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ABSTRACT: OBJECTIVE:: To assess the effects of preoperative chemoradiotherapy (CRT) on anastomotic leakage (AL) after rectal cancer resection, using propensity score matching. BACKGROUND:: Conflicting data have emerged over the last decade regarding the effect of preoperative CRT on AL. METHODS:: We reviewed 1437 consecutive patients with rectal cancer who underwent low anterior resection (LAR) at our institution between 2005 and 2012. AL evaluated as grade C was the primary endpoint, as proposed by the International Study Group of Rectal Cancer in 2010. The patients were treated with (n = 360) or without (n = 1077) preoperative CRT. The total radiation dose was 50.4 Gy in 28 fractions. Multivariate and propensity score matching analyses were used to compensate for the differences in some baseline characteristics. RESULTS:: The preoperative CRT group contained more patients with the following characteristics, older age, male sex, smoker, advanced stage tumor, lower/mid rectal tumor location, ultra-LAR, and diverting stoma, than the non-preoperative CRT group (all Ps < 0.05). Postoperative AL occurred in 91 patients (6.3%). Before propensity score matching, the incidence of AL in patients with or without preoperative CRT was 7.5% and 5.9%, respectively (P = 0.293). After propensity score matching, the 2 groups were nearly balanced except for the initial stage and the length of the surgeon's career, and the incidence of AL in patients with or without preoperative CRT was 7.5% and 8.1%, respectively (P = 0.781). CONCLUSIONS:: We did not observe that preoperative CRT increased the risk of postoperative AL after LAR in patients with rectal cancer, using propensity score matching analysis.
Annals of surgery 04/2013; · 7.90 Impact Factor
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ABSTRACT: BACKGROUND AND OBJECTIVES: This study aimed to describe clinical outcomes of rectal carcinoids according to the 7th American Joint Council on Cancer (AJCC) TNM staging system. METHODS: We retrospectively reviewed 122 patients who were treated for rectal carcinoids between 1995 and 2010. RESULTS: Among 122 patients, 81.2% (n = 99) were classified as stage I, 4.9% (n = 6) as stage II, 11.5% (n = 14) as stage III, and 2.5% (n = 3) as stage IV. Lymph node (LN) metastasis rates for pT1a, 1b, 2, and 3 stages were 1.2% (1/85), 16.7% (3/18), 0% (0/4) and 84.6% (11/13), respectively. The 5-year overall survival (OS) rate was 88.4%. The 5-year OS rates were estimated to be 100%, 80%, 51.4% and 0% for stage I, II, III, and IV, respectively (P < 0.001). The 5-year disease-free survival (DFS) rate was 82.3%. The 5-year DFS rates were estimated to be 97.7%, 62.5%, 17.1%, and 0% for stages I, II, III, and IV, respectively (P < 0.001). CONCLUSIONS: Using the new TNM stage, we confirmed a prognostic difference in LN metastasis rates, OS, and DFS for rectal carcinoids. In clinical practice, the new TNM stage can be very useful for predicting prognosis. J. Surg. Oncol © 2013 Wiley Periodicals, Inc.
Journal of Surgical Oncology 03/2013; · 2.10 Impact Factor
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ABSTRACT: BACKGROUND: Robot-assisted surgery is a new and emerging surgical procedure for rectal cancer patients. However, there is a lack of information regarding oncologic outcomes for this procedure. We aimed to evaluate oncologic and perioperative clinicopathologic outcomes of surgical resection using robotic instruments for rectal cancer. METHODS: Data from rectal cancer patients (n = 370) diagnosed with stage I-IV disease sited below 15 cm from the anal verge who underwent robot-assisted tumor-specific mesorectal excision consecutively from June 2006 to December 2010 were evaluated. Clinicopathologic and follow-up data were recorded prospectively and analyzed retrospectively. Perioperative clinicopathologic outcomes, postoperative complications, 3-year overall survival rate, and 3-year disease-free survival rate were analyzed. RESULTS: All patients underwent robot-assisted tumor-specific mesorectal excision. Of all postoperative pathologic stages, 15 (4.1 %) were stage 0 (pathologic complete remission), 126 (34.1 %) stage I, 95 (25.7 %) stage II, 118 (31.9 %) stage III, and 16 (4.3 %) stage IV. The 3-year overall survival rate was 93.1 % (pathologic complete remission = 100 %, stage I = 99.2 %, stage II = 97.1 %, stage III = 90.1 %, and stage IV = 48.4 %). The 3-year disease-free survival rate was 79.2 % (pathologic complete remission = 100 %, stage I = 93.7 %, stage II = 79.8 %, stage III = 69.6 %, and stage IV = 0.0 %). The 3-year cumulative local recurrence rate was 3.6 % (n = 10). The circumferential resection margin positive rate was 5.7 % (n = 21). Local recurrence developed in one patient and systemic recurrence developed in five patients. The total number of patients with postoperative complications was 86 (23.2 %). CONCLUSIONS: These data show the feasibility and safety of robot-assisted tumor-specific mesorectal excision for rectal cancer in terms of oncologic outcomes.
Annals of Surgical Oncology 02/2013; · 4.17 Impact Factor
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ABSTRACT: The aim of this study is to assess the effects of age on the short-term outcomes of a laparoscopic resection of colorectal cancer in elderly (≥75 years old), as compared with younger (<75 years old), patients.
A retrospective analysis of patients who underwent laparoscopic surgery for colorectal cancer between January 2007 and December 2009 was performed. There were two groups: age <75 years old (group A) and age ≥75 years old (group B). The perioperative outcomes between group A and group B were compared.
The study included 824 patients in group A and 92 patients in group B. The body mass index (BMI) and the American Society of Anesthesiologists (ASA) score were significantly different between group B and group A (BMI: 22.5 vs. 23.5, P = 0.002; ASA score: 1.88 vs. 1.48, P = 0.001). Mean operating times were similar between the groups (325.4 minutes vs. 351.6 minutes, P = 0.07). We observed a higher overall complication rate in group B than in group A (12.0% vs. 6.2%, P = 0.047), but the number of severe complications of Accordion Severity Classification ≥3 (those that required an invasive procedure) was not significantly different between the two groups (6.5% vs. 3.4%, P = 0.142). There was no significant difference in the length of hospital stay (13.0 days vs. 12.0 days, P = 0.053).
Although the elderly patients had a significantly higher overall postoperative complication rate, no significant difference was seen in either the number of severe complications of Accordion Severity Classification ≥3 or in the length of hospital stay. A laparoscopic colorectal cancer resection in elderly patients, especially those aged 75 years or older, is safe and feasible.
Annals of coloproctology. 02/2013; 29(1):22-7.
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ABSTRACT: BACKGROUND: Anastomotic leakage is a major cause of postoperative morbidity and mortality in the treatment of colorectal cancer. The aim of this study was to investigate the modified double-stapling technique (MDST), as an alternative for conventional double-stapling technique (DST), and whether it could reduce the anastomotic leakage rate in laparoscopic anterior resection (Lapa-AR). STUDY DESIGN: Between March 2009 and October 2010, a total of 189 patients who underwent Lapa-AR for the treatment of adenocarcinoma of the sigmoid colon or rectosigmoid colon were divided into the MDST group (n = 95) and the DST group (n = 94) according to the anastomotic technique. Data were analyzed retrospectively. Morbidity and anastomotic leakage rate were compared between the two groups. RESULTS: Patient demographics, preoperative comorbidity, tumor size, stage, and operative details were comparable between the two groups. There was no difference in operation time between the two groups. The overall complication rate was significantly lower in the MDST group than in the DST group (3.2 vs. 10.6 %, p = 0.042), including anastomotic leakage rate (0 vs.4.6 %, p = 0.029). The anastomotic technique was the only factor associated with anastomotic leakage in univariate analysis. CONCLUSIONS: Our comparative study demonstrates MDST to have better short-term outcome in reducing anastomotic leakage compared with DST. This technique could be an alternative approach to maximize the patients' benefit in laparoscopic anterior resection.
Journal of Gastrointestinal Surgery 01/2013; · 2.83 Impact Factor
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ABSTRACT: Purpose: Circumferential resection margin (CRM) involvement is a well-known predictor for poor prognosis in rectal cancer. However, the significance is controversial in some studies. Accordingly, this study attempted to examine the prognostic impact of CRM involvement in stage III rectal cancer. Materials and Methods: Between January 1990 and December 2007, a total of 449 patients who underwent curative resection followed by complete adjuvant chemoradiotherapy for stage III rectal cancer located within 12 cm from the anal verge were selected. Patients were divided into a CRM-positive group (n=79, 17.6%) and a CRM-negative group (n=370, 82.4%). Results: With a median follow-up of 56.6 months, recurrent disease was seen in 53.2 and 43.5% of the CRM-positive and CRM-negative group, respectively. CRM involvement was an independent prognostic factor for 5-year systemic recurrence-free survival (HR: 1.5, CI: 1.0-2.2, p=0.017). However, no significant difference was observed for local recurrence rate between the two groups (13.0 and 13.5%, respectively, p=0.677). Conclusion: In this study, local recurrence rate did not differ according to CRM involvement status in stage III rectal cancer patients, although CRM involvement was shown to be an independent poor prognostic factor. Accordingly, validation of the results of this study by further large prospective randomized trials is warranted.
Yonsei medical journal 01/2013; 54(1):131-8. · 0.77 Impact Factor
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ABSTRACT: BACKGROUND: Robotically assisted colon resection is a new type of surgery for colon cancer. However, the evidence is inadequate for the general adaptation of robotic colon surgery. This study aimed to show the oncologic and perioperative clinical results of robotically assisted anterior resection (R-AR) compared with those of laparoscopically assisted anterior resection (L-AR) for sigmoid colon cancer. METHODS: A total of 180 patients (sigmoid colon cancer stages 1-3) were assigned to receive either R-AR (n = 34) or L-AR (n = 146) between April 2006 and September 2008. Patient characteristics, perioperative clinical results, and long-term oncologic outcomes were compared between the two groups. RESULTS: The patient characteristics did not differ significantly between the two groups. The mean operation time was 217.6 ± 70.7 min for L-AR versus 252.5 ± 94.9 min for R-AR (p = 0.016). The total postoperative complication rate was 10.3 % for R-AR versus 5.9 % for L-AR (p = 0.281). The 3-year overall survival rate for all the patients was 93.4 % for L-AR versus 92.1 % for R-AR (p = 0.723). The 3-year overall survival rate was 100 % for both L-AR and R-AR in stage 1, 95.5 % for L-AR versus 100 % for R-AR (p = 0.386) in stage 2, and 88.4 % for L-AR versus 72.9 % (p = 0.881) for R-AR in stage 3. CONCLUSION: In this study, R-AR showed safety and feasibility in terms of perioperative clinical and long-term oncologic outcomes. However, the advanced technologies of R-AR did not translate into better long-term oncologic outcomes compared with L-AR.
Surgical Endoscopy 12/2012; · 4.01 Impact Factor
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ABSTRACT: PURPOSE: Colorectal cancer (CRC) in childhood is extremely rare, and only a few case reports exist. We hereby present four cases of childhood CRC along with a literature review. METHODS: A retrospective review of four cases from our institute was conducted, and 15 articles from PubMed describing childhood CRC were reviewed. RESULTS: Case reports: Four patients ranging in age from 11 to 14 years were treated for colon cancer between the years 2000 and 2011. The presenting symptoms varied and included abdominal pain, nausea, vomiting, diarrhea, constipation, and hematochezia, with symptom duration ranging from a few days to 4 months. No patient had a predisposing disease or syndrome. All patients underwent surgical resections, with the most prevalent histology being mucinous adenocarcinoma. Despite radical surgery followed by systemic chemotherapy, the disease progressed in all patients. Literature review: A total of 239 cases were reviewed. The youngest patient was 6 years old. The most frequent predisposing conditions were hereditary nonpolyposis colorectal cancer and familial adenomatous polyposis. Most of the patients presented advanced stage, with the most common histopathologic diagnosis being mucinous adenocarcinoma, followed by poorly differentiated adenocarcinoma and signet ring cell carcinoma. Even though most of the patients underwent aggressive treatment, the overall prognosis was poor. CONCLUSIONS: Childhood CRC has an aggressive pathology and distinct genetic features, which result in an advanced stage at diagnosis and consequently a poor prognosis. Although the incidence is very low, every physician should be aware of CRC as a possible childhood diagnosis.
International Journal of Colorectal Disease 10/2012; · 2.38 Impact Factor
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ABSTRACT: OBJECTIVE:: The objective of this study was to clarify the impact of robotic surgery (RS) in the management of mid and low rectal cancer in comparison with open surgery (OS) and laparoscopic surgery (LS). BACKGROUND:: The benefits of RS in the treatment of rectal cancer have not yet been clearly described. METHODS:: Using propensity scores for adjustment of sex, age, body mass index, tumor stage, and tumor height, a well-balanced cohort with 165 patients in each group, was created by matching each patient who underwent RS as the study group with one who underwent OS or LS as the control group (RS:OS = 1:1, RS:LS = 1:1 match). Pathological results, morbidity, perioperative recovery, and short-term oncological results were compared between the 3 groups. RESULTS:: In RS and LS, the time to first flatus and resumed soft diet and length of hospital stay were significantly shortened compared with OS. Robotic surgery showed better recovery outcomes than LS with regard to time to resumed soft diet and length of hospital stay. The visual analog scale was significantly lower in the RS than in the OS and LS from postoperative days 1 to 5. The voiding problem and circumferential resection margin involvement rate were significantly lower in the RS group than in the OS group. No significant difference in 2-year disease-free survival was observed among the 3 groups. CONCLUSIONS:: Robotic surgery may be an effective tool in the effort to maximize the advantages of minimally invasive surgery in the management of mid to low rectal cancer.
Annals of surgery 10/2012; · 7.90 Impact Factor
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ABSTRACT: The two main diseases of inflammatory bowel disease are Crohn's disease and ulcerative colitis. The pathogenesis of inflammatory disease is that abnormal intestinal inflammations occur in genetically susceptible individuals according to various environmental factors. The consequent process results in inflammatory bowel disease. Medical treatment consists of the induction of remission in the acute phase of the disease and the maintenance of remission. Patients with Crohn's disease finally need surgical treatment in 70% of the cases. The main surgical options for Crohn's disease are divided into two surgical procedures. The first is strictureplasty, which can prevent short bowel syndrome. The second is resection of the involved intestinal segment. Simultaneous medico-surgical treatment can be a good treatment strategy. Ulcerative colitis is a diffuse nonspecific inflammatory disease that involves the colon and the rectum. Patients with ulcerative colitis need surgical treatment in 30% of the cases despite proper medical treatment. The reasons for surgical treatment are various, from life-threatening complications to growth retardation. The total proctocolectomy (TPC) with an ileal pouch anal anastomosis (IPAA) is the most common procedure for the surgical treatment of ulcerative colitis. Medical treatment for ulcerative colitis after a TPC with an IPAA is usually not necessary.
Journal of the Korean Society of Coloproctology 06/2012; 28(3):121-31.
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ABSTRACT: We investigated the usefulness of a clinical risk scoring system (CRS) for guiding management and defining prognosis for patients with colorectal liver met"astases (CLM).
We retrospectively analyzed data about the correlation between outcomes and Fong's CRS from 1989 to 2010 for patients treated for CLM at the Severance Hospital.
Of 566 patients, 232 received adjuvant treatment after liver resection. Of these patients, 185 (81%) had a low CRS (0-2) and 47 (19%) had a high CRS (3-5). Stratification into high and low CRS allowed significant distinction between Kaplan-Meier curves for outcome. The 5-year survival rate was 88.5% and 11.5% among patients with a low and high CRS, respectively (P < 0.001). Seventy patients with initially unresectable CLM underwent liver resection after tumor downsizing by induction chemotherapy. Shifting of the CRS from high to low (8 patients; 11.4%) improved disease-free survival and overall survival.
High CRS is associated with worse survival after resection in resectable and unresectable disease. The CRS may be used for risk assessment when recommending oncological surgical timing in initially unresectable disease and treatment options for perioperative or adjuvant treatment in resectable disease.
Surgical Oncology 05/2012; 21(3):e125-30. · 2.44 Impact Factor
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ABSTRACT: The aim of this study was to determine the need for additional treatment following endoscopic mucosal resection for early
colorectal cancer. Risk factors for residual carcinoma were investigated using specimens of curative surgical resection performed
after endoscopic mucosal resection. A total of 44 patients who had received imperfect endoscopic mucosal resection initially
for early colorectal cancers and, therefore, had undergone subsequent surgical resection were enrolled in this study. Of
these, 39 (88.6%) were resected completely by endoscopic mucosal resection based on gross inspection, while the other five
cases (11.4%) were incompletely resected. Histopathological examination of specimens of endoscopic mucosal resection revealed
that microscopic lateral resection margin was positive in 11 cases (25.0%) and vertical resection margin was positive in 16
cases (36.4%). However, after curative surgery, residual cancer within colorectal tissue was found in only five cases (11.4%),
while lymph node metastases were found in three cases (6.8%). Gross incomplete resection (P<0.001) and microscopic vertical margin positivity (P = 0.031) were found to be risk factors of residual cancer within the colorectal tissue, whereas lymphovascular invasion was
a risk factor for lymph node metastasis (P = 0.040). However, no residual cancer cells were found after supplementary surgery in the microscopic lateral resection margin-positive
cases. In conclusion, grossly incomplete resection, microscopic vertical resection margin positivity, or the presence of lymphovascular
invasion after endoscopic mucosal resection for early colorectal cancer indicate the need for further treatment with surgical
resection and lymph node dissection. However, microscopic lateral margin positivity without gross remnant tumor and deep submucosal
invasion might not indicate residual cancer. This needs to be further validated by a large scale, prospective study with long-term
follow-up.
Digestive Diseases and Sciences 04/2012; 53(11):2941-2946. · 2.12 Impact Factor
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ABSTRACT: Pedunculated extra-luminal leiomyoma is a rare solid tumor. We present a case of a 20-year-old Caucasian woman with a painful
pedunculated extraluminal mass located on the bladder dome and associated with dysuria. She underwent robot-assisted laparoscopic
resection, and the histological findings confirmed a leiomyoma.
Journal of Robotic Surgery 04/2012; 3(4):245-247.
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ABSTRACT: The purpose of the study is to evaluate the oncologic outcomes of a laparoscopic-assisted right hemicolectomy for the treatment of colon cancer and compare the results with those of previous randomized trials.
From June 2006, to December 2008, 156 consecutive patients who underwent a laparoscopic right hemicolectomy with a curative intent for colon cancer were evaluated. The clinicopatholgic outcomes and the oncologic outcomes were evaluated retrospectively by using electronic medical records.
There were 84 male patients and 72 female patients. The mean possible length of stay was 7.0 ± 1.5 days (range, 4 to 12 days). The conversion rate was 3.2%. The total number of complications was 30 (19.2%). Anastomotic leakage was not noted. There was no mortality within 30 days. The 3-year overall survival rate of all stages was 93.3%. The 3-year overall survival rates according to stages were 100% in stage I, 97.3% in stage II, and 84.8% in stage III. The 3-year disease-free survival rate of all stages was 86.1%. The 3-year disease-free survival rates according to stage were 96.2% in stage I, 90.3% in stage II, and 75.6% in stage III. The mean follow-up period was 36.3 (3 to 60) months.
A laparoscopic right hemicolectomy for the treatment of colon cancer is technically feasible and safe to perform in terms of oncologic outcomes. The present data support previously reported randomized trials.
Journal of the Korean Society of Coloproctology 02/2012; 28(1):42-8.
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ABSTRACT: The robotic system has been adopted as the new modality for minimally invasive surgery for rectal cancer. However, analysis of risk factors for complications after robotic rectal cancer surgery (RRS) has been limited. This study aimed to identify the risk factors for complications after RRS.
The records of 389 consecutive patients who underwent RRS between June 2006 and October 2010 were retrieved from our prospectively collected database.
The overall complication rate was 19%. The most common complication was anastomotic leakage (7.0%), followed by voiding difficulty, intrapelvic abscess, and ileus/obstruction. Multivariate analysis revealed the following as risk factors for postoperative complications: male gender, history of previous abdominal surgery, and lower tumor level (hazard ratio [HR] = 1.8, 95% confidence interval [CI] = 1.0-3.1, p = 0.041; HR = 2.3; 95% CI = 1.2-4.6, p = 0.012; and HR = 1.9, 95% CI = 1.1-3.3, p = 0.020, respectively). With regard to pelvic septic complications, lower tumor level, large tumor size, and preoperative chemoradiation remained variables that retained their statistical significance in multivariate analysis (HR = 2.6, 95% CI = 1.1-6.1, p = 0.029; HR = 2.7, 95% CI = 1.1-6.1, p = 0.017; HR = 2.9, 95% CI = 1.3-6.5, p = 0.007, respectively). The rate of postoperative complications was not influenced by the difference in laparoscopic surgery experience or the technique of robotic surgery.
Surgeons should be more cautious with these patient factors to optimize the benefits of robotic rectal resection.
World Journal of Surgery 09/2011; 35(11):2555-62. · 2.36 Impact Factor
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ABSTRACT: The aim of the study is to assess the safety and oncologic feasibility of laparoscopic-assisted resection for rectal cancer vs open rectal resection as a phase II pilot study for a planned randomized control trial.
A case-matched controlled prospective analysis of 54 patients who underwent laparoscopic-assisted resection for stage I to III (no T4) rectal cancer within 12 cm of the anal verge from 2002 to 2005 was performed. Patients were matched with contemporary patients who underwent open rectal cancer surgery (n = 108) in a 1 to 2 fashion. The perioperative clinical outcomes, postoperative pathology, and oncologic outcomes were compared between the groups.
The demographic data did not differ significantly between the groups. The laparoscopic group manifested early return of bowel function (P = .003). The complication rate was 22.2% in the laparoscopic group and 32.4% in the open group (P = .178). Local recurrence was similar (2.0% laparoscopic, 4.2% open, P = .417). The 5-year overall and disease-free survival rate also were similar (overall survival, 90.8% laparoscopic, 88.5% open, P = .261; disease-free survival, 80.8% laparoscopic, 75.8% open. P = .390).
The laparoscopic-assisted resection for rectal cancer was acceptable in terms of oncologic outcomes and perioperative clinical outcomes. The present data are the basis for a large-scale randomized trial for comparison of laparoscopic and open rectal cancer surgeries (American College of Surgeons Oncology Group Z6051).
Diseases of the Colon & Rectum 01/2011; 54(1):6-14. · 3.13 Impact Factor
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ABSTRACT: Commercially available hemostatic-adhesive has the risk of disease transmission because it is derived from a plasma component. The purpose of this study is to manufacture a new hemostatic adhesive and evaluate its performances.
Two atelocollagen-based hemostatic adhesives were produced and named as Bleestop A (2% esterified atelocollagen in 75% ethanol + 1% CaCl(2) + 0.71% DOPA + 0.1% tranexamic acid in DW) and Bleestop B (2% esterified atelocollagen in DW + 1% CaCl(2) + 0.71% DOPA + 0.1% aminocaproic acid in DW). These are compared with the negative control group (no adhesives used group) and the positive control group (Tissucol Duo Quick group). The adult male Sprague-Dawley rat model was adopted and the hemostatic-adhesion activities of each group were assessed by the adhesion strength test and the morphologic features of adhesion. The liver tissues were used. Histologic assessment of adhesion was accessed using light microscopy.
Bleeding was controlled immediately after application of Bleestop A and partial adhesion was observed after 30 s. More than 95% area of the resected surface attached after 1 min. In Bleestop B, partial adhesion was observed after 30 s. More than 95% area of the resected surface was attached after 45 s. Histologic evaluation showed that Bleestop A and B mediated organized adhesion rapidly between both resected tissue surfaces. The adhesion strength of Bleestop A and B was better than the negative control group and showed same adhesion strength as the positive control group after 3 min.
Bleestop A and B showed significant hemostasis and adhesion capability within 1 min. They are comparable to the positive control group.
Journal of Surgical Research 09/2010; 164(2):e221-8. · 2.25 Impact Factor
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Sang Joon Shin,
Nam Kyu Kim,
Ki Chang Keum,
Ho Geun Kim,
Jun Seok Im,
Hye Jin Choi, Seung Hyuk Baik,
Jae Hee Choen,
Hei-Cheul Jeung,
Sun Young Rha,
Jae Kyung Roh,
Hyun Cheol Chung,
Joong Bae Ahn
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ABSTRACT: The aim of this study is to evaluate the efficacy and safety of preoperative radiation therapy combined with S-1 and irinotecan (SI) in LARC.
Patients were considered LARC if they had a T3/T4 lesion or node positive. Weekly doses of 40 mg/m(2) irinotecan were intravenously administered once per week during weeks 1-5 of radiotherapy. S-1 (70 mg/m(2)) was given from Monday to Friday in all weeks of radiotherapy. 3-D conformal radiotherapy was given at daily fractions of 1.8Gy for 5days for a total dose of 50.4 (45+5.4)Gy. Surgery was performed 4-6 weeks following the completion of chemoradiation.
Between June 2006 and November 2007, 43 pts were enrolled. The stage was: cT3 24 patients, cT4 6 patients; 28 patients were cN+. Forty-one patients completed the chemoradiation and 42 patients underwent operation: a low anterior resection was performed in 36 patients, a total colectomy in 1 patient, and an abdominal perineal resection in 5 patients. T downstaging was observed in 50%; 23 N+ patients became N- (55%). The complete pathological response was observed in 9 patients (21%). The 3-year locoregional failure rate, distant failure rate, disease-free survival, and overall survival were 9.5%, 18.6%, 72.1%, and 94.3%, respectively. Only three patients experienced G3 diarrhea; one had G3 sepsis and two had septic shock. Hematological toxicity (G3-G4) was observed in five patients.
This study demonstrated the efficacy of preoperative CRT with S-1 and irinotecan with 21% of complete response. However, prompt recognition and management of infection is needed to use it in patients with locally advanced rectal cancer.
Radiotherapy and Oncology 03/2010; 95(3):303-7. · 5.58 Impact Factor
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ABSTRACT: A systematic and effective welfare system for people with digestive system impairments is required. In Korea, an objective and scientific rating guideline does not exist to judge the digestive system impairments. Whether the impairments exist or not and the degree of it need to be examined. Thus, with these considerations we need a scientific rating guideline for digestive system impairments to fit our cultural and social background. In 2007, a research team, for the development of rating impairment guidelines, was organized under the supervision of Korean Academy of Medical Sciences. The rating guidelines for digestive system impairments was classified into upper and lower gastrointestinal tracts impairments and liver impairment. We developed objective rating guidelines for the upper gastrointestinal tract, the impairment generated after surgery for the stomach, duodenum, esophagus, and for the lower gastrointestinal tract, the impairment generated after construction and surgery for colon, rectum, anus, and intestinal stomas. We tried to make the rating impairment guidelines to include science, objectivity, convenience, rationality, and actuality. We especially emphasized objectivity as the most important value. We worked to make it easy and convenient to use for both the subjects who received the impairment ratings and the doctors who will give the ratings.
Journal of Korean medical science 06/2009; 24 Suppl 2:S271-6. · 0.84 Impact Factor
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Seung Hyuk Baik
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ABSTRACT: Robotic colorectal surgery has gradually been performed more with the help of the technological advantages of the da Vinci system. Advanced technological advantages of the da Vinci system compared with standard laparoscopic colorectal surgery have been reported. These are a stable camera platform, three-dimensional imaging, excellent ergonomics, tremor elimination, ambidextrous capability, motion scaling, and instruments with multiple degrees of freedom. However, despite these technological advantages, most studies did not report the clinical advantages of robotic colorectal surgery compared to standard laparoscopic colorectal surgery. Only one study recently implies the real benefits of robotic rectal cancer surgery. The purpose of this review article is to outline the early concerns of robotic colorectal surgery using the da Vinci system, to present early clinical outcomes from the most current series, and to discuss not only the safety and the feasibility but also the real benefits of robotic colorectal surgery. Moreover, this article will comment on the possible future clinical advantages and limitations of the da Vinci system in robotic colorectal surgery.
Yonsei Medical Journal 01/2009; 49(6):891-6. · 1.14 Impact Factor
