Colorectal cancer is the third most common cancer in Korea and the third leading cause of death from cancer. Treatment outcomes for colon cancer are steadily improving due to national health screening programs with advances in diagnostic methods, surgical techniques, and therapeutic agents.. The Korea Colon Cancer Multidisciplinary (KCCM) Committee intends to provide professionals who treat colon cancer with the most up-to-date, evidence-based practice guidelines to improve outcomes and help them make decisions that reflect their patients’ values and preferences. These guidelines have been established by consensus reached by the KCCM Guideline Committee based on a systematic literature review and evidence synthesis and by considering the national health insurance system in real clinical practice settings. Each recommendation is presented with a recommendation strength and level of evidence based on the consensus of the committee.

Purpose: Outcome analysis of urachal cancer (UraC) is limited due to the scarcity of cases and different staging methods compared to urothelial bladder cancer (UroBC). We attempted to assess survival outcomes of UraC and compare to UroBC after stage-matched analyses. Materials and Methods: Total 203 UraC patients from a multicenter database and 373 UroBC patients in single institution from 2000 to 2018 were enrolled (median follow-up, 32 months). Sheldon stage conversion to corresponding TNM staging for UraC was conducted for head-to-head comparison to UroBC. Perioperative clinical variables and pathological results were recorded. Stage-matched analyses for survival by stage were conducted. Results: UraC patients were younger (mean age, 54 vs. 67 years; p < 0.001), with 163 patients (80.3%) receiving partial cystectomy and 23 patients (11.3%) radical cystectomy. UraC was more likely to harbor ≥ pT3a tumors (78.8% vs. 41.8%). While 5-year recurrence-free survival, cancer-specific survival (CSS) and overall survival were comparable between two groups (63.4%, 67%, and 62.1% in UraC and 61.5%, 75.9%, and 67.8% in UroBC, respectively), generally favorable prognosis for UraC in lower stages (pT1-2) but unfavorable outcomes in higher stages (pT4) compared to UroBC was observed, although only 5-year CSS in ≥ pT4 showed statistical significance (p=0.028). Body mass index (hazard ratio [HR], 0.929), diabetes mellitus (HR, 1.921), pathologic T category (HR, 3.846), and lymphovascular invasion (HR, 1.993) were predictors of CSS for all patients. Conclusion Despite differing histology, UraC has comparable prognosis to UroBC with relatively favorable outcome in low stages but worse prognosis in higher stages. The presented system may be useful for future grading and risk stratification of UraC.

PURPOSE: The purpose of this study was to investigate the feasibility and survival benefits of combined treatment with radiotherapy and adjuvant temozolomide (TMZ) in a Korean sample. MATERIALS AND METHODS: A total of 750 Korean patients with histologically confirmed glioblastoma multiforme, who received concurrent chemoradiotherapy with TMZ (CCRT) and adjuvant TMZ from January 2006 until June 2011, were analyzed retrospectively. RESULTS: After the first operation, a gross total resection (GTR), subtotal resection (STR), partial resection (PR), biopsy alone were achieved in 388 (51.7%), 159 (21.2%), 96 (12.8%), and 107 (14.3%) patients, respectively. The methylation status of O6-methylguanine-DNA methyltransferase (MGMT) was reviewed retrospectively in 217 patients. The median follow-up period was 16.3 months and the median overall survival (OS) was 17.5 months. The actuarial survival rates at the 1-, 3-, and 5-year OS were 72.1%, 21.0%, and 9.0%, respectively. The median progression-free survival (PFS) was 10.1 months, and the actuarial PFS at 1-, 3-, and 5-year PFS were 42.2%, 13.0%, and 7.8%, respectively. The patients who received GTR showed a significantly longer OS and PFS than those who received STR, PR, or biopsy alone, regardless of the methylation status of the MGMT promoter. Patients with a methylated MGMT promoter also showed a significantly longer OS and PFS than those with an unmethylated MGMT promoter. Patients who received more than six cycles of adjuvant TMZ had a longer OS and PFS than those who received six or fewer cycles. Hematologic toxicity of grade 3 or 4 was observed in 8.4% of patients during the CCRT period and in 10.2% during the adjuvant TMZ period. CONCLUSION: Patients treated with CCRT followed by adjuvant TMZ had more favorable survival rates and tolerable toxicity than those who did not undergo this treatment.
Biopsy ; Chemoradiotherapy* ; Disease-Free Survival ; Follow-Up Studies ; Glioblastoma* ; Humans ; Korea* ; Methylation ; Radiotherapy ; Retrospective Studies* ; Survival Rate

BACKGROUND AND OBJECTIVES: In treating attic cholesteatoma, traditional microscopic approach provides limited exposure to the attic space. Recently, the use of endoscope has emerged as a new treatment option for attic cholesteatoma. The aim of this study is to report the preliminary results of transcanal endoscopic removal of attic cholesteatoma and to evaluate the feasibility of endoscopic approach to attic cholesteatoma. SUBJECTS AND METHOD: Six patients with attic cholesteatoma were enrolled in this study from Sep 2014 to Oct 2015. Cholesteatoma was removed via transcanal endoscopic approach. We analyzed the clinical characteristics, surgical management and treatment outcomes. RESULTS: All patients had attic cholesteatoma in the epitympanic space with scutum erosion. However, the disease was restricted to the epitympanic space in three patients, whereas a limited extension of cholesteatoma to the aditus ad antrum was observed in two patients, and mesotympanum was involved in the remaining one patient. All of the patients suffered from conductive or mixed hearing loss with mean air-bone gap of 17.4 dB, and underwent endoscopic transcanal removal of cholesteatoma and scutoplasty. In three patients, the incus and malleus head were removed due to ossicular erosion, and a second-stage ossicular reconstruction was planned. No residual or recurrent diseases were noted during the follow-up period (mean: 13 months). No surgical complications were observed postoperatively, and favorable hearing outcome was obtained in all patients. CONCLUSION: Transcanal endoscopic approach was successfully performed in patients with limited attic cholesteatoma. Further studies involving a large number of patients with long-term follow-ups are necessary to prove the clinical efficacy of transcanal endoscopic approach in managing limited attic cholesteatoma.
Cholesteatoma* ; Endoscopes ; Follow-Up Studies ; Head ; Hearing ; Hearing Loss, Mixed Conductive-Sensorineural ; Humans ; Incus ; Malleus ; Methods ; Minimally Invasive Surgical Procedures ; Treatment Outcome

BACKGROUND/AIMS: A subset of patients may develop colorectal cancer after a colonoscopy that is negative for malignancy. These missed or de novo lesions are referred to as interval cancers. The aim of this study was to determine whether interval colon cancers are more likely to result from the loss of function of mismatch repair genes than sporadic cancers and to demonstrate microsatellite instability (MSI). METHODS: Interval cancer was defined as a cancer that was diagnosed within 5 years of a negative colonoscopy. Among the patients who underwent an operation for colorectal cancer from January 2013 to December 2014, archived cancer specimens were evaluated for MSI by sequencing microsatellite loci. RESULTS: Of the 286 colon cancers diagnosed during the study period, 25 (8.7%) represented interval cancer. MSI was found in eight of the 25 patients (32%) that presented interval cancers compared with 22 of the 261 patients (8.4%) that presented sporadic cancers (p=0.002). In the multivariable logistic regression model, MSI was associated with interval cancer (OR, 3.91; 95% confidence interval, 1.38 to 11.05). CONCLUSIONS: Interval cancers were approximately four times more likely to show high MSI than sporadic cancers. Our findings indicate that certain interval cancers may occur because of distinct biological features.
Colonic Neoplasms ; Colonoscopy ; Colorectal Neoplasms* ; DNA Mismatch Repair ; Humans ; Logistic Models ; Microsatellite Instability* ; Microsatellite Repeats*

OBJECTIVES: Neuroblastoma (NBL) predominantly affects children under 5 years of age. Through multimodal therapy, including chemotherapy, radiotherapy, surgery, and peripheral blood stem cell transplantation, the survival rate in patients with NBL have improved while treatment-related complications have also increased. Treatment-related ototoxicity, mainly from cisplatin, can result in profound hearing loss requiring cochlear implantation (CI). We analyzed the effectiveness and hearing preservation of CI recipients who had treated with multimodal therapy due to NBL. METHODS: Patients who received multimodal therapy for NBL and subsequent CIs were enrolled. A detailed review of the perioperative hearing test, speech evaluation, and posttreatment complications was conducted. Speech performance was analyzed using the category of auditory performance (CAP) score and the postoperative hearing preservation of low frequencies was also compared. Patients who were candidates for electro-acoustic stimulation (EAS) used an EAS electrode for low frequency hearing preservation. RESULTS: Three patients were identified and all patients showed improvement of speech performance after CI. The average of CAP score improved from 4.3 preoperatively to 5.8 at 1 year postoperatively. Two patients who were fitted with the Flex electrode showed complete hearing preservation and the preserved hearing was maintained over 1 year. The one remaining patient was given the standard CI-512 electrode and showed partial hearing preservation. CONCLUSION: Patients with profound hearing loss resulting from NBL multimodal therapy can be good candidates for CI, especially for EAS. A soft surgical technique as well as a specifically designed electrode should be applied to this specific population during the CI operation in order to preserve residual hearing and achieve better outcomes.
Child* ; Cisplatin ; Cochlear Implantation* ; Cochlear Implants* ; Combined Modality Therapy* ; Drug Therapy ; Electrodes ; Hearing Loss* ; Hearing Tests ; Hearing* ; Humans ; Neuroblastoma* ; Peripheral Blood Stem Cell Transplantation ; Radiotherapy ; Survival Rate

OBJECTIVES: The aim of this cross-sectional study was to compare the subjective quality of life in the four groups of antipsychotics according to the risk of weight gain in patients with schizophrenia. METHODS: One hundred and thirty-two patients with schizophrenia that had taken the same antipsychotics for more than 1 year were enrolled in the analyses. Anti-psychotic agents were classified by the risk of weight gain into four groups : serious, common, not unusual, and unusual. The quality of life was measured with the Schizophrenia Quality of Life Scale Korean version, 4th Revision (SQLS-R4K). We analyzed the correlation between the total score of SQLS-R4K and clinical variables. RESULTS: The SQLS-R4K score was significantly different in the four anti-psychotic groups (F=5.200, p=0.002). Gender, type of anti-psychotics (typical, atypical), duration of treatment with current antipsychotics, duration of illness, and Body Mass Index were not significantly correlated with the SQLS-R4K score. CONCLUSION: The subjective quality of life was different according to the risk of weight gain groups of anti-psychotic agents.
Antipsychotic Agents ; Body Mass Index ; Cross-Sectional Studies ; Humans ; Quality of Life ; Schizophrenia ; Weight Gain

OBJECTIVES: Many antipsychotics are associated with hyperprolactinemia and sexual dysfunction. This study investigated the prevalence of hyperprolactinemia and amenorrhea and explored the association between hyperprolactinemia and sexual dysfunction. METHODS: We analyzed 285 patients with schizophrenia or schizoaffective disorder who had been taking antipsychotics more than one year, examining their serum prolactin levels and administering the Arizona Sexual Experience Scale (ASEX) to evaluate for sexual dysfunction. We conducted an ANCOVA to evaluate the effect of hyperprolactinemia on ASEX score and amenorrhea. RESULTS: We found hyperprolactinemia in 52.3% of the patients, finding it to be more common in females (60.8%) than in males (49%). Patients taking risperidone had the highest prevalence of hyperprolactinemia (86.5%), and patients taking aripiprazole showed no hyperprolactinemia. Amenorrhea prevalence was 21.5%. Hyperprolactinemia did not significantly affect ASEX scores, but it significantly affected amenorrhea. CONCLUSION: Many patients taking antipsychotics still experience hyperprolactinemia in a real clinical setting. The prevalence of hyperprolactinemia varies among antipsychotics. Clinicians should consider the possibility of antipsychotic-induced hyperprolactinemia, with its potential adverse effects, when treating such patients.
Amenorrhea ; Antipsychotic Agents ; Arizona ; Female ; Humans ; Hyperprolactinemia ; Male ; Piperazines ; Prevalence ; Prolactin ; Psychotic Disorders ; Quinolones ; Risperidone ; Schizophrenia ; Aripiprazole

OBJECTIVES: A previous study conducted in 2000 measuring the heart rate variability (HRV) of carbon disulfide (CS2)-poisoned subjects suggested that their HRV was reduced after exposure cessation. However, the study was limited by the following procedural limitations: (1) only 71 CS2-poisoned subjects participated, (2) no females participated, and (3) the CS2-poisoned subjects were older than the controls. This study was therefore conducted to overcome these limitations of the earlier study. METHODS: The study subjects comprised 122 retired workers with CS2 poisoning and the same number of age- and sex-matched controls. Information on individual age, sex, height, weight, smoking history, alcohol drinking, regular exercise, medical and occupational history, chest x-ray, and ECG recording of the two groups was collected though a self-administered questionnaire and a medical examination. Standard Deviation of NN intervals (SDNN), Root-Mean-Square of Successive Differences (RMSSD), Total Power (TP), Low Frequency (LF), High Frequency (HF), and LF/HF ratio were measured as HRV indices for 5 minutes in the sitting position. RESULTS: Univariate analysis revealed that all HRV indices of CS2-poisoned subjects were lower than those of the controls. Multiple linear regression analysis showed that CS2 poisoning had negative association with all HRV indices and that its association with RMSSD was statistically significant (P<0.05). CONCLUSIONS: This study suggests that CS2-poisoned subjects continue to have reduced HRV, even though the exposure has ceased.
Alcohol Drinking ; Carbon Disulfide* ; Carbon* ; Electrocardiography ; Female ; Heart Rate* ; Heart* ; Humans ; Linear Models ; Poisoning ; Questionnaires ; Smoke ; Smoking ; Thorax

The authors present the case of a patient who suffered from cerebellar dysfunction, radiographically documented brainstem compression, and neurological deterioration after proximal artery occlusion in a giant vertebral artery aneurysm. Symptom resolution was achieved after complete embolization of remained lumen of aneurysm. The cause of neurological deterioration is brainstem compression due to mass effect of the aneurysm. In order to avoid this fatal complication, it is necessary to determine appropriate therapy for the vertebral artery giant aneurysm by evaluating cerebral blood flow and other factors about growth of aneurysm.
Aneurysm* ; Arteries* ; Brain Stem ; Cerebellar Diseases ; Humans ; Vertebral Artery*