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Colorectal Perforation After Anorectal Manometry for Low Anterior Resection Syndrome.

Kyung Ha LEE ; Ji Yeon KIM ; Young Hoon SUL

Annals of Coloproctology.2017;33(4):146-149. doi:10.3393/ac.2017.33.4.146

We experienced 3 cases of manometry-induced colon perforation. A 75-year-old man (case 1) underwent anorectal manometry (ARM) 3 years after radiotherapy for prostate cancer and a laparoscopic intersphincteric resection for rectal cancer. A 70-year-old man (case 2) underwent ARM 3 months after conventional neoadjuvant chemoradiotherapy and a laparoscopic low anterior resection for rectal cancer. A 78-year-old man (case 3) underwent ARM 2 months after a laparoscopic intersphincteric resection for rectal cancer. In all cases, a colon perforation with fecal peritonitis occurred. All were treated successfully using prompt and active operations and were discharged without any complications. ARM with a balloon, as a measure of rectal compliance, should be performed 2 months or longer after surgery. If a perforation occurs, prompt and active surgical intervention is necessary due to the high possibility of extensive fecal peritonitis.
Aged ; Arm ; Chemoradiotherapy ; Colon ; Compliance ; Humans ; Manometry* ; Peritonitis ; Prostatic Neoplasms ; Radiotherapy ; Rectal Neoplasms

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Anaphase-Promoting Complex 7 is a Prognostic Factor in Human Colorectal Cancer.

Ik Yong KIM ; Hye Yeon KWON ; Kwang Hwa PARK ; Dae Sung KIM

Annals of Coloproctology.2017;33(4):139-145. doi:10.3393/ac.2017.33.4.139

PURPOSE: The anaphase-promoting complex (APC) is a multiprotein complex with E3 ubiquitin ligase activity and is required for ubiquitination of securin and cyclin-B. Several APC-targeting molecules are reported to be oncogenes. Dysregulation of APC may be associated with tumorigenesis. This study examines the relationship between APC expression and clinicopathological factors and evaluates the possibility of an aberrant APC function in colorectal carcinomas (CRCs). METHODS: To determine whether the loss of APC7 expression is related to tumorigenesis, we used tissue micro-arrays in 114 resected CRCs to scrutinize the expressions of APC7 and Ki-67 immunohistochemistry and to find relations with clinocopathologic parameters. The expression of APC7 was defined as positive for summed scores of staining intensities from 0 to 3+. RESULTS: Forty-four cases (67.7%) of colon cancer and 38 cases (77.6%) of rectal cancer showed immunopositive reactions to APC. The grade of APC expression was not statistically correlated with tumor location, age, T or TNM stage, or differentiation. However, the expression of APC did correlate with the expression of Ki-67 and to the tumor recurrent. Higher APC expression showed the better 5-year overall survival rate in 74% of grades 2, 3 groups (high expression) than 57% of grades 0, 1 groups (lower expression) respectively (P = 0.042). CONCLUSION: Positive APC expression may be a good prognostic factor for patients with CRC, and the loss of APC expression in tumor tissue may be related with the risk for recurrence and a poor survival rate compared to high APC expression. Further study of APC in controlling the cell cycle as aberrant function in CRC is needed.
Adenocarcinoma ; Anaphase-Promoting Complex-Cyclosome ; Carcinogenesis ; Cell Cycle ; Colonic Neoplasms ; Colorectal Neoplasms* ; Humans* ; Immunohistochemistry ; Oncogenes ; Rectal Neoplasms ; Recurrence ; Securin ; Survival Rate ; Ubiquitin ; Ubiquitin-Protein Ligases ; Ubiquitination

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The First Year After Colorectal Surgery in the Elderly.

Verena N N KORNMANN ; Jeroen L A VAN VUGT ; Anke B SMITS ; Bert VAN RAMSHORST ; Djamila BOERMA

Annals of Coloproctology.2017;33(4):134-138. doi:10.3393/ac.2017.33.4.134

PURPOSE: Surgery for colorectal malignancy is increasingly being performed in the elderly. Little is known about the impact of complications on late mortality. This study aimed to analyze whether a complicated postoperative course affects the 1-year survival in elderly patients. METHODS: All consecutive patients older than 75 years of age who underwent colorectal cancer surgery between January 2009 and April 2013 were included in this study. The main outcome was mortality at 1 year after surgery. Logistic regression analyses were performed to determine risk factors for a poor outcome (mortality) after survival of the early postoperative course of surgery at 1-year follow-up. Patients who died within 30 days postoperatively were excluded from analysis. RESULTS: The early mortality rate was 6.3% (n = 15), and 2 patients died during follow-up as a result of complications after a second surgery. A total of 223 patients survived the perioperative period and were included in this study. Twenty-two patients (9.9%) died during the first year of follow-up. Stage IV disease (P = 0.002), complications of primary surgery (P = 0.016), and comorbidity (P = 0.050) were risk factors for 1-year mortality. Intensive care unit stay, reoperation and readmission were not associated with a worse 1-year outcome. CONCLUSION: Elderly patients with stage IV disease at the time of surgery, comorbidity, and postoperative complications are at risk for mortality during the first year after surgery. A patient-tailored approach with special attention to perioperative care should be considered in the elderly.
Aged* ; Colorectal Neoplasms ; Colorectal Surgery* ; Comorbidity ; Follow-Up Studies ; Humans ; Intensive Care Units ; Logistic Models ; Mortality ; Perioperative Care ; Perioperative Period ; Postoperative Complications ; Reoperation ; Risk Factors

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Clinical Significance of Preoperative Virtual Colonoscopy for Evaluation of the Proximal Colon in Patient With Obstructive Colorectal Cancer.

Jae Hyuk HEO ; Chun Geun RYU ; Eun Joo JUNG ; Jin Hee PAIK ; Dae Yong HWANG

Annals of Coloproctology.2017;33(4):130-133. doi:10.3393/ac.2017.33.4.130

PURPOSE: Virtual colonoscopy is the most recently developed tool for detecting colorectal cancers and polyps, but its effectiveness is limited. In our study, we compared the result of preoperative virtual colonoscopy to result of preoperative and postoperative colonoscopy. We evaluated also the accuracy of preoperative virtual colonoscopy in patients who had obstructive colorectal cancer that did not allow passage of a colonoscope. METHODS: A total of 164 patients who had undergone preoperative virtual colonoscopy and curative surgery after the diagnosis of a colorectal adenocarcinoma between November 2008 and August 2013 were pooled. We compared the result of conventional colonoscopy with that of virtual colonoscopy in the nonobstructive group and the results of preoperative virtual colonoscopy with that of postoperative colonoscopy performed at 6 months after surgery in the obstructive group. RESULTS: Of the 164 patients, 108 were male and 56 were female patients. The mean age was 62.7 years. The average sensitivity, specificity, and accuracy of virtual colonoscopy for all patients were 31.0%, 67.2%, and 43.8%, respectively. In the nonobstructive group, the average sensitivity, specificity, and accuracy were 36.6%, 66.2%, and 48.0%, respectively, whereas in the obstructive group, they were 2%, 72.4%, and 25.4%. Synchronous cancer was detected via virtual colonoscopy in 4 of the 164 patients. CONCLUSION: Virtual colonoscopy may not be an effective method for the detection of proximal colon polyps, but it can be helpful in determining the therapeutic plan when its results are correlated with the results of other studies.
Adenocarcinoma ; Colon* ; Colonic Polyps ; Colonography, Computed Tomographic* ; Colonoscopes ; Colonoscopy ; Colorectal Neoplasms* ; Diagnosis ; Female ; Humans ; Male ; Methods ; Polyps ; Sensitivity and Specificity

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Hand-Assisted Laparoscopic Surgery: A Versatile Tool for Colorectal Surgeons.

Ju Yong CHEONG ; Christopher J YOUNG

Annals of Coloproctology.2017;33(4):125-129. doi:10.3393/ac.2017.33.4.125

PURPOSE: Hand-assisted laparoscopic surgery (HALS) is a minimally invasive surgical technique with the combined benefits of laparoscopic surgery while allowing the use of the surgeon's hand for better tactile control. Obesity has been associated with higher conversion rates with multiport laparoscopic surgery, but not with HALS. This study aimed to examine the versatility of HALS in various clinical contexts. METHODS: All HALSs performed at 2 major tertiary centers in Sydney were prospectively collected for retrospective analysis. Variables including age, sex, body mass index (BMI), previous surgeries, pathologies including size and T-stage, and the number of conversions to a midline laparotomy were examined. RESULTS: A total of 121 HALS colorectal resections were analyzed. The median age of the patients was 62 years, with 63.6% being women. Seven patients required conversion to a midline laparotomy. Of the 121 patients, 50.2% were overweight or obese, and 52.9% had undergone previous abdominal/pelvic operations. However, neither obesity nor abdominal adhesions from previous operations were an indication for conversion to an open laparotomy in any of the 7 converted patients. The presence of intra-abdominal adhesions did not impact the operative time. HALS allowed access to the entire colon and rectum and allowed resection of the bladder, uterus, and ureter, when these organs were involved. CONCLUSION: HALS is a versatile, minimally invasive technique, which is independent of the patient's BMI, for performing a colorectal resection.
Body Mass Index ; Colon ; Colorectal Surgery ; Female ; Hand ; Hand-Assisted Laparoscopy* ; Humans ; Laparoscopy ; Laparotomy ; Obesity ; Operative Time ; Overweight ; Pathology ; Prospective Studies ; Rectum ; Retrospective Studies ; Surgeons* ; Ureter ; Urinary Bladder ; Uterus

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What is the Meaning of Anaphase-Promoting Complex 7 in Malignant Neoplasms?.

Weon Young CHANG

Annals of Coloproctology.2017;33(4):123-124. doi:10.3393/ac.2017.33.4.123

No abstract available.
Anaphase-Promoting Complex-Cyclosome ; Neoplasms ; Cell Nucleus ; Colorectal Neoplasms ; Anaplasia ; Aneuploidy

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Colorectal Cancer Surgery in Elderly Patients.

Young Jin KIM

Annals of Coloproctology.2017;33(4):121-122. doi:10.3393/ac.2017.33.4.121

No abstract available.
Aged* ; Colorectal Neoplasms* ; Humans

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Need for Reappraisal of Hand-Assisted Laparoscopic Surgery for Colorectal Diseases in the Era of Desiring Small Incisions.

Chang Nam KIM

Annals of Coloproctology.2017;33(4):119-120. doi:10.3393/ac.2017.33.4.119

No abstract available.
Hand-Assisted Laparoscopy*

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Clinical Significance of Signet-Ring-Cell Colorectal Cancer as a Prognostic Factor.

Sang Oh YUN ; Yong Beom CHO ; Woo Yong LEE ; Hee Cheol KIM ; Seong Hyeon YUN ; Yoon Ah PARK ; Jung Wook HUH

Annals of Coloproctology.2017;33(6):232-238. doi:10.3393/ac.2017.33.6.232

PURPOSE: The aim of this study is to evaluate the prognosis for patients with a signet-ring-cell carcinoma (SRCC) who undergo curative surgery by comparing them to patients with an adenocarcinoma (ADC), excluding a mucinous ADC. METHODS: Between September 1994 and December 2013, 14,110 patients with colorectal cancer underwent surgery and among them, 12,631 patients were enrolled in this study. 71 patients with a SRCC and 12,570 patients with a ADC were identified. We analyzed the disease-free survival and the overall survival rates before and after a 1:2 propensity score matching and evaluated those rates after stage stratification. RESULTS: The median follow-up durations were 48.5 months for the SRC group and 48.6 months for the ADC group. The disease-free survival rates and the overall survival rates were significantly lower in the SRC group before and after propensity score matching (P < 0.001). After stratification by stage, no differences were observed between the SRC and the ADC groups for the disease-free survival (DFS) and the overall survival (OS) rates for patients with cancer in its early stages (P = 0.913 and P = 0.380 for the DFS and the OS, respectively, in stages 0 and I, and P = 0.223 and P = 0.991 for the DFS and the OS, respectively, in stage II), but those rates were significantly lower in the SRC group for cancer in its later stages (P < 0.001, respectively in stages III and IV). CONCLUSION: For cancer in advanced stages, patients with a resectable colorectal SRCC had a poorer prognosis after propensity score matching than those with an ADC did. Therefore, more intensive surveillance and closer observation should be offered to such patients.
Adenocarcinoma ; Colorectal Neoplasms* ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Mucins ; Prognosis ; Propensity Score ; Survival Rate

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Which One is Better? Comparison of the Acute Inflammatory Response, Raja Isteri Pengiran Anak Saleha Appendicitis and Alvarado Scoring Systems.

Mohammad Yasin KARAMI ; Hadi NIAKAN ; Navid ZADEBAGHERI ; Parviz MARDANI ; Zahra SHAYAN ; Iman DEILAMI

Annals of Coloproctology.2017;33(6):227-231. doi:10.3393/ac.2017.33.6.227

PURPOSE: Acute appendicitis (AA) is one of the most common causes of an acute abdomen. The accuracies of the Alvarado and the acute inflammatory response (AIR) scores in the diagnosis of appendicitis is very low in Asian populations, so a new scoring system, the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) system, was designed recently. We applied and compared the Alvarado, AIR, and RIPASA scores in the diagnoses of appendicitis in the Iranian population. METHODS: We prospectively compared the RIPASA, Alvarado, and AIR systems by applying them to 100 patients. All the scores were calculated for patients who presented with right quadrant pain. Appendectomies were performed; then, the postoperative pathology reports were correlated with the scores. Scores of 8, 7, and 5 or more are optimal cutoffs for the RIPASA, Alvarado, and AIR scoring systems, respectively. The sensitivities, specificities, positive predictive values, negative predictive values (NPVs), positive and negative likelihood ratios (LRs) for the 3 systems were determined. RESULTS: The sensitivity and the specificity of the RIPASA score were 93.18% and 91.67%, respectively. The sensitivities of the Alvarado and the AIR scores were both 78.41%. The specificities of the Alvarado and the AIR scores were 100% and 91.67%, respectively. The RIPASA score correctly classified 93% of all patients confirmed with histological AA compared with 78.41% for the Alvarado and the AIR scores. CONCLUSION: The RIPASA scoring system had more sensitivity, better NPV, a positive LR, and a less negative LR for the Iranian population whereas the Alvarado scoring system was more specific.
Abdomen, Acute ; Appendectomy ; Appendicitis* ; Asian Continental Ancestry Group ; Diagnosis ; Humans ; Pathology ; Prospective Studies ; Sensitivity and Specificity ; Skates (Fish)*

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