Nam Kyu Kim

Wonju Severance Christian Hospital, Genshū, Gangwon-do, South Korea

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Publications (229)602.69 Total impact

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    ABSTRACT: Four consecutive cases of a colonic stricture following a da Vinci robot-assisted ultra-low anterior resection (LAR) with coloanal anastomosis and diverting ileostomy for the treatment of rectal cancer are reported. The colonic strictures developed after early proximal colonic ischemia without anastomotic site leakage or disruption. All patients were treated with preoperative chemoradiation therapy. During the postoperative recovery period, patients developed colonic ischemia, presenting with a high, spiking fever, but without any symptoms of peritonitis. Patients were treated with conservative management (antibiotic therapy) and discharged after two weeks when in good condition. Several months after discharge, all four patients developed a long-segment colonic stricture from the anastomosis site to the distal colon. Management of the colon strictures, including the anastomotic site, involved colonic dilation with a Hegar dilator in an outpatient clinic for several months. The ileostomies in three patients could not be closed.
    Annals of Coloproctology 09/2015; 31(4):157-162. DOI:10.3393/ac.2015.31.4.157
  • International journal of radiation oncology, biology, physics 08/2015; DOI:10.1016/j.ijrobp.2015.08.037 · 4.26 Impact Factor
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    ABSTRACT: Extralevator abdominoperineal resection had oncologic superiority with reduced local recurrence and improving survival rates. However, extended perineal resection resulted in complicated perineal reconstructions. Therefore, a new surgical technique to overcome previous limitations is required. This study aims to demonstrate a surgical procedure and outcomes of the modified extralevator abdominoperineal resection, which satisfies both an extended cylindrical resection and a convenient perineal wound closure by modification of the surgical dissection plane. From September 2011 to February 2014, 12 consecutive patients (five males and seven females) who underwent the modified extralevator abdominoperineal resection for low rectal cancer were evaluated. Intraoperative and postoperative outcomes were assessed. Pathologic outcomes were evaluated for the oncologic results. The mean age was 55.3 ± 15.1 years, and body mass index was 21.8 ± 3.1 kg/m(2). Ten patients (83.3 %) received preoperative chemoradiotherapy. The operations were performed by five cases of laparoscopic surgery, six cases of open surgery and one case of robotic surgery. The mean operation time was 258.8 ± 58.0 min. There were no conversions and no tumor perforations. Days to first soft diet was 4.7 ± 3.4 days, and the mean hospital stay was 11.2 ± 4.7 days. Postoperative complications were two cases of grade I, two cases of grade II and one case of grade III. There was one patient (8.3 %) with a positive circumferential resection margin, and there was one case of local recurrence. The modified extralevator abdominoperineal resection was feasible and safe for patients with low rectal cancer with extended perineal dissection and convenient direct wound closure.
    Surgical Endoscopy 07/2015; DOI:10.1007/s00464-015-4400-x · 3.26 Impact Factor
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    ABSTRACT: To explore the role of adjuvant chemotherapy for patients with ypT0-2N0 rectal cancer treated by preoperative chemoradiation therapy (PCRT) and radical resection. A national consortium of 10 institutions was formed, and patients with ypT0-2N0 mid- and low-rectal cancer after PCRT and radical resection from 2004 to 2009 were included. Patients were categorized into 2 groups according to receipt of additional adjuvant chemotherapy: Adj CTx (+) versus Adj CTx (-). Propensity scores were calculated and used to perform matched and adjusted analyses comparing relapse-free survival (RFS) between treatment groups while controlling for potential confounding. A total of 1016 patients, who met the selection criteria, were evaluated. Of these, 106 (10.4%) did not receive adjuvant chemotherapy. There was no overall improvement in 5-year RFS as a result of adjuvant chemotherapy [91.6% for Adj CTx (+) vs 87.5% for Adj CTx (-), P=.18]. There were no differences in 5-year local recurrence and distant metastasis rate between the 2 groups. In patients who show moderate, minimal, or no regression in tumor regression grade, however, possible association of adjuvant chemotherapy with RFS would be considered (hazard ratio 0.35; 95% confidence interval 0.14-0.88; P=.03). Cox regression analysis after propensity score matching failed to show that addition of adjuvant chemotherapy was associated with improved RFS (hazard ratio 0.81; 95% confidence interval 0.39-1.70; P=.58). Adjuvant chemotherapy seemed to not influence the RFS of patients with ypT0-2N0 rectal cancer after PCRT followed by radical resection. Thus, the addition of adjuvant chemotherapy needs to be weighed against its oncologic benefits. Copyright © 2015 Elsevier Inc. All rights reserved.
    International journal of radiation oncology, biology, physics 07/2015; 92(3):540-547. DOI:10.1016/j.ijrobp.2015.02.020 · 4.26 Impact Factor
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    Seungwan Park · Nam Kyu Kim
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    ABSTRACT: The conventional laparoscopic approach to rectal surgery has several limitations, and therefore many colorectal surgeons have great expectations for the robotic surgical system as an alternative modality in overcoming challenges of laparoscopic surgery and thus enhancing oncologic and functional outcomes. This review explores the possibility of robotic surgery as an alternative approach in laparoscopic surgery for rectal cancer. The da Vinci® Surgical System was developed specifically to compensate for the technical limitations of laparoscopic instruments in rectal surgery. The robotic rectal surgery is associated with comparable or better oncologic and pathologic outcomes, as well as low morbidity and mortality. The robotic surgery is generally easier to learn than laparoscopic surgery, improving the probability of autonomic nerve preservation and genitourinary function recovery. Furthermore, in very complex procedures such as intersphincteric dissections and transabdominal transections of the levator muscle, the robotic approach is associated with increased performance and safety compared to laparoscopic surgery. The robotic surgery for rectal cancer is an advanced technique that may resolve the issues associated with laparoscopic surgery. However, high cost of robotic surgery must be addressed before it can become the new standard treatment. Graphical Abstract
    Journal of Korean Medical Science 07/2015; 30(7):837. DOI:10.3346/jkms.2015.30.7.837 · 1.27 Impact Factor
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    ABSTRACT: This study aims to validate the oncologic outcomes of anastomotic leakage (AL) after laparoscopic total mesorectal excision (TME) in a large multicenter cohort.The impact of AL after laparoscopic TME for rectal cancer surgery has not yet been clearly described.This was a multicenter retrospective study of 1083 patients who underwent laparoscopic TME for nonmetastatic rectal cancer (stage 0-III). AL was defined as an anastomotic complication within 30 days of surgery irrespective of requiring a reoperation or interventional radiology. Estimated local recurrence (LR), disease-free survival (DFS), and overall survival (OS) were compared between the leakage group and the no leakage group using the log-rank method. Multivariate Cox-regression analysis was used to adjust confounding for survival.The incidence of AL was 6.4%. Mortality within 30 days of surgery occurred in 1 patient (1.4%) in the leakage group and 2 patients (0.2%) in the no leakage group. The leakage group showed a higher LR rate (6.4% vs 1.8%, P = 0.011). Five-year DFS and OS were significantly lower in the leakage group than the no leakage group (DFS 71.7% vs 82.1%, P = 0.016, OS 81.8% vs 93.5%, P = 0.007). Multivariate analysis showed that AL was an independent poor prognostic factor for DFS and OS (hazard ratio [HR] = 1.6; 95% confidence intervals [CI]: 1.0-2.6; P = 0.042, HR = 2.1; 95% CI: 1.0-4.2; P = 0.028, respectively).AL after laparoscopic TME was significantly associated with an increased rate of LR, systemic recurrence and poor OS.
    Medicine 07/2015; 94(29):e1202. DOI:10.1097/MD.0000000000001202 · 5.72 Impact Factor
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    ABSTRACT: A minimum of 12 harvested lymph nodes (hLNs) are recommended in colorectal cancer. However, a paucity of hLNs is frequently presented after preoperative chemoradiation (pCRT) in rectal cancer and the significance of this is still uncertain. The aim of this study is to analyze the impact of hLNs on long-term oncologic outcomes.A total of 302 patients with locally advanced rectal cancer who underwent pCRT and curative resection between 1989 and 2009 were reviewed. Patients were categorized into 2 groups according to the number of hLNs: <12 versus ≥12 LN. The 2 groups were compared with respect to 5-year disease-free and overall survival. The optimal number or ratio of hLNs was investigated in subgroup analysis according to LN status.The median follow-up was 57 months. Patient characteristics other than age did not differ between the 2 groups. The group with <12 LNs had more favorable ypTNM and ypN stage than those with ≥12 LNs. However, the long-term oncologic outcomes were not significantly different between the 2 groups. In subgroup analysis of ypN(-), the group with <5 hLNs had the most favorable oncologic outcomes. In ypN(+) cases, a higher LN ratio tended to be associated with poorer 5-year overall survival.The paucity of hLNs in locally advanced rectal cancer after chemoradiation did not imply poor oncologic outcomes in this study. In addition, <5 hLNs in ypN(-) patients could reflect a good tumor response rather than suboptimal radicality.
    Medicine 07/2015; 94(28):e1133. DOI:10.1097/MD.0000000000001133 · 5.72 Impact Factor
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    Sung Uk Bae · Byung Soh Min · Nam Kyu Kim
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    ABSTRACT: By integrating intraoperative near infrared fluorescence imaging into a robotic system, surgeons can identify the vascular anatomy in real-time with the technical advantages of robotics that is useful for meticulous lymphovascular dissection. Herein, we report our initial experience of robotic low ligation of the inferior mesenteric artery (IMA) with real-time identification of the vascular system for rectal cancer using the Firefly technique. The study group included 11 patients who underwent a robotic total mesorectal excision with preservation of the left colic artery for rectal cancer using the Firefly technique between July 2013 and December 2013. The procedures included five low anterior resections and six ultra-low anterior resections with loop ileostomy. The median total operation time was 327 min (226-490). The low ligation time was 10 min (6-20), and the time interval between indocyanine green injection and division of the sigmoid artery was 5 min (2-8). The estimated blood loss was 200 mL (100-500). The median time to soft diet was 4 days (4-5), and the median length of stay was 7 days (5-9). Three patients developed postoperative complications; one patients developed anal stricture, one developed ileus, and one developed non-complicated intraabdominal fluid collection. The median total number of lymph nodes harvested was 17 (9-29). Robotic low ligation of the IMA with real-time identification of the vascular system for rectal cancer using the Firefly technique is safe and feasible. This technique can allow for precise lymph node dissection along the IMA and facilitate the identification of the left colic branch of the IMA.
    Yonsei medical journal 07/2015; 56(4):1028-1035. DOI:10.3349/ymj.2015.56.4.1028 · 1.29 Impact Factor
  • Nam Kyu Kim · Young Wan Kim · Min Soo Cho
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    ABSTRACT: The primary goal of surgical intervention for rectal cancer is to achieve an oncologic cure while preserving function. Since the introduction of total mesorectal excision (TME), the oncologic outcome has improved greatly in terms of local recurrence and cancer-specific survival. However, there are still concerns regarding functional outcomes such as sexual and urinary dysfunction, even among experienced colorectal surgeons. Intraoperative nerve damage is the primary reason for sexual and urinary dysfunction and occurs due to lack of anatomical knowledge and poor visualization of the pelvic autonomic nerves. The rectum is located concavely along the curved sacrum and both the ischial tuberosity and iliac wing limit the pelvic cavity boundary. Thus, pelvic autonomic nerve preservation during dissection in a narrow or deep pelvis, with adherence to the TME principles, is very challenging for colorectal surgeons. Recent developments in robotic technology enable overcoming these difficulties caused by complex pelvic anatomy. This system can facilitate better preservation of the pelvic autonomic nerve and thereby achieve favorable postoperative sexual and voiding functions after rectal cancer surgery. The nerve-preserving TME technique includes identification and preservation of the superior hypogastric plexus nerve, bilateral hypogastric nerves, pelvic plexus, and neurovascular bundles. Standardized procedures should be performed sequentially as follows: posterior dissection, deep posterior dissection, anterior dissection, posterolateral dissection, and final circumferential pelvic dissection toward the pelvic floor. In future perspective, a structured education program on nerve-preserving robotic TME should be incorporated in the training for minimally invasive surgery. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Surgical Oncology 06/2015; DOI:10.1016/j.suronc.2015.06.012 · 3.27 Impact Factor
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    ABSTRACT: Few studies have examined the surgical treatment of intestinal Behçet disease. Consequently, there is currently no standard surgical treatment for intestinal Behçet disease. Instead, treatment is empirical and symptom based. Our aim was to evaluate the clinical course after surgery and determine the appropriate surgical options for intestinal Behçet disease. Medical charts of patients who underwent surgery for intestinal Behçet were retrospectively reviewed. The study was conducted at a tertiary referral center. Ninety-one patients who underwent surgical treatment for intestinal Behçet disease between January 1995 and December 2012 were included in this study. Primary outcomes measured were patient demographics, clinical characteristics, operative and postoperative outcomes, and long-term follow-up data. Surgical treatment was mainly in response to intractability to medical treatment (56.0%), and 19.8% of patients underwent an emergency operation. Surgery was performed laparoscopically in 33.0% of the patients. Most patients received an ileocecectomy (39.6%) or a right hemicolectomy (34.1%). Twenty-eight patients (30.8%) experienced postoperative morbidities, and 8 patients (8.8%) required reoperations. There were 3 deaths. Reoperation was required for recurrent disease in 32 patients during the long-term follow-up, and the 5-year cumulative reoperation rate was 31.2% (95% CI, 20.4%-42.0%). Among those requiring a second operation, 53.1% were segmental colonic resections that included the previous anastomosis. From multivariable Cox regression analysis, independent predictors of surgical recurrence included postoperative use of steroids (HR = 2.85 (95% CI, 1.21-6.75); p = 0.02), postoperative complications (HR = 2.42 (95% CI, 1.12-5.22); p = 0.03), and BMI (HR per 1-kg/m increase in BMI = 0.90 (95% CI, 0.82-0.99); p = 0.04). This study was designed retrospectively and had a small sample size. Patients treated surgically for intestinal Behçet disease frequently have postoperative complications and the need for a stoma and have a high risk of recurrence.
    Diseases of the Colon & Rectum 06/2015; 58(6):575-81. DOI:10.1097/DCR.0000000000000373 · 3.75 Impact Factor
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    ABSTRACT: Although the total cost of robotic surgery (RS) is known to be higher than that of laparoscopic surgery (LS), the cost-effectiveness of RS has not yet been verified. The aim of the study is to clarify the cost-effectiveness of RS compared with LS for rectal cancer.From January 2007 through December 2011, 311 and 560 patients underwent totally RS and conventional LS for rectal cancer, respectively. A propensity score-matching analysis was performed with a ratio of 1:1 to reduce the possibility of selection bias. Costs and perioperative short-term outcomes in both the groups were compared. Additional costs due to readmission were also analyzed.The characteristics of the patients were not different between the 2 groups. Most perioperative outcomes were not different between the groups except for the operation time. Complications within 30 days of surgery were not significantly different. Total hospital charges and patients' bill were higher in RS than in LS. The total hospital charges for patients who recovered with or without complications were higher in RS than in LS, although their short-term outcomes were similar. In patients with complications, the postoperative course after RS appeared to be milder than that of LS. Total hospital charges for patients who were readmitted due to complications were similar between the groups.RS showed similar short-term outcomes with higher costs than LS. Therefore, cost-effectiveness focusing on short-term perioperative outcomes of RS was not demonstrated.
    Medicine 06/2015; 94(22):e823. DOI:10.1097/MD.0000000000000823 · 5.72 Impact Factor
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    ABSTRACT: The purpose of the current study was to examine the effect of an oncologist's exercise recommendation with and without an exercise motivation package on the amount of exercise participation and quality of life (QOL) in survivors of breast and colorectal cancer. A total of 162 survivors of early-stage breast and colorectal cancer who completed primary and adjuvant treatments were recruited for the current study. Participants were randomly assigned into 1 of 3 groups: 1) control (59 patients); 2) those receiving an oncologist's exercise recommendation (53 patients); and 3) those receiving an oncologist's exercise recommendation with an exercise motivation package (50 patients). At baseline and after 4 weeks, the level of exercise participation and QOL were assessed. Of the 162 participants, 130 (80.2%) completed the trial. Intention-to-treat analysis indicated that participants who received an oncologist's exercise recommendation with an exercise motivation package significantly increased their level of exercise participation in terms of minutes (47.57 added minutes per week; 95% confidence interval, 9.62-85.52 minutes [P =.022] vs control) and in Metabolic Equivalent of Task (MET)-hours per week (4.14 additional MET-hours per week; 95% confidence interval, 1.70-6.58 MET-hours [P =.004] vs control) compared with the control group. Participants who received only their oncologist's exercise recommendation did not increase their exercise participation level. Further analysis demonstrated that role functioning was significantly improved among participants who received an oncologist's exercise recommendation with an exercise motivation package. Providing an exercise motivation package in addition to the oncologist's exercise recommendation to increase the level of exercise among survivors of breast and colorectal cancer should be considered. Cancer 2015. © 2015 American Cancer Society. © 2015 American Cancer Society.
    Cancer 05/2015; 121(16). DOI:10.1002/cncr.29400 · 4.89 Impact Factor
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    ABSTRACT: Hypermethylation of the CpG island of p16 (INK4a) occurs in a significant proportion of colorectal cancer (CRC). We aimed to investigate its predictive role in CRC patients treated with 5-fluorouracil, leucovorin, irinotecan (FOLFIRI), and cetuximab. Pyrosequencing was used to identify KRAS mutation and hypermethylation of 6 CpG island loci (p16, p14, MINT1, MINT2, MINT31, and hMLH1) in DNA extracted from formalin-fixed paraffin-embedded specimens. Logistic regression and Cox regression were performed for analysis of the relation between methylation status of CIMP markers including p16 and clinical outcome. Hypermethylation of the p16 gene was detected in 14 of 49 patients (28.6%) and showed significant association with KRAS mutation (Fisher`s exact, P=0.01) and CIMP positivity (Fisher`s exact, P=0.002). Patients with p16-unmethylated tumors had significantly longer time to progression (TTP, median 9.0 vs 3.5 months; log-rank, P=0.001) and overall survival (OS, median 44.9 vs 16.4 months; log-rank, P=0.008) than those with p16-methylated tumors. Patients with both KRAS and p16 aberrancy (n=6) had markedly shortened TTP (median 2.8 months) compared to those with either KRAS or p16 aberrancy (n=11; median 8.6 months, P=0.021) or those with neither (n=32; median 9.0 months, P <0.0001). In multivariate analysis, KRAS mutation and p16 methylation showed independent association with shorter TTP (KRAS mutation HR=3.21, P=0.017; p16 methylation HR=2.97, P=0.027). Hypermethylation of p16 was predictive of clinical outcome in mCRC patients treated with cetuximab and FOLFIRI, irrespective of KRAS mutation.
    Cancer Research and Treatment 04/2015; DOI:10.4143/crt.2014.314 · 3.32 Impact Factor
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    ABSTRACT: The purpose of the present study was to examine 1) characteristics and attitudes of oncologists toward exercise and toward recommending exercise to their patients, 2) association among oncologists' own physical activity levels, exercise recommendations, and their attitudes toward recommending exercise. A total of 167 oncologists participated in this survey study (41 surgeons, 78 medical oncologists, 25 radiation oncologists, and 21 others). Most oncologists included in the study treat more than one type of cancer, including colorectal, gastric, breast, lung, and liver cancer. To analyze the data, the one-way ANOVA, and t-test were used. All data were indicated for mean, SD, and proportions. Most oncologists agreed that exercise is beneficial (72.8%) and important (69.6%), but only 39.2% of them agreed that exercise is safe, and only 7.2% believed that cancer patients manage to exercise during cancer treatment. Forty-six percentage of the surveyed oncologists recommended exercise to their patients during the past month. The average amount of participation in physical activity by oncologists who participated in the study was 139.5 ± 120.3 min per week, and 11.4% of the study participants met the American College of Sports Medicine (ACSM) guidelines. Oncologists' own physical activity levels were associated with their attitudes toward recommending exercise. Belief in the benefits of exercise in the performance of daily tasks, improvement of mental health, and the attenuation of physical decline from treatment were the three most prevalent reasons why oncologists recommend exercise to their patients. Barriers to recommending exercise to patients included lack of time, unclear exercise recommendations, and the safety of patients. Oncologists have favorable attitudes toward exercise and toward recommending exercise to their patients during treatment. However, they also experience barriers to recommending exercise, including lack of time, unclear exercise guidelines for cancer patients, and concerns regarding the safety of exercise.
    BMC Cancer 04/2015; 15(1):249. DOI:10.1186/s12885-015-1250-9 · 3.36 Impact Factor
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    ABSTRACT: Surgical treatment of intestinal Behcet's disease (BD) is not well established. Specifically, it is still difficult to assess the clinical value of laparoscopic surgery to address this condition. We aimed to evaluate the clinical course and the characteristics of laparoscopic surgery for intestinal BD compared with open surgery. We reviewed charts of 91 patients who underwent surgical treatment for intestinal BD between January 1995 and December 2012. We retrospectively compared the laparoscopic group (LG, n = 30) and the open group (OG, n = 61) in terms of patient demographics, clinical features, operative data, postoperative course, complications within 30 days after operation, and long-term follow-up data. There were more females in the LG than in the OG (63.3 vs. 36.1 %, p = 0.014), and oral/genital ulcers were more frequent in the LG (76.7 vs. 54.1 %, p = 0.038; 60 vs. 36.1 %, p = 0.031). Intractability with medical treatment was dominant in the LG (76.7 vs. 45.9 %, p = 0.02), while intestinal perforation or fistula were more prevalent in the OG (10 vs. 44.3 %, p = 0.001). Most patients received an ileocecectomy or a right hemicolectomy as their first surgery. In the LG, the patients had a shorter operation time (162.0 vs. 228.5 min, p < 0.001) and had less blood loss (61.7 vs. 232.3 ml, p = 0.003). There were no significant differences in postoperative complications, reoperation, mortality, and hospital stay between the groups. During the follow-up period, the mean number of operations was less in the LG than in the OG (1.3 vs. 2.1, p = 0.011). Analysis indicated that 20 % of patients in the LG and 50.8 % in the OG underwent more than two operations (p = 0.005). Laparoscopic surgery is feasible and safe for selected intestinal BD patients. However, there were no better short-term outcomes in LG compared with OG.
    Surgical Endoscopy 03/2015; DOI:10.1007/s00464-015-4166-1 · 3.26 Impact Factor
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    ABSTRACT: The true benefits of robotic surgery are controversial, and whether robotic total mesorectal excision (R-TME) can be justified as a standard treatment for rectal cancer patients needs to be clarified. This case-matched study aimed to compare the postoperative complications and short- and long-term outcomes of R-TME and laparoscopic TME (L-TME) for rectal cancer.Among 1029 patients, we identified 278 rectal cancer patients who underwent R-TME. Propensity score matching was used to match this group with 278 patients who underwent L-TME.The mean follow-up period was similar between both groups (L-TME vs R-TME: 52.5 ± 17.1 vs 51.0 ± 13.1 months, P = 0.253), as were patient characteristics. The operation time was significantly longer in the R-TME group than in the L-TME group (361.6 ± 91.9 vs 272.4 ± 83.8 min; P < 0.001), whereas the conversion rate, length of hospital stay, and recovery of pain and bowel motility were similar between both groups. The rates of circumferential resection margin involvement and early complications were similar between both groups (L-TME vs R-TME: 4.7% vs 5.0%, P = 1.000; and 23.7% vs 25.9%, P = 0.624, respectively), as were the 5-year overall survival, disease-free survival, and local recurrence rates (93.1% vs 92.2%, P = 0.422; 79.6% vs 81.8%, P = 0.538; 3.9% vs 5.9%, P = 0.313, respectively).The oncologic quality, short- and long-term outcomes, and postoperative morbidity in the R-TME group were comparable with those in the L-TME group.
    Medicine 03/2015; 94(11):e522. DOI:10.1097/MD.0000000000000522 · 5.72 Impact Factor
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    ABSTRACT: This study compared the long-term oncologic outcomes of patients with rectal cancer who underwent either laparoscopic or robotic total mesorectal excision (TME) via minimally invasive surgery (MIS) to those patient who underwent open TME. This study was a retrospective, case-control study; patients in the 2 groups were matched according to age, sex, MIS vs open operation, body mass index, tumor location, pathologic TNM stage (ie, tumor-node-metastasis), neoadjuvant treatment, and adjuvant treatment. A total of 633 patients (MIS, n = 211; open, n = 422) were assessed. The median follow-up period was 64 (2-124) months. Patient characteristics did not differ between the groups. Overall postoperative complication rates did not differ between the groups (16.0% [MIS]; 17.0% [open]; P = .76). Rates of the involvement of the circumferential resection margin did not differ between the groups (4.0% [MIS]; 5.0% [open]; P = .84). The 5-year overall survival, disease-specific survival, disease-free survival, and local recurrence rates were not different between the MIS and open groups (overall survival = 88.4% vs 85.3%, P = .23; disease-specific survival = 88.8% vs 87.4%, P = .53, disease-free survival = 80.7% vs 78.4%, P = .74; local recurrence = 5.7% vs 5.1%, P = .95). In subgroup analysis, no differences were found in terms of the long-term, oncologic outcomes, oncologic adequacy, and postoperative complications among 3 groups. We found no differences in the oncologic outcomes between MIS and open surgery, suggesting that MIS for rectal cancer is a safe option for rectal cancer that does not increase the risk of serious complications. Copyright © 2015 Elsevier Inc. All rights reserved.
    Surgery 02/2015; 157(6). DOI:10.1016/j.surg.2015.01.010 · 3.38 Impact Factor
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    ABSTRACT: Compared with conventional laparoscopic surgery, single-incision laparoscopic surgery produces better cosmetic benefits. The aim of this study was to investigate the learning curve for single-incision laparoscopic anterior resection (SILAR) for sigmoid colon cancer using multidimensional methods. From September 2009 through May 2014, one hundred and thirteen patients underwent SILAR for sigmoid colon cancer by a single surgeon at Severance Hospital. The learning curve was analyzed using moving average, cumulative sum control chart (CUSUM), and risk-adjusted CUSUM methods. For risk-adjusted CUSUM, surgical failure was defined as conversion to open surgery or conventional laparoscopic surgery, morbidity within 30 days after surgery, <12 harvested lymph nodes, or local recurrence. Using the moving average method, the peak point for operation time occurred at the 65(th) case (173 minutes). The CUSUM method also showed the operation time peak point at the 65(th) case. However, the risk-adjusted CUSUM curve did not ascend after the 61st case. The operation time and hospital stay for the 60 phase 1 patients (cases 1 to 60) were longer than for 53 phase 2 patients (cases 61 to 113) (166.6 vs 140 minutes; p < 0.001 and 7.1 vs 5.5 days; p = 0.009). Phase 2 patients had a significantly larger tumor diameter and more harvested lymph nodes. The learning curve for SILAR for sigmoid colon cancer was 61 to 65 cases according to multidimensional statistical analyses. Single-incision laparoscopic anterior resection is feasible for surgeons experienced in laparoscopic surgery. However, SILAR required more cases for proficiency than the number previously reported for conventional laparoscopic surgery, likely because of its technical challenges. Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.
    Journal of the American College of Surgeons 02/2015; 221(2). DOI:10.1016/j.jamcollsurg.2015.02.016 · 5.12 Impact Factor
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    ABSTRACT: The impact of cancer on quality of life and depression is an important issue. The purpose of this study was to identify the impact of physical fitness on quality of life and depression in stage II-III colorectal cancer survivors. Participants in the current study included 122 stage II-III colorectal cancer survivors (57 females; 56.67 ± 9.16 years of age and 55 males; 54.69 ± 9.78 years of age). Fitness was assessed using the 6-min walk test, chair stand test, and push-up test. Quality of life and depression were measured using the Functional Assessment of Cancer Therapy-Colorectal (FACT-C) scale and a 9-item patient health questionnaire interview, respectively. There was a significant association between physical fitness and quality of life and depression in colorectal cancer survivors. The 6-min walk test results were associated with FACT-C total (r = 0.298, p < 0.05), physical well-being (r = 0.230, p < 0.05), functional well-being (r = 0.234, p < 0.05), colorectal cancer concern (r = 0.229, p < 0.05), and depression (r = -0.228, p < 0.05), and the chair stand test results were associated with functional well-being (r = 0.231, p < 0.05), colorectal cancer concern (r = 0.242, p < 0.05), and depression (r = -0.227, p < 0.05) even after controlling for all potentially confounding variables. A multiple regression analysis indicated that the 6-min walk was a significant predictor of health-related quality of life, and participants in the lowest tertile of the 6-min walk test results had lower quality of life and greater depression than those in the highest tertile. Improving and maintaining physical fitness are important for quality of life and depression in stage II-III colorectal cancer survivors.
    Supportive Care Cancer 02/2015; 23(9). DOI:10.1007/s00520-015-2615-y · 2.36 Impact Factor
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    ABSTRACT: To review and compare clinical manifestations of and risk factors for anastomotic leakage (AL) after low anterior resection for rectal cancer between minimally invasive surgery (MIS) and open surgery (OS). MIS for rectal cancer has become popular, and its clinical course is different from OS. Many studies have reported on the risk factors and oncologic influence of AL. However, few have directly compared clinical manifestations and risk factors for AL between MIS and OS. From January 2004 to December 2012, a total of 1704 consecutive patients who underwent elective low anterior resection with colorectal anastomosis for rectal cancer were eligible. The variables associated with short-term outcomes and risk factors were analyzed. The overall AL incidence was 6.4%. In the MIS-AL group, the time to diagnosis of AL and the time to second operation were shorter. A majority of the patients (77.8%) in the MIS-AL group underwent second MIS operation, whereas none in the OS-AL group. The hospital stays after second MIS were shorter than those after second open operation. Multivariate analyses revealed that male sex, smoking and alcohol intake history, previous abdominal surgery, longer operation times, low-lying tumor, and using 2 or more staplers for distal rectal resection were independent risk factors in the MIS-AL group, whereas smoking and alcohol intake history, operation times, and blood loss were significant in the OS-AL group. The clinical manifestations of and risk factors for AL were different between MIS and OS. AL after MIS may be more influenced by factors related to technical difficulties. Close attention should be given to patients undergoing surgery with risk factors for AL.
    Annals of Surgery 02/2015; DOI:10.1097/SLA.0000000000001157 · 8.33 Impact Factor

Publication Stats

2k Citations
602.69 Total Impact Points


  • 2015
    • Wonju Severance Christian Hospital
      Genshū, Gangwon-do, South Korea
  • 2002–2015
    • Yonsei University
      • • Department of Surgery
      • • Division of Medical Oncology
      • • College of Medicine
      Sŏul, Seoul, South Korea
  • 1998–2015
    • Yonsei University Hospital
      • • Surgery
      • • Department of Internal Medicine
      Sŏul, Seoul, South Korea
  • 2013
    • Kosin University
      Tsau-liang-hai, Busan, South Korea
  • 2010
    • Korea Institute of Radiological & Medical Sciences
      Sŏul, Seoul, South Korea