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CORRIGENDUM: Correction of the affiliation name. Comparison of the outcomes of robotic cholecystectomy and laparoscopic cholecystectomy.

Eun Kyoung LEE ; Eunyoung PARK ; Won Oak OH ; Nah Mee SHIN

Annals of Surgical Treatment and Research.2017;93(4):229-229. doi:10.4174/astr.2017.93.4.229

In the original publication, The authors found a mistake in funding statement. Also in the title page (1st affiliation) and main text, the authots would like to revise the affiliation name.

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Inferior mesenteric arteriovenous fistula.

Seunghun LEE ; Jooweon CHUNG ; Byungkwon AHN ; Seunghyun LEE ; Sunguhn BAEK

Annals of Surgical Treatment and Research.2017;93(4):225-228. doi:10.4174/astr.2017.93.4.225

Arteriovenous fistula (AVF) involving the inferior mesenteric artery and vein is very rare with only 33 cases described in the literature and may be of congenital or acquired (iatrogenic or traumatic) or idiopathic etiology. The pathophysiology of AVF that acts as a left-to-right shunt has accounted for clinical signs and symptoms associated with ischemic colitis, portal hypertension, and heart failure. A low incidence and nonspecific clinical signs and symptoms such as abdominal pain, thrill and mass, lower and upper gastrointestinal bleeding make it difficult to establish a diagnosis of inferior mesenteric AVF. Diagnosis of inferior mesenteric AVF is usually established by radiological or intraoperative examination. We report a case of idiopathic inferior mesenteric AVF causing ischemic colitis in a 56-year-old man that was diagnosed preoperatively by multidetector computed tomography and angiography and successfully treated by surgical resection.
Abdominal Pain ; Angiography ; Arteriovenous Fistula* ; Colitis, Ischemic ; Diagnosis ; Heart Failure ; Hemorrhage ; Humans ; Hypertension, Portal ; Incidence ; Mesenteric Artery, Inferior ; Middle Aged ; Multidetector Computed Tomography ; Veins

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The inflammatory response of neutrophils in an in vitro model that approximates the postcardiac arrest state.

Young Duck CHO ; Sung Jun PARK ; Sung Hyuk CHOI ; Young Hoon YOON ; Jung Youn KIM ; Sung Woo LEE ; Chae Seung LIM

Annals of Surgical Treatment and Research.2017;93(4):217-224. doi:10.4174/astr.2017.93.4.217

PURPOSE: Postcardiac arrest syndrome (PCAS) shares many features with sepsis including plasma cytokine elevation with dysregulation of cytokine production, and the presence of endotoxin in plasma. PCAS is closely related to ischemia-reperfusion injury. During ischemia-reperfusion injury, neutrophil, which is the first line of innate immunity, plays a major role. In this study, we investigated the inflammatory response of human neutrophils in an in vitro model which we simulated with hypoxia-normoxia and hypoxia-hyperoxia environments. METHODS: After separation of neutrophils from the whole blood, they were divided into 3 experimental groups: normoxia-normoxia, hypoxia-normoxia, and hypoxia-hyperoxia groups. The production of H₂O₂, the expression of Toll-like receptor 4 (TLR₄) receptor, and the extent of apoptosis of the neutrophils were checked. RESULTS: The in vitro hypoxia-normoxia and -hyperoxia models, which simulated the PCAS, showed initiation of the neutrophils' inflammatory reaction by hypoxia insult. Lipopolysaccharide amplifies such inflammation; therefore, prevention of secondary infection may be critical in postresuscitation patients. Temporary hyperoxia following hypoxic insult showed no difference in inflammatory reaction compared with hypoxia-normoxia. Rather, temporary hyperoxia may suppress or minimize inflammation by attenuation of TLR4 receptor. CONCLUSION: It is well known that continuous hyperoxygenation after successful cardiac arrest harms patients, but temporary hyperoxygenation with 100% O₂ in a clinical situation may be helpful.
Anoxia ; Apoptosis ; Coinfection ; Heart Arrest ; Humans ; Hyperoxia ; Immunity, Innate ; In Vitro Techniques* ; Inflammation ; Neutrophils* ; Passive Cutaneous Anaphylaxis ; Plasma ; Reperfusion Injury ; Sepsis ; Toll-Like Receptor 4

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The optimal duration of ischemic preconditioning for renal ischemia-reperfusion injury in mice.

Hyun Su CHOI ; Jeong Kye HWANG ; Jeong Goo KIM ; Hyeon Seok HWANG ; Sang Ju LEE ; Yoon kyung CHANG ; Ji Il KIM ; In Sung MOON

Annals of Surgical Treatment and Research.2017;93(4):209-216. doi:10.4174/astr.2017.93.4.209

PURPOSE: The aim of the present study was to investigate the protective effects of ischemic preconditioning for different periods of time and to elucidate the optimal safe ischemic preconditioning time for renal ischemia-reperfusion (I/R) injury in mice. METHODS: A total of 25 male C57BL/6 mice were randomly divided into 5 groups (sham, I/R, ischemic preconditioning [IP]-3, IP-5, and IP-7 groups), in which the kidney was preconditioned with IP of various durations and then subjected to I/R injury (the last 3 groups). To induce renal ischemia, the left renal pedicle was occluded with a nontraumatic microaneurysm clamp for 30 minutes followed by reperfusion for 24 hours. The effects of IP on renal I/R injury were evaluated in terms of renal function, tubular necrosis, apoptotic cell death and inflammatory cytokines. RESULTS: Results indicated that BUN and creatinine (Cr) levels increased significantly in the I/R group, but the elevations were significantly lower in IP groups, especially in the IP-5 group. Histological analysis revealed that kidney injury was markedly decreased in the IP-5 group compared with the I/R group, as evidenced by reduced renal necrosis/apoptosis. In addition, IP significantly inhibited gene expression of pro-inflammatory cytokines (TNF-α, IL-1β, and IL-6) and chemokines (monocyte chemoattractant protein-1). Western blot analysis indicated that the expression levels of Toll-like receptor 4 (TLR4) and nuclear factor-kappa B (NF-κB) were upregulated in the I/R group, while expression was inhibited in the IP groups. CONCLUSION: Five-minute IP had the greatest protective effect against I/R injury.
Animals ; Blotting, Western ; Cell Death ; Chemokines ; Creatinine ; Cytokines ; Gene Expression ; Humans ; Ischemia ; Ischemic Preconditioning* ; Kidney ; Male ; Mice* ; Necrosis ; Reperfusion ; Reperfusion Injury* ; Toll-Like Receptor 4

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Mortality risk factor analysis in colonic perforation: would retroperitoneal contamination increase mortality in colonic perforation?.

Ri Na YOO ; Bong Hyeon KYE ; Gun KIM ; Hyung Jin KIM ; Hyeon Min CHO

Annals of Surgical Treatment and Research.2017;93(4):203-208. doi:10.4174/astr.2017.93.4.203

PURPOSE: Colonic perforation is a lethal condition presenting high morbidity and mortality in spite of urgent surgical treatment. This study investigated the surgical outcome of patients with colonic perforation associated with retroperitoneal contamination. METHODS: Retrospective analysis was performed for 30 patients diagnosed with colonic perforation caused by either inflammation or ischemia who underwent urgent surgical treatment in our facility from January 2005 to December 2014. Patient characteristics were analyzed to find risk factors correlated with increased postoperative mortality. Using the Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) audit system, the mortality and morbidity rates were estimated to verify the surgical outcomes. Patients with retroperitoneal contamination, defined by the presence of retroperitoneal air in the preoperative abdominopelvic CT, were compared to those without retroperitoneal contamination. RESULTS: Eight out of 30 patients (26.7%) with colonic perforation had died after urgent surgical treatment. Factors associated with mortality included age, American Society of Anesthesiologists (ASA) physical status classification, and the ischemic cause of colonic perforation. Three out of 6 patients (50%) who presented retroperitoneal contamination were deceased. Although the patients with retroperitoneal contamination did not show significant increase in the mortality rate, they showed significantly higher ASA physical status classification than those without retroperitoneal contamination. The mortality rate predicted from Portsmouth POSSUM was higher in the patients with retroperitoneal contamination. CONCLUSION: Patients presenting colonic perforation along with retroperitoneal contamination demonstrated severe comorbidity. However, retroperitoneal contamination was not found to be correlated with the mortality rate.
Classification ; Colon* ; Comorbidity ; Humans ; Inflammation ; Intestinal Perforation ; Ischemia ; Mortality* ; Postoperative Complications ; Retroperitoneal Space ; Retrospective Studies ; Risk Factors* ; Sepsis

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Novel anal sphincter saving procedure with partial excision of levator-ani muscle in rectal cancer invading ipsilateral pelvic floor.

Gyoung Tae NOH ; Jeonghee HAN ; Chinock CHEONG ; Yoon Dae HAN ; Nam Kyu KIM

Annals of Surgical Treatment and Research.2017;93(4):195-202. doi:10.4174/astr.2017.93.4.195

PURPOSE: Tumors at the level of the anorectal junction had required total levator-ani muscle excision to achieve an adequate resection margin. However, in the cases of tumor invading ipsilateral levator-ani muscle and intact external sphincter, en bloc resection of rectum with levator-ani muscle including tumor would be possible. This hemilevator excision (HLE) technique enables preserving the anal sphincter function while obtaining oncologic clearance and avoiding permanent colostomy in those patients. This study aimed to evaluate the surgical outcomes and feasibility of HLE. METHODS: Data on 13 consecutive patients who underwent HLE for pathologically proven low rectal cancer were retrospectively collected. All 13 patients presented low rectal cancer at the anorectal ring level that was suspected to invade or abut to the ipsilateral side of the levator-ani muscle. RESULTS: A secure resection margin was achieved in all cases, and anastomotic leakage occurred in 2 patients. During follow-up, 3 patients experienced tumor recurrence (2 systemic and 1 local). Among 6 patients who underwent diverting ileostomy closure after the index operation, 2 complained of fecal incontinence. The other 4 patients without fecal incontinence showed <10 times of bowel movement per day. Accessing their incontinence scale, mean Wexner score was 9.4. CONCLUSION: HLE is a novel sphincter-preserving technique that can be a treatment option for low rectal cancer invading ipsilateral levator-ani muscle, which has been an indication for abdominoperineal resection (APR) or extralevator APR. However, the long-term oncologic and functional outcomes of this procedure still need to be assessed to confirm its validity.
Anal Canal* ; Anastomotic Leak ; Colostomy ; Fecal Incontinence ; Follow-Up Studies ; Humans ; Ileostomy ; Pelvic Floor* ; Rectal Neoplasms* ; Rectum ; Recurrence ; Retrospective Studies

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Survival outcome and prognostic factors of neoadjuvant treatment followed by resection for borderline resectable pancreatic cancer.

Hyeong Seok KIM ; Jin Young JANG ; Youngmin HAN ; Kyoung Bun LEE ; Ijin JOO ; Doo Ho LEE ; Jae Ri KIM ; Hongbeom KIM ; Wooil KWON ; Sun Whe KIM

Annals of Surgical Treatment and Research.2017;93(4):186-194. doi:10.4174/astr.2017.93.4.186

PURPOSE: Neoadjuvant treatment may provide improved survival outcomes for patients with borderline resectable pancreatic cancer (BRPC). The purpose of this study is to evaluate the clinical outcomes of neoadjuvant treatment and to identify prognostic factors. METHODS: Forty patients who met the National Comprehensive Cancer Network definition of BRPC and received neoadjuvant treatment followed by surgery between 2007 and 2015 were evaluated. Prospectively collected clinicopathological outcomes were analyzed retrospectively. RESULTS: The mean age was 61.7 years and the male-to-female ratio was 1.8:1. Twenty-six, 3, and 11 patients received gemcitabine-based chemotherapy, 5-fluorouracil, and FOLFIRINOX, respectively. The 2-year survival rate (2YSR) was 36.6% and the median overall survival (OS) was 20 months. Of the 40 patients, 34 patients underwent resection and the 2YSR was 41.2% while the 2YSR of patients who did not undergo resection was 16.7% (P = 0.011). The 2YSR was significantly higher in patients who had partial response compared to stable disease (60.6% vs. 24.3%, P = 0.038), in patients who did than did not show a CA 19-9 response after neoadjuvant treatment (40.5% vs. 0%, P = 0.039) and in patients who did than did not receive radiotherapy (50.8% vs. 25.3%, P = 0.036). Five patients had local recurrence and 17 patients had systemic recurrence with a median disease specific survival of 15 months. CONCLUSION: Neoadjuvant treatment followed by resection is effective for BRPC. Pancreatectomy and neoadjuvant treatment response may affect survival. Effective systemic therapy is needed to improve long-term survival since systemic metastasis accounts for a high proportion of recurrence.
Drug Therapy ; Fluorouracil ; Humans ; Neoadjuvant Therapy* ; Neoplasm Metastasis ; Pancreatectomy ; Pancreatic Neoplasms* ; Prognosis ; Prospective Studies ; Radiotherapy ; Recurrence ; Retrospective Studies ; Survival Rate

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Effect of intraperitoneal CO₂ concentration on postoperative pain after laparoscopic cholecystectomy.

Ji Won CHUNG ; Kyu Sik KANG ; Sang Hyun PARK ; Chun Sook KIM ; Jin Hun CHUNG ; Sie Hyeon YOO ; Nan Seol KIM ; Yong Han SEO ; Ho Soon JUNG ; Hea Rim CHUN ; Hyung Youn GONG ; Hae Il JUNG ; Sang Ho BAE ; Su Yeon PARK

Annals of Surgical Treatment and Research.2017;93(4):181-185. doi:10.4174/astr.2017.93.4.181

PURPOSE: This study set out to identify the association between the intraperitoneal CO₂ concentrations and postoperative pain by dividing the participants into a control group and 2 experimental groups receiving irrigation (1 L and 2 L), and directly measuring their intraperitoneal CO₂ concentrations with a CO₂ gas detector. METHODS: A total of 101 patients, American Society of Anesthesiologists physical status classification I and II patients aged 18–65 years were enrolled in the study. Group 1 did not receive irrigation with normal saline, while groups 2 and 3 were administered irrigation with 1 L and 2 L of normal saline, respectively, after laparoscopic cholecystectomy. Intraperitoneal CO₂ concentrations were measured with a CO₂ gas detector through the port, and postoperative pain was assessed on a visual analogue scale at 6, 12, and 24 hours after surgery. RESULTS: The intraperitoneal CO₂ concentrations were 1,016.0 ± 960.3 ppm in group 1, 524.5 ± 383.2 ppm in group 2, and 362.2 ± 293.6 ppm in group 3, showing significantly lower concentrations in groups 2 and 3. Postoperative pain was significantly lower in group 3 at 6 hours after surgery, and in groups 2 and 3 at 12 hours after the surgery. However, there was no significant difference between the 3 groups in postoperative pain 24 hours after the surgery. CONCLUSION: This study found a causal relationship between the amount of normal saline used for irrigation and the intraperitoneal CO₂ concentrations in that irrigation with normal saline reduces pain on the day of the surgery.
Cholecystectomy, Laparoscopic* ; Classification ; Humans ; Pain, Postoperative* ; Saline Waters

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Establishing a colorectal cancer liver metastasis patient-derived tumor xenograft model for the evaluation of personalized chemotherapy.

Joohee JUNG ; Jisup KIM ; Hyun Kyung LIM ; Kyoung Mee KIM ; Yun Sun LEE ; Joon Seong PARK ; Dong Sup YOON

Annals of Surgical Treatment and Research.2017;93(4):173-180. doi:10.4174/astr.2017.93.4.173

PURPOSE: In order to suggest optimal anticancer drugs for patient-tailored chemotherapy, we developed a colorectal cancer (CRC)-liver metastasis patient-derived tumor xenograft (PDTX) model. METHODS: Tissue obtained from a patient with CRC-liver metastasis (F0) was transplanted in a nonobese female mouse with diabetic/severe combined immune deficiency (F1) and the tumor tissue was retransplanted into nude mice (F2). When tumor volumes reached ~500 mm³, the F2 mice were randomly divided into 4 groups (n = 4/group) of doxorubicin, cisplatin, docetaxel, and nontreated control groups. The tumor tissues were investigated using H&E staining, terminal deoxynucleotidyl transferase dUTP nick end labeling assays, and immunohistochemistry. To determine where the mutant allele frequencies varied across the different passages, we isolated genomic DNA from the primary tumor, liver metastasis, and PDTX models (F1/F2). RESULTS: The physiological properties of the tumor were in accord with those of the patient's tumors. Anticancer drugs delayed tumor growth, inhibited proliferation, and caused apoptosis. Histological assessments revealed no observable heterogeneity among the intragenerational PDTX models. Target exon sequencing analysis without high-quality filter conditions revealed some genetic variations in the 83 cancer-related genes across the generations. However, when de novo mutations were defined as a total count of zero in F0 and ≥5 in F2, exactly prognostic impact of clone cancer profiling (EGFR, KRAS, BRAF, PIK3CA, NRAS, APC and TP53) were detected in the paired. CONCLUSION: A CRC liver metastasis PDTX model was established for the evaluation of chemotherapeutic efficacy. This model retained the physiological characters of the patient tumors and potentially provides a powerful means of assessing chemotherapeutic efficacy.
Animals ; Apoptosis ; Cisplatin ; Clone Cells ; Colorectal Neoplasms* ; DNA ; DNA Nucleotidylexotransferase ; Doxorubicin ; Drug Therapy* ; Exons ; Family Characteristics ; Female ; Gene Frequency ; Genetic Variation ; Heterografts* ; Humans ; Immunohistochemistry ; Liver* ; Mice ; Mice, Nude ; Neoplasm Metastasis* ; Population Characteristics ; Sequence Analysis ; Xenograft Model Antitumor Assays

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ERRATUM: Correction for affiliation of the 8th author-corresponding author. Multicenter nonrandomized trial of ramosetron versus palonosetron in controlling chemotherapy-induced nausea and vomiting for colorectal cancer.

Jin Soo KIM ; Ji Yeon KIM ; Sang Jeon LEE ; Dong Kook PARK ; Hwan NAMGUNG ; Chang Nam KIM ; Won Jun CHOI ; Moo Jun BAEK

Annals of Surgical Treatment and Research.2014;87(2):112-112. doi:10.4174/astr.2014.87.2.112

The affiliation of the 8th author was misprinted.

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