Pre-operative chemoradiotherapy (CRT) is a preferable treatment option for patients with locally advanced rectal cancer. However, few data are available regarding pre-operative CRT for locally advanced colon cancer. Here, we describe two cases of successful treatment with pre-operative CRT and establish evidence supporting this treatment option in patients with locally advanced colon cancer. In the first case, a 65-year-old woman was diagnosed with ascending colon cancer with duodenal invasion. In the second case, a 63-year-old man was diagnosed with a colonic-duodenal fistula due to transverse colon cancer invasion. These case reports will help to establish a treatment consensus for pre-operative CRT in patients with locally advanced colon cancer.
Aged ; Chemoradiotherapy ; Colon ; Colon, Ascending ; Colon, Transverse ; Colonic Neoplasms ; Consensus ; Female ; Fistula ; Humans ; Middle Aged ; Rectal Neoplasms

BACKGROUND/AIMS: Early diagnosis of peritoneal metastases in patients with colorectal cancer (CRC) can influence patient prognosis. The aim of this study was to identify the clinical significance of carcinoembryonic antigen (CEA) in peritoneal fluid detected during operation in stage I–III CRC patients. METHODS: Between April 2009 and April 2015, we reviewed medical records from a total of 60 stage I–III CRC patients who had peritoneal fluid collected during operation. Patients who had positive cytology in the assessment of peritoneal fluid were excluded. We evaluated the values of CEA in peritoneal fluid (pCEA) to predict the long-term outcomes of these patients using Kaplan-Meier curves and Cox regression models. RESULTS: The median follow-up duration was 37 months (interquartile range, 21–50 months). On receiver operating characteristic analysis, pCEA had the largest area under the curve (0.793; 95% confidence interval, 0.635–0.950; P=0.001) with an optimal cutoff value of 26.84 (sensitivity, 80.0%; specificity, 76.6%) for predicting recurrence. The recurrence rate was 8.1% in patients with low pCEA ( < 26.84 ng/mL, n=37), and 52.2% in patients with high pCEA (≥26.84 ng/mL, n=23). In multivariate Cox regression analysis, high pCEA (≥26.84 ng/mL) was a risk factor for poor cancer-free survival (CFS) in stage I–III patients. CONCLUSIONS: In this study, we determined that high pCEA (≥26.84 ng/mL) detected during operation was helpful for the prediction of poor CFS in patients with stage I–III CRC.
Ascitic Fluid* ; Carcinoembryonic Antigen* ; Colorectal Neoplasms* ; Early Diagnosis ; Follow-Up Studies ; Humans ; Medical Records ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Risk Factors ; ROC Curve ; Sensitivity and Specificity

Common causes of lower gastrointestinal bleeding include diverticular disease, vascular disease, inflammatory bowel disease, neoplasms, and hemorrhoids. Lower gastrointestinal bleeding of appendiceal origin is extremely rare. We report a case of lower gastrointestinal bleeding due to angiodysplasia of the appendix. A 72-year-old man presented with hematochezia. Colonoscopy showed active bleeding from the orifice of the appendix. We performed a laparoscopic appendectomy. Microscopically, dilated veins were found at the submucosal layer of the appendix. The patient was discharged uneventfully. Although lower gastrointestinal bleeding of appendiceal origin is very rare, clinicians should consider it during differential diagnosis.
Aged ; Angiodysplasia* ; Appendectomy ; Appendix* ; Colonoscopy ; Diagnosis, Differential ; Gastrointestinal Hemorrhage* ; Hemorrhage ; Hemorrhoids ; Humans ; Inflammatory Bowel Diseases ; Lower Gastrointestinal Tract ; Vascular Diseases ; Veins

BACKGROUND/AIMS: Laparoscopic surgery has been proven to be an effective alternative to open surgery in patients with colon cancer. However, data on laparoscopic surgery in patients with rectal cancer are insufficient. The aim of this study was to compare the long-term outcomes of laparoscopic and open surgery in patients with rectal cancer. METHODS: A total of 307 patients with rectal cancer who were treated by open and laparoscopic curative resection at Kosin University Gospel Hospital (Busan, Korea) between January 2002 and December 2011 were reviewed retrospectively. RESULTS: Regarding treatment, 176 patients underwent an open procedure and 131 patients underwent a laparoscopic procedure. The local recurrence rate after laparoscopic resection was 2.3%, compared with 5.7% after open resection (p=0.088). Distant metastases occurred in 6.9% of the laparoscopic surgery group, compared with 24.4% in the open surgery group (p<0.001). In univariate analysis, age (> or =75 years vs. < or =60 years), preoperative staging, surgical approach (open vs. laparoscopic), elevated initial CEA level, elevated follow-up CEA level, number of positive lymph nodes, and postoperative chemotherapy affected overall survival and disease free survival. However, in multivariate analysis, the surgical approach apparently did not affect long-term oncologic outcome. CONCLUSIONS: In this study, long-term outcomes after laparoscopic surgery for rectal cancer were not inferior to those after open surgery. Therefore, laparoscopic surgery would be an alternative operative tool to open resection for rectal cancer, although further investigation is needed.
Adult ; Aged ; Aged, 80 and over ; Antineoplastic Agents/therapeutic use ; Combined Modality Therapy ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; *Laparoscopy ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Positron-Emission Tomography ; Rectal Neoplasms/mortality/*surgery/therapy ; Retrospective Studies ; Survival Rate ; Tomography, X-Ray Computed ; Treatment Outcome

OBJECTIVES: The purpose of this study is to evaluate feasibility and safety of simultaneous laparoscopy-assisted resection for synchronous colorectal and gastric cancer. METHODS: From January 2001 to December 2013, a total of 29 patients underwent simultaneous resection for synchronous colorectal and gastric cancers. Medical records were reviewed, retrospectively. RESULTS: Eight patients (5 male) underwent laparoscopy-assisted resection (LAP group) and twenty one patients (17 male) underwent open surgery (Open group). In the both group, the mean age (65.2 vs. 63.7 years, p =0.481), body mass index (22.6 vs. 22.3, p = 0.896) was comparable, respectively. In LAP group, laparoscopy-assisted distal gastrectomy was performed for all eight patients. In Open group, subtotal gastrectomy with billroth I gastroduodenostomy was most common procedure (66.7%). The operation time, blood loss volume was similar between the two groups. Gas out was earlier (3.0 vs. 4.6 days p = 0.106), postoperative hospital stay was shorter (12.0 vs. 18.3 days, p = 0.245) in LAP group. The postoperative complications were an ileus, a wound seroma and a bile leakage in LAP group, pneumonia (10.0%), wound bleeding (5.0%) and leakage (5.0%) in Open group. CONCLUSIONS: The simultaneous laparoscopy-assisted resection for synchronous colorectal cancer and gastric cancer is a feasible and safe procedure.
Bile ; Body Mass Index ; Colorectal Neoplasms ; Gastrectomy ; Gastroenterostomy ; Hemorrhage ; Humans ; Ileus ; Laparoscopy ; Length of Stay ; Medical Records ; Pneumonia ; Postoperative Complications ; Retrospective Studies ; Seroma ; Stomach Neoplasms* ; Wounds and Injuries

With advancement of minimal invasive surgery, a simultaneous laparoscopy-assisted resection for colorectal cancer and metastasis has become feasible. Hence, we report three cases of simultaneous laparoscopic surgery for colorectal cancer with liver or lung metastasis. In the first case, laparoscopic right hemicolectomy and left lateral segmentectomy of liver was performed for ascending colon cancer and liver metastasis. In the second case, laparoscopic right hemicolectomy and wedge resection of right lower lung was performed for cecal cancer and lung metastasis. In the third case, laparoscopic right hemicolectomy and wedge resection of left lower lung was performed for ascending colon cancer and lung metastasis. In the first two cases, patients quickly returned to normal activity. In the third case, postoperative bleeding was observed, but spontaneously stopped. There was no postoperative mortality. Simultaneous laparoscopic surgery represents a feasible option for colorectal cancer with metastases on the other organs.
Cecal Neoplasms ; Colon, Ascending ; Colorectal Neoplasms* ; Hemorrhage ; Humans ; Laparoscopy ; Liver ; Lung ; Mastectomy, Segmental ; Mortality ; Neoplasm Metastasis*

Single-incision laparoscopic surgery (SILS) has become popular due to the advantage of minimizing surgical. We report on two cases of simultaneous appendectomy and cholecystectomy using a single-incision laparoscopic technique. The patients were 49- and 50-year old females diagnosed with acute appendicitis with concomitant cholelithiasis. Body mass indices of the patients were 22.3 and 26.0. A 3 cm abdominal incision was made via the umbilicus, and a single port platform was created using a small wound retractor (ALEXIS(R) wound retractor S, Applied Medical, Santa Margarita, CA, USA) and a surgical glove. Cholecystectomy was performed first, followed by the appendectomy. The operation times were 165 and 280 minutes, and blood loss was 50 and 150 cc, respectively. The postoperative hospital stays were five and seven days, and one patient had a wound seroma as a surgical complication. We believe that SILS for simultaneous appendectomy and cholecystectomy is a feasible and safe minimally invasive procedure.
Appendectomy* ; Appendicitis ; Cholecystectomy* ; Cholelithiasis ; Female ; Gloves, Surgical ; Humans ; Laparoscopy* ; Length of Stay ; Seroma ; Umbilicus ; Wounds and Injuries

Single-incision laparoscopic surgery (SILS) has become popular due to the advantage of minimizing surgical. We report on two cases of simultaneous appendectomy and cholecystectomy using a single-incision laparoscopic technique. The patients were 49- and 50-year old females diagnosed with acute appendicitis with concomitant cholelithiasis. Body mass indices of the patients were 22.3 and 26.0. A 3 cm abdominal incision was made via the umbilicus, and a single port platform was created using a small wound retractor (ALEXIS(R) wound retractor S, Applied Medical, Santa Margarita, CA, USA) and a surgical glove. Cholecystectomy was performed first, followed by the appendectomy. The operation times were 165 and 280 minutes, and blood loss was 50 and 150 cc, respectively. The postoperative hospital stays were five and seven days, and one patient had a wound seroma as a surgical complication. We believe that SILS for simultaneous appendectomy and cholecystectomy is a feasible and safe minimally invasive procedure.
Appendectomy* ; Appendicitis ; Cholecystectomy* ; Cholelithiasis ; Female ; Gloves, Surgical ; Humans ; Laparoscopy* ; Length of Stay ; Seroma ; Umbilicus ; Wounds and Injuries

PURPOSE: This study aimed at evaluation of the learning curve for laparoscopic colorectal surgery with varied operative procedures. METHODS: From June 2004 to May 2010, 269 consecutive patients underwent laparoscopic colorectal surgery. Patients were divided into four groups according to operative methods: right-side colectomy, left-side colectomy, rectal resection, and total colectomy group. Each group was divided into three-early, middle, and late-groups according to operation numbers. Learning curves were generated for each group using moving average methods. Prospective collection and retrospective review of data on operative outcomes, including open conversion, operation time, intra-operative blood loss, postoperative hospital stay, and postoperative complication were performed. RESULTS: Operations included 75 right-side colectomies, 12 left-side colectomies, 178 rectal resections, four total colectomies, and seven open conversions (2.6%). The mean operative time for right-side colectomy and rectal resection showed a significant decline from the early group to the middle and late groups, while the left-side colectomy group showed no significant difference. Operation time was platitude after 50 cases of whole laparoscopic colorectal surgery, 11 cases in the right-side colectomy group, eight cases in the left-side colectomy group, and 34 cases in the recto-sigmoid resection group. CONCLUSION: For the surgeon, laparoscopic colorectal surgery can be performed more independently after 50 cases. The learning curve may be determined according to the general skill of laparoscopic colorectal surgery. The question of whether the learning curve is determined by varied operative procedures has not yet been resolved.
Colectomy ; Colorectal Surgery ; Humans ; Laparoscopy ; Learning ; Learning Curve ; Length of Stay ; Operative Time ; Postoperative Complications ; Postoperative Hemorrhage ; Prospective Studies ; Retrospective Studies ; Surgical Procedures, Operative

OBJECTIVES: To reduce the risk of postoperative infectious complications and anastomotic leakage in colorectal surgery, preoperative mechanical bowel preparation (MBP) is performed routinely. The aim of this study was to evaluate the safety of primary anastomosis in elective colorectal surgery without MBP. METHODS: From Jan. 2005 to Dec. 2006, three hundred and seventy-nine patients of elective colorectal surgery with primary anastomosis were performed with MBP in 352 cases (Prep group) and without MBP in 24 cases (Non-prep group). For preoperative MBP, 4 liters of polyethylene glycol solution was administered. Postoperative infectious complications and other morbidity were reviewed with medical records and prospectively collected data. RESULTS: Demographic, clinical and treatment characteristics did not differ significantly between the two groups. The overall rate of abdominal infectious complications (wound infection, anastomotic leak) was 2.9 % in the Prep group and 9 % in the Non-prep group (P > 0.05). Anastomotic leak occurred in nine patients (2.6%) in the Prep group and one (4.5%) in the Non-prep group. CONCLUSIONS: The incidence of infectious complications after elective colorectal surgery without MBP did not differ significantly compare to that with MBP. However, prospective, randomized clinical trial is needed to assess the safety of primary anastomosis in elective colorectal surgery without MBP.
Anastomotic Leak ; Colorectal Surgery ; Humans ; Incidence ; Medical Records ; Polyethylene Glycols ; Prospective Studies