PURPOSE: Rectovaginal fistula (RVF) after low anterior resection for rectal cancer is a type of anastomotic leakage. The aim of this study was to find out the difference of leakage, according to RVF presence or absence and to identify the optimal strategy for RVF. METHODS: All female patients who underwent low anterior resection with colorectal anastomosis or coloanal anastomosis (n = 950) were retrospectively analyzed. Patients' demographics and perioperative outcomes were analyzed between the RVF group and leakage without the RVF (nRVF) group. We performed 4 types of procedures—primary repair, diverting stoma, redo coloanal anastomosis (RCA), and conservative procedure—to treat RVF, and calculated the success rates of each type of procedure. RESULTS: The leakage occurred in 47 patients (4.9%). Among them, 18 patients (1.9%) underwent an RVF and 29 (3.0%) underwent nRVF. The RVF group received more perioperative radiotherapy (27.8% vs. 3.4%, P < 0.015) and occurred late onset after surgery (181.3 ± 176.4 days vs. 23.2 ± 53.6 days, P < 0.001) more than did the nRVF group. In multivariate analysis for the risk factor of the RVF group, the RVF group was statistically associated with less than 5 cm of anastomosis more than was the no-leakage group. A total of 35 procedures were performed in 18 patients with RVF for treatment. RCA showed satisfactory success rates (85.7%, n = 6) and, primary repair (transanal or transvaginal) showed acceptable success rate (33.3%, n = 8). CONCLUSION: After low anterior resection for rectal cancer, RVF was strongly correlated with a lower level of primary tumor location. Among the patients who underwent leakages, receipt of perioperative radiotherapy was significantly high in the RVF group than that of the nRVF group. Additionally, this study suggests that RCA might be considered another successful treatment strategy for RVF.
Anastomotic Leak ; Colectomy ; Demography ; Female ; Humans ; Multivariate Analysis ; Radiotherapy ; Rectal Neoplasms ; Rectovaginal Fistula ; Retrospective Studies ; Risk Factors

PURPOSE: We developed a technique of totally-robotic right colectomy with D3 lymphadenectomy and intracorporeal anastomosis via a suprapubic transverse linear port. This article aimed to introduce our novel robotic surgical technique and assess the short-term outcomes in a series of five patients. METHODS: All colectomies were performed using the da Vinci Xi system. Four robot trocars were placed transversely in the supra pubic area. Totally-robotic right colectomy was performed, including colonic mobilization, D3 lymphadenectomy, and intra corporeal stapled functional anastomosis. The 2 middle suprapubic trocar incisions were then extended to retrieve the specimen. RESULTS: Five robotic right colectomies via the suprapubic approach were performed between August 2015 and February 2016. The mean operation time was 183 ± 29.37 minutes, and the mean estimated blood loss was 27 ± 9.75 mL. The time to clear liquid intake was 3 days in all patients, and the mean length of stay after surgery was 6.2 ± 0.55 days. No patient required conversion to conventional laparoscopic surgery. There were no perioperative complications. According to the pathology report, the mean number of harvested lymph nodes was 36.6 ± 4.45. Four patients were stage III, and 1 patient was stage II according to the 7th edition of the American Joint Committee on Cancer system. CONCLUSION: Totally-robotic right colectomy via the suprapubic approach can be performed successfully in selected patients. Further comparative studies are required to verify the clinical advantages of our technique over conventional robotic surgery.
Colectomy ; Colon ; Colonic Neoplasms ; Humans ; Joints ; Laparoscopy ; Length of Stay ; Lymph Node Excision ; Lymph Nodes ; Pathology ; Robotic Surgical Procedures ; Surgical Instruments

PURPOSE: Redo surgery in patients with a persistent anastomotic failure (PAF) is a rare procedure, and data about this procedure are lacking. This study aimed to evaluate the surgical outcomes of redo surgery in such patients. METHODS: Patients who underwent a redo anastomosis for PAF from January 2004 to November 2016 were retrospectively evaluated. Data from a prospective colorectal database were analyzed. Success was defined as the combined absence of any anastomosis-related complications and a stoma at the last follow-up. RESULTS: A total of 1,964 patients who underwent curative surgery for rectal cancer during this study period were included. Among them, 32 consecutive patients underwent a redo anastomosis for PAF. Thirteen patients of those 32 had major anastomotic dehiscence with a pelvic sinus, 12 had a recto-vaginal fistula, and 7 had anastomosis stenosis. There were no postoperative deaths. The median operation time was 255 minutes (range, 80–480 minutes), and the median blood loss was 80 mL (range, 30–1,000 mL). The overall success rate was 78.1%, and the morbidity rate was 40.6%. Multivariable analyses showed that the primary tumor height at the lower level was the only statistically significant risk factor for redo surgery (P = 0.042; hazard ratio, 2.444). CONCLUSION: In our experience, a redo anastomosis is a feasible surgical option that allows closure of a stoma in nearly 80% of patients. Lower tumor height (<5 cm from the anal verge) is the only independent risk factor for nonclosure of defunctioning stomas after primary rectal surgery.
Constriction, Pathologic ; Fistula ; Follow-Up Studies ; Humans ; Laparoscopy ; Prospective Studies ; Rectal Neoplasms ; Retrospective Studies ; Risk Factors

Benign prostatic hyperplasia (BPH) is one of the most common diseases in older men and it may be accompanied with significant problems in the quality of life. Histological changes of BPH is starting at the age of 35, and there is induced in 60% of 60-year-old men, 80% of 80-year-old men, in 50% of the patient group may lead to lower urinary tract symptoms (LUTS). A 74-year-old man with huge BPH visited outpatient clinic with severe LUTS of an year duration. He was diagnosed with BPH 11 years ago and underwent transurethral resection of prostate twice. However, the prostate grew up to remarkable size again, which lead to the bladder outlet obstruction (BOO) and renal failure. There is no report for huge BPH (above 300 g) in Korea, we report a case with huge prostate size that is measured 330 g and treated with suprapubic open prostatectomy.
Aged ; Aged, 80 and over ; Ambulatory Care Facilities ; Humans ; Korea ; Lower Urinary Tract Symptoms ; Male ; Middle Aged ; Prostate ; Prostatectomy ; Prostatic Hyperplasia* ; Quality of Life ; Renal Insufficiency ; Transurethral Resection of Prostate ; Urinary Bladder Neck Obstruction

OBJECTIVE: The aim of this study was to report a case series of in vitro matured (IVM) oocyte freezing in gynecologic cancer patients undergoing radical surgery under time constraints as an option for fertility preservation (FP). METHODS: Case series report. University-based in vitro fertilization center. Six gynecologic cancer patients who were scheduled to undergo radical surgery the next day were referred for FP. The patients had endometrial (n=2), ovarian (n=3), and double primary endometrial and ovarian (n=1) cancer. Ex vivo retrieval of immature oocytes from macroscopically normal ovarian tissue was followed by mature oocyte freezing after IVM or embryo freezing with intracytoplasmic sperm injection. RESULTS: A total of 53 oocytes were retrieved from five patients, with a mean of 10.6 oocytes per patient. After IVM, a total of 36 mature oocytes were obtained, demonstrating a 67.9% maturation rate. With regard to the ovarian cancer patients, seven IVM oocytes were frozen from patient 3, who had stage IC cancer, whereas one IVM oocyte was frozen from patient 4, who had stage IV cancer despite being of a similar age. With regard to the endometrial cancer patients, 15 IVM oocytes from patient 1 were frozen. Five embryos were frozen after the fertilization of IVM oocytes from patient 6. CONCLUSION: Immature oocytes can be successfully retrieved ex vivo from macroscopically normal ovarian tissue before radical surgery. IVM oocyte freezing provides a possible FP option in patients with advanced-stage endometrial or ovarian cancer without the risk of cancer cell spillage or time delays.
Cryopreservation* ; Embryonic Structures ; Endometrial Neoplasms ; Female ; Fertility Preservation ; Fertilization ; Fertilization in Vitro ; Freezing ; Humans ; In Vitro Oocyte Maturation Techniques ; In Vitro Techniques* ; Oocyte Retrieval* ; Oocytes* ; Ovarian Neoplasms ; Sperm Injections, Intracytoplasmic ; Uterine Neoplasms

BACKGROUND/OBJECTIVES: Yacon (Samallanthus sonchifolius), a common edible plant grown throughout the world, is well known for its antidiabetic properties. It is also known to have several other pharmacological properties including anti-inflammatory, anti-oxidant, anti-allergic, and anti-cancer effects. To date, the effect of yacon on gliomas has not been studied. In this study, we investigated the effects of yacon on the migration and proliferation of C6 glioma cells stimulated by fetal bovine serum (FBS). MATERIALS/METHODS: Cell growth and proliferation were determined by evaluating cell viability using an EZ-Cytox Cell Viability Assay Kit. FBS-induced migration of C6 glioma cells was evaluated by performing the scratch wound healing assay and the Boyden chamber assay. We also used western blot analysis to determine the expression levels of extracellular signal-regulated kinase 1/2 (ERK1/2), a major regulator of migration and proliferation of glioma cells. Matrix metallopeptidase (MMP) 9 and TIMP-1 levels were measured by performing reverse transcription PCR. RESULTS: Yacon (300 microg/mL) reduced both the FBS-induced proliferation of C6 glioma cells and the dose-dependent migration of the FBS-stimulated C6 cells. FBS-stimulated C6 glioma cells treated with yacon (200 and 300 microg/mL) showed reduced phosphorylation of ERK1/2 and inhibition of MMP 9 expression compared to those shown by the untreated FBS-stimulated C6 cells. In contrast, yacon (200 and 300 microg/mL) induced TIMP-1 expression. CONCLUSIONS: On the basis of these results, we suggest that yacon may exert an anti-cancer effect on FBS-stimulated C6 glioma cells by inhibiting their proliferation and migration. The most likely mechanism for this is down-regulation of ERK1/2 and MMP9 and up-regulation of TIMP-1 expression levels.
Blotting, Western ; Cell Proliferation* ; Cell Survival ; Down-Regulation ; Ethanol* ; Glioma* ; Phosphorylation ; Phosphotransferases ; Plants, Edible ; Polymerase Chain Reaction ; Reverse Transcription ; Tissue Inhibitor of Metalloproteinase-1 ; Up-Regulation ; Wound Healing

Complicated malaria is mainly caused by Plasmodium falciparum, but, increasingly, Plasmodium vivax is also being reported as a cause. Since the reemergence of indigenous vivax malaria in 1993, cases of severe malaria have been steadily reported in Korea. Herein, we report a case of vivax malaria complicated by adult respiratory distress syndrome (ARDS) that was successfully managed with extracorporeal membrane oxygenation (ECMO). A 59-year-old man presented at our hospital with fever and abdominal pain, which had persisted for 10 days. On admission, the patient had impaired consciousness, shock, hypoxia and haziness in both lungs, jaundice, thrombocytopenia and disseminated intravascular coagulation, metabolic acidosis, and acute kidney injury. A peripheral blood smear and a rapid diagnostic test verified P. vivax mono-infection. Ten hours after admission, hypoxia became more severe, despite providing maximal ventilatory support. The administration of antimalarial agents, ECMO, and continuous venovenous hemofiltration resulted in an improvement of his vital signs and laboratory findings. He was discharged from the hospital 7 weeks later, without any sequelae.
Acute Kidney Injury ; Anoxia ; Antimalarials/*administration & dosage ; Extracorporeal Membrane Oxygenation ; Humans ; Lung/radiography ; Malaria, Vivax/*complications/diagnosis/radiography/therapy ; Male ; Middle Aged ; Multiple Organ Failure ; Plasmodium vivax/*isolation & purification ; Republic of Korea ; Respiratory Distress Syndrome, Adult/*complications/radiography/therapy ; Treatment Outcome

In this study, the patient with localized prostate cancer who had previously been treated at Ajou University Hospital was randomly selected since March, 2009. we performed IMRT and 2RA plans and the same dose objectives were used for CTVs, PTVs, rectum, bladder, and femoral head of the respective plans. Arc optimizations and dose calculations were performed using Eclipse versions 8.6. In this paper, we evaluated the performance of IMRT and RA plans to investigate the clinical effect of RA for prostate cancer case. In our comparison of treatment techniques, RA was found to be superior to IMRT being better dose conformity of target volume. As for the rectum and bladder, RA was better than IMRT at decreasing the volume irradiated. RA has the ability to avoid critical organs selectively through applied same dose constraints while maximally treating the target dose. Therefore, this result suggests that there should be less rectal toxicity with RA compared with IMRT, with no compromise in tumor margin. These findings, which show more favorable rectal, bladder, and femoral head DVHs with RA, imply that should not result in excess risk of toxicity when this technique is used. Many experiences with RA have shown not only dosimetric advantage, but also improved clinical toxicity when comparing with IMRT. The main drawbacks of RA are the more complex and time-consuming treatment planning process and the need for more exact physics quality assurance (QA).
Head ; Humans ; Imidazoles ; Nitro Compounds ; Prostate ; Prostatic Neoplasms ; Rectum ; Urinary Bladder

In this paper, we evaluated the performance of 3D CRT, IMRT and three kind of RA plannings to investigate the clinical effect of RA with liver cancer case. The patient undergoing liver cancer of small volume and somewhat constant motion were selected. We performed 3D CRT, IMRT and RA plannings such as 2RA, limited triple arcs (3RA) and 3MRA with Eclipse version 8.6.15. The same dose volume objectives were defined for only CTV, PTV and body except heart, liver and partial body in IMRT and RA plannings. The steepness of dose gradient around tumor was determined by the Normal Tissue Objective function with the same parameters in place of respective definitions of dose volume objectives for the normal organs. The approach between the defined dose constraints and the practical DVH of CTV, PTV and Body was the best in 3MRA and the worst in IMRT. The DVHs were almost the same among RAs. Plans were evaluated using Conformity Index (CI), Homogeneity Index (HI) and Quality of coverage (QoC) by RTOG after prescription with dose level surrounding 98% of PTV in the respective plans. As a result, 3MRA planning showed the better favorable indices than that of the others and achieved the lowest MUs. In this study, RA planning is a technique that is possible to obtain the faster and better dose distribution than 3D CRT or IMRT techniques. Our result suggest that 3MRA planning is able to reduce the MUs further, keeping a similar or better targer dose homogeneity, conformity and sparing normal tissue than 2RA or 3RA.
Animals ; Heart ; Humans ; Hypogonadism ; Liver ; Liver Neoplasms ; Mice ; Mitochondrial Diseases ; Ophthalmoplegia ; Prescriptions

A trocar site hernia is a rare complication after laparoscopic surgery. Hence, a trocar site that's larger than 10 mm should be closed to prevent complications. Here we describe a case of strangulated small bowel herniation through a 12 mm-trocar site even though the fascia had been closed. A 78-year-old obese (BMI 30.7 kg/m2) patient with rectal cancer underwent an uncomplicated laparoscopic low anterior resection. On the eighth post-operative day, she presented with a right lower quadrant painful mass, and abdominal CT showed small bowel herniation through the right lower quadrant 12-mm trocar site. In the surgical field, the small bowel was resected via the extended trocar site wound and the fascial defect was repaired.
Aged ; Fascia ; Hernia ; Humans ; Laparoscopy ; Obesity ; Rectal Neoplasms ; Surgical Instruments