PURPOSE: The Korean Hereditary Tumor Registry, the first and one of the largest registries of hereditary tumors in Korea, has registered about 500 families with hereditary cancer syndromes. This study evaluates the temporal changes in clinicopathologic features and surgical patterns of Lynch syndrome (LS) patients. MATERIALS AND METHODS: Data on 182 unrelated LS patients were collected retrospectively. The patients were divided into the period 1 group (registered in 1990-2004) and 2 (registered in 2005-2014). The clinical characteristics of the two groups were compared to identify changes over time. RESULTS: The period 1 group included 76 patients; the period 2 group, 106 patients. The mean ages at diagnosis were 45.1 years (range, 13 to 85 years) for group 1 and 49.7 years (range, 20 to 84 years) for group 2 (p=0.015). The TNM stage at diagnosis did not differ significantly-period 1 group: stage 0-I (n=18, 23.7%), II (n=37, 48.7%), III (n=19, 25.0%), and IV (n=2, 2.6%); period 2 group: stage 0-I (n=30, 28.3%), II (n=35, 33.0%), III (n=37, 34.9%), and IV (n=4, 3.8%). Extended resection was more frequently performed (55/76, 72.4%) in the period 1 group than period 2 (49/106, 46.2%) (p=0.001). CONCLUSION: Colorectal cancer in patients with LS registered at the Korean Hereditary Tumor Registry is still diagnosed at an advanced stage, more than two decades after registry's establishment. Segmental resection was more frequently performed in the past decade. A prompt nationwide effort to raise public awareness of hereditary colorectal cancer and to support hereditary cancer registries is required in Korea.
Colorectal Neoplasms ; Colorectal Neoplasms, Hereditary Nonpolyposis* ; Diagnosis ; Humans ; Korea ; Neoplastic Syndromes, Hereditary ; Registries ; Retrospective Studies

PURPOSE: Hepatic resection is a standard method of treatment for colorectal liver metastases (CRLM). However, the pathologic factors of metastatic lesions that affect tumor recurrence are less well defined in CRLM. The aim of this study was to evaluate the risk factors for recurrence of CRLM, focusing on histopathologic factors of metastatic lesions of the liver. METHODS: From January 2003 to December 2008, 117 patients underwent curative hepatic resection for CRLM were reviewed. Tumor size and number, differentiation, tumor budding, angio-invasion, dedifferentiation and tumor infiltrating inflammation of metastatic lesions were investigated. RESULTS: The mean number of hepatic tumors was 2 (range, 1-8). The mean size of the largest tumor was 2.9 cm (range, 0.3-18.5 cm) in diameter. The moderate differentiation of the hepatic tumor was the most common in 86.3% of the patients. Tumor budding, angio-invasion, and dedifferentiation were observed in 81%, 34%, and 12.8% of patients. Inflammation infiltrating tumor was detected in 6.8% of patients. Recurrence after hepatic resection appeared in 69 out of 117 cases (58.9%). Recurrence-free survival at 1, 2 and 5 years were 62.4%, 43.6%, and 34.3%. The multivariate analysis showed the number of metastases > or =3 (P = 0.007), the tumor infiltrating inflammation (P = 0.047), and presence of dedifferentiation (P = 0.020) to be independent risk factors for tumor recurrence. CONCLUSION: Histopathological factors, i.e., dedifferentiation and tumor infiltrating inflammation of the metastatic lesion, could be one of the risk factors of aggressive behavior as well as the number of metastases even after curative resection for CRLM.
Colorectal Neoplasms ; Humans ; Inflammation ; Liver* ; Multivariate Analysis ; Neoplasm Metastasis* ; Recurrence* ; Risk Factors

PURPOSE: An inflamed appendix can be removed either openly (open appendectomy [OA]) or laparoscopically (laparoscopic appendectomy [LA]). Surgical-site infection (SSI) is a representative healthcare-associated infection and can impose serious economic burdens on patients as well as affect morbidity and mortality rates. The aim of this study was to compare LA with OA in terms of SSI. METHODS: The medical records of 749 patients (420 males; mean age, 33 years) who underwent appendectomy (OA, 431; LA, 318) between September 1, 2008 and April 29, 2010 were retrospectively reviewed for demographic and pathologic characteristics, recovery of bowel movement, length of hospital stay, and postoperative complications. RESULTS: The frequency of purulent/gangrenous or perforated appendicitis was not significantly different between LA and OA groups (83% [263/318 cases] vs. 83% [359/431 cases], P = 0.183). The time to first flatus after surgery was not significantly different between the two groups (1.38 +/- 1.07 days for LA, 1.33 +/- 0.90 days for OA, P = 0.444), but the length of hospital stay was significantly shorter in LA group than in OA group (3.37 +/- 0.12 days vs. 3.83 +/- 0.12 days, P = 0.006). The frequency of overall SSI was not significantly different between the two groups (2.8% for LA, 4.6% for OA, P = 0.204), but that of superficial incisional SSI was significantly lower in LA group (0.6% vs. 3.9%, P = 0.016). CONCLUSION: The results of this study suggest that LA may lead to a shorter length of hospital stay and may have a lower risk of superficial incisional SSI than OA.
Appendectomy ; Appendicitis ; Appendix ; Flatulence ; Humans ; Length of Stay ; Medical Records ; Retrospective Studies

PURPOSE: We analyzed the clinical data of T3 colorectal cancer patients to assess whether T3 subdivision correlates with node (N) or metastasis (M) staging and stage-independent factors. METHODS: Five hundred fifty-five patients who underwent surgery for primary colorectal cancer from January 2003 to December 2009 were analyzed for T3 subdivision. T3 subdivision was determined by the depth of invasion beyond the outer border of the proper muscle (T3a, <1 mm; T3b, 1 to 5 mm; T3c, >5 to 15 mm; T3d, >15 mm). We investigated the correlation between T3 subdivision and N, M staging and stage-independent prognostic factors including angiolymphatic invasion (ALI), venous invasion (VI) and perineural invasion (PNI). RESULTS: The tumors of the 555 patients were subclassified as T3a in 86 patients (15.5%), T3b in 209 patients (37.7%), T3c in 210 patients (37.8%) and T3d in 50 patients (9.0%). The nodal metastasis rates were 39.5% for T3a, 56.5% for T3b, 75.7% for T3c and 74.0% for T3d. The distant metastasis rates were 7.0% for T3a 9.1% for T3b, 27.1% for T3c and 40.0% for T3d. Both N and M staging correlated with T3 subdivision (Spearman's rho = 0.288, 0.276, respectively; P < 0.001). Other stage-independent prognostic factors correlated well with T3 subdivision (Spearman's rho = 0.250, P < 0.001 for ALI; rho = 0.146, P < 0.001 for VI; rho = 0.271, P < 0.001 for PNI). CONCLUSION: Subdivision of T3 colorectal cancer correlates with nodal and metastasis staging. Moreover, it correlates with other prognostic factors for colorectal cancer.
Colorectal Neoplasms ; Humans ; Muscles ; Neoplasm Metastasis ; Neoplasm Staging

BACKGROUNDS/AIMS: Hepatic resection has only guaranteed long-term survival in patients with colorectal liver metastasis (CRLM) even in the era of effective chemotherapy. The definite role of neoadjuvant chemotherapy (NCT) is to improve outcomes of unresectable CRLMs, but it its role has not been defined for initially resectable CRLMs (IR-CRLMs). METHODS: We reviewed the medical records of 226 patients, who had been diagnosed and treated for IR-CRLM between 2003 and 2008; the patients had the following pathologies: 10% had more than 4 nodules, 11% had tumors larger than 5 cm, and 61% had synchronous CRMLs. Among these patients, 20 patients (Group Y) were treated with NCT, and 206 (Group N) did not receive NCT according to their physician's preference. The median follow-up time was 34.1 months. RESULTS: The initial surgical plans were changed after NCT to further resection in 20% and to limited resection in 10% of 20 patients. Complication rates of Groups Y (30%) were indifferent from Group N (23%) (p=0.233), but intraoperative transfusions were more frequent in Group N (15%) than in Group Y (5%) (p=0.006). There was one case of hospital mortality (0.44%). Disease-free survival rates in Groups Y and N were 23% and 39%, respectively, and patient survival rates were 42% and 66% (p>0.05). By multivariate analysis, old age (> or =60 years), differentiation of primary tumor (poorly/mucinous), resection margin involvement, and no adjuvant chemotherapy were associated with poor patient survival; the number of CRLMs (> or =4) was associated with poor disease-free survival. CONCLUSIONS: NCT had neither a positive impact nor a negative impact on survival, even with intraoperative transfusion, as observed on operative outcomes for patients with IR-CRLM. Further study is required to elucidate the role of NCT for treatment of patient with IR-CRLMs.
Chemotherapy, Adjuvant ; Disease-Free Survival ; Follow-Up Studies ; Hospital Mortality ; Humans ; Liver ; Medical Records ; Multivariate Analysis ; Neoplasm Metastasis ; Survival Rate

BACKGROUND/AIMS: The prevalence of gastric polyps, duodenal adenoma and duodenal cancer has been reported as being high among familial adenomatous polyposis (FAP) patients, but there have been no reports of this association in Korea. This study evaluated the prevalence of gastric and duodenal polyps and risk factors for duodenal neoplasm in FAP patients in Korea. METHODS: We reviewed both initial and follow-up endoscopic results from FAP patients. We also investigated the treatment modality of duodenal adenomas and analyzed the risk factors of duodenal neoplasms by logistic regression analysis. RESULTS: A total of 148 patients with FAP underwent esophagogastroduodenoscopy (EGD), and the fi ndings were as follows: gastric polyp 39.9% (fundic gland polyp 25.7% and gastric adenoma 14.2%), duodenal adenoma 15.5%, gastric cancer 2.7%, and duodenal cancer 0.7%. There were two cases of gastric cancer that developed from benign gastric polyps. There were progressions of duodenal adenomatosis during follow-up, and some degree of relapse occurred after endoscopic resection. Patients with gastric polyps showed a correlation with the occurrence of duodenal neoplasm (odds ratio, 2.814; p=0.024). CONCLUSIONS: In Korean FAP patients, gastric cancer was detected more frequently, but fundic gland polyps, duodenal adenoma and duodenal cancer were detected less frequently than in Western patients. FAP patients with gastric polyps should undergo regular EGD, particularly for the early detection of duodenal neoplasia.
Adenoma ; Adenomatous Polyposis Coli ; Duodenal Neoplasms ; Endoscopy, Digestive System ; Follow-Up Studies ; Humans ; Korea ; Logistic Models ; Polyps ; Prevalence ; Recurrence ; Risk Factors ; Stomach Neoplasms

PURPOSE: Since 2004, the National Cancer Screening Program of Korea has included colorectal cancer screening based on primary screening with the fecal occult blood test (FOBT). We report on the clinical features of colorectal cancer detected by the National Cancer Screening Program. METHODS: We retrospectively analyzed 577 patients who underwent elective surgery for colorectal cancer at the Seoul National University Hospital between January 2008 and December 2009. We compared the clinical features of colorectal cancers detected by the National Cancer Screening Program (NCSP group) with those of the control group in terms of age, gender, preoperative symptom, location of the tumor, surgical technique and tumor-node-metastasis (TNM) stage. RESULTS: Age, gender, location of the tumor and operation types were not different between the two groups. The proportion of asymptomatic patients was significantly higher in the NCSP group than it was in the control group (86.5% vs. 20.0%; P < 0.001). The proportion of less invasive lesions (T1 or T2) was significantly higher in the NCSP group (46.3% vs. 27.7%; P = 0.002). The pathologic stages of the colorectal cancers in the NCSP group were I, 40.3%; II, 17.9%; III, 40.3% and IV, 1.5% whereas in the control group, they were I, 20.8%; II, 32.9%; III, 34.9% and IV, 11.4%. The proportion of stage I cancer was significantly higher in the NCSP group than in the control group (40.3% vs. 20.8%; P = 0.006). CONCLUSION: Our study demonstrates the FOBT in the NCSP is effective in early detection of colorectal cancer.
Colorectal Neoplasms ; Early Detection of Cancer ; Humans ; Korea ; Mass Screening ; Occult Blood ; Retrospective Studies

PURPOSE: To examine the effect of suboptimal chemotherapy in patients undergoing preoperative chemoradiotherapy for the treatment of rectal cancer. MATERIALS AND METHODS: The medical records of 43 patients who received preoperative concurrent chemoradiotherapy, followed by radical surgery for the treatment of pathologically proven adenocarcinoma of the rectum from April 2003 to April 2006 were retrospectively reviewed. The delivered radiation dose ranged from 41.4 to 50.4 Gy. The standard group consisted of patients receiving two cycles of a 5-FU bolus injection for three days on the first and fifth week of radiotherapy or twice daily with capecitabine. The standard group included six patients for each regimen. The non-standard group consisted of patients receiving one cycle of 5-FU bolus injection for three days on the first week of radiotherapy. The non-standard group included 31 patients. Radical surgery was performed at a median of 58 days after the end of radiotherapy. A low anterior resection was performed in 36 patients, whereas an abdominoperineal resection was performed in 7 patients. RESULTS: No significant difference was observed between the groups with respect to pathologic responses ranging from grades 3 to 5 (83.3% vs. 67.7%, p=0.456), downstaging (75.0% vs. 67.7%, p=0.727), and a radial resection margin greater than 2 mm (66.7% vs. 83.9%, p=0.237). The sphincter-saving surgery rate in low-lying rectal cancers was lower in the non-standard group (100% vs. 75%, p=0.068). There was no grade 3 or higher toxicity observed in all patients. CONCLUSION: Considering that the sphincter-saving surgery rate in low-lying rectal cancer was marginally lower for patients treated with non-standard, suboptimal chemotherapy, and that toxicity higher than grade 2 was not observed in the both groups, suboptimal chemotherapy should be avoided in this setting.
Adenocarcinoma ; Chemoradiotherapy ; Deoxycytidine ; Fluorouracil ; Humans ; Medical Records ; Rectal Neoplasms ; Rectum ; Retrospective Studies ; Capecitabine

PURPOSE: This study was performed to evaluate the effects of age and sex on anorectal manometry. METHODS: Seventy-four consecutive patients who underwent surgery for sigmoid colon cancer and who had neither anal disorders nor colonic obstruction were included in this study. There were 45 men and 29 women, and the mean age was 58.6. Pressure measurements used both the rapid and the station pull-through (RPT and SPT) methods, and volume measurements used a balloon-tipped catheter. Three pressure indices (vector volume, maximal pressure, and mean pressure), three sphincter length indices (sphincter length, high pressure zone [HPZ] length, and maximal pressure position), and three volume indices (minimal sensory volume, maximal tolerance volume, and rectoanal inhibitory reflex) were analyzed. RESULTS: Squeezing pressures were higher in men than in women, especially in the RPT method, while resting pressures were not different. Sphincter length and HPZ length were not different between the sexes, but the maximal pressure position was farther from the anal verge in men. Rectal volume indices were not different between the sexes. The resting and squeezing pressures decreased linearly with aging in men, but not in women. The differences in squeezing pressures between men and women were evident in their forties and fifties, but decreased gradually with aging, with no differences being observed in their seventies. With aging, the minimal sensory volume increased in women, and the maximal tolerance volume increased in men. CONCLUSION: Anal canal pressures and volume indices are influenced by sex, age, and measurement method. Therefore, sex, age, and measurement method must be considered in the evaluation and application of anorectal manometry.
Aging ; Anal Canal ; Catheters ; Colon ; Female ; Humans ; Male ; Manometry ; Sigmoid Neoplasms

This study was to evaluate the effectiveness of the first proactive Quitline service for smoking cessation in Korea and determine the predictors of successful smoking cessation. Smoking participants were voluntarily recruited from 18 community health centers. The participants were proactively counseled for smoking cessation via 7 sessions conducted for 30 days from November 1, 2005 to January 31, 2006. Of the 649 smoking participants, 522 completed 30 days at the end of the study and were included in the final analysis. The continuous abstinence rate at 30 days of follow-up was found to be 38.3% (200/522), in the intention-to-treat analysis. Compared with non-quitters, quitters were mostly male, smoked <20 cigarettes/ day, had started smoking at the age of > or =20 yr, and were less dependent on nicotine. Based on the stepwise multiple logistic regression analysis, the significant predictors of successful smoking cessation were determined to be male sex, low cigarette consumption, and older age at smoking initiation. We investigated the short-term effectiveness of the Quitline service and determined the predictors of successful smoking cessation.
Adult ; Aged ; Female ; Health Promotion ; Hotlines/*utilization ; Humans ; Korea ; Life Style ; Male ; Middle Aged ; Regression Analysis ; Smoking/epidemiology/*prevention & control ; Smoking Cessation/methods/psychology/*statistics & numerical data ; Telephone ; Treatment Outcome