300

PURPOSE: Crohn's disease is an inflammatory bowel disease with various symptoms and progressions. For effective identification of various causes and follow up of patients, we used the Vienna Classification from 1998, but we started applying the Montreal Classification in 2005. In this study, our aim was to identify the clinical characteristics of Korean patients with Crohn's disease by using the Montreal Classification. METHODS: A retrospective study was carried out among 111 patients who were evaluated at KyungHee Medical Center from March 1986 through February 2008 as having Crohn's disease. RESULTS: The male-to-female ratio was 1.8:1, and the average age was 27.2+/-9.6 yr. Abdominal pain was the major symptom, and extraintestinal manifestations were seen in 16 cases. Of the Crohn's disease patients, 25.2% were initially misdiagnosed as having tuberculosis. Concerning age at diagnosis, A2 (patients 17 to 40 yr of age) was the largest group. The most common disease location was the ileocolon (L3), and a combined upper gastrointestinal lesion (L4) was most commonly seen in L3. The most common disease behaviors were nonstricturing and nonpenetrating (B1), and although perianal lesions were most common in B1, there were no statistical correlations (P=0.061). Surgical treatments were performed in 46 cases, especially in cases involving complex disease (stricturing&penetrating) (P<0.005) and ileal disease (L1) (P=0.024). CONCLUSION: According to the Montreal Classification of Korean Crohn's disease patients, a more stable manifestation was seen in the group with lower age at diagnosis. Perianal lesions did not have any correlation with the form in which the disease manifested itself. Complex disease and ileal disease required a surgical procedure the most.
Abdominal Pain ; Crohn Disease ; Follow-Up Studies ; Humans ; Ileal Diseases ; Inflammatory Bowel Diseases ; Korea ; Retrospective Studies ; Tuberculosis

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