In Ja Park

Ulsan University Hospital, Urusan, Ulsan, South Korea

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Publications (52)123.03 Total impact

  • Kyungyeon Hwang, In Ja Park, Chang Sik Yu, Seok-Byung Lim, Jong Lyul Lee, Yong Sik Yoon, Chan Wook Kim, Jin Cheon Kim
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    ABSTRACT: To ascertain pathologic stage as a prognostic indicator for rectal cancer patients receiving preoperative chemoradiotherapy (PCRT). Patients with mid- and low rectal carcinoma (magnetic resonance imaging - based clinical stage II or III) between 2000 and 2009 and treated with curative radical resection were identified. Patients were divided into two groups: PCRT and No-PCRT. Recurrence-free survival (RFS) was examined according to pathologic stage and addition of adjuvant treatment. Overall, 894 patients were identified. Of these, 500 patients received PCRT. Adjuvant chemotherapy was delivered to 81.5% of the No-PCRT and 94.8% of the PCRT patients. Adjuvant radiotherapy was given to 29.4% of the patients in the No PCRT group. The 5-year RFS for the No-PCRT group was 92.6% for Stage I, 83.3% for Stage II, and 72.9% for Stage III. The 5-year RFS for the PCRT group was 95.2% for yp Stage 0, 91.7% for yp Stage I, 73.9% for yp Stage II, and 50.7% for yp Stage III. Pathologic stage can predict prognosis in PCRT patients. 5-year RFS is significantly lower among PCRT patients than No-PCRT patients in pathologic stage II and III. These results should be taken into account when considering adjuvant treatment for patients treated with PCRT.
    World journal of gastroenterology : WJG. 01/2015; 21(2):555-62.
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    ABSTRACT: Objectives: This study investigates the clinical significance of the gene encoding AP-2ε (TFAP2E) in colorectal cancer (CRC) patients undergoing curative resection. Methods: A single-institution cohort of 248 patients who underwent curative resection of stage I/II/III CRCs between March and December 2004 was enrolled, and 193 patients whose tumors were available for the determination of the TFAP2E methylation status were included in the analysis. Results: TFAP2E hypermethylation was detected in 112 patients (58%) and was significantly associated with distally located CRCs, low pathologic T stage (T1/T2), and stage I tumors. After a median follow-up of 86.3 months, the patients with TFAP2E hypermethylation tended to show better relapse-free survival (RFS) and overall survival (OS) than the patients with TFAP2E hypomethylation (5-year RFS rate: 90 vs. 80%, p = 0.063; 6-year OS rate: 88 vs. 80%, p = 0.083). Multivariate analysis showed that the pathologic nodal stage and TFAP2E methylation status were independent prognostic factors for RFS and OS, and they remained significant factors in the subgroup analysis that included 154 patients with stage II/III CRCs who had received adjuvant chemotherapy. Conclusions: TFAP2E hypermethylation is associated with good clinical outcomes and may be considered as an independent prognostic factor in patients with curatively resected CRCs. © 2014 S. Karger AG, Basel.
    Oncology 10/2014; 88(2):122-132. · 2.17 Impact Factor
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    In Ja Park
    Annals of coloproctology. 10/2014; 30(5):208-9.
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    ABSTRACT: The impact of the number of retrieved lymph nodes (LNs) on oncological outcomes in patients with rectal cancer remains unclear. This study was designed to evaluate the prognostic implications of the number of retrieved LNs in patients with rectal cancer receiving preoperative chemoradiotherapy (CRT).
    Journal of Gastrointestinal Surgery 08/2014; · 2.39 Impact Factor
  • Korean Journal of Clinical Oncology. 06/2014; 10(1):29-34.
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    ABSTRACT: Selecting the best surgical approach for treating complete rectal prolapse involves comparing the operative and functional outcomes of the procedures. The aims of this study were to evaluate and compare the operative and functional outcomes of abdominal and perineal surgical procedures for patients with complete rectal prolapse.
    Annals of surgical treatment and research. 05/2014; 86(5):249-55.
  • In Ja Park, Chang Sik Yu
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    ABSTRACT: In patients with locally advanced rectal cancer, preoperative chemoradiotherapy has proven to significantly improve local control and cause lower treatment-related toxicity compared with postoperative adjuvant treatment. Preoperative chemoradiotherapy followed by total mesorectal excision or tumor specific mesorectal excision has evolved as the standard treatment for locally advanced rectal cancer. The paradigm shift from postoperative to preoperative therapy has raised a series of concerns however that have practical clinical implications. These include the method used to predict patients who will show good response, sphincter preservation, the application of conservative management such as local excision or "wait-and-watch" in patients obtaining a good response following preoperative chemoradiotherapy, and the role of adjuvant chemotherapy. This review addresses these current issues in patients with locally advanced rectal cancer treated by preoperative chemoradiotherapy.
    World Journal of Gastroenterology 02/2014; 20(8):2023-2029. · 2.43 Impact Factor
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    In Ja Park
    Annals of coloproctology. 02/2014; 30(1):7-8.
  • Korean Journal of Clinical Oncology. 12/2013; 9(2):134-138.
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    ABSTRACT: PURPOSE: To evaluate stage IIA colorectal cancer in terms of recurrence so as to discover whether high preoperative serum carcinoembryonic antigen (s-CEA) levels indicate that the patient should be included in a high-risk group in stage II colorectal cancer. METHODS: We retrospectively reviewed the records of 1543 patients with stage IIA colorectal cancer who underwent curative surgery between January 2000 and December 2007. RESULTS: The 5-year disease-free survival and overall survival rates were significantly lower in patients with a higher than normal preoperative s-CEA (90.5 % vs. 82.5 %, P < 0.001, and 92.4 % vs. 87.8 %, P = 0.034, respectively). Multivariate analysis revealed that elevated preoperative s-CEA level, preoperative obstruction, rectal cancer, and dissection of fewer than 12 nodes were independent statistically significant prognostic factors that predicted disease-free survival in patients with stage IIA disease after curative resection. CONCLUSIONS: Elevated preoperative s-CEA concentration is a reliable predictor of recurrence after curative resection in patients with stage IIA colorectal cancer. Patients with stage IIA disease with elevated preoperative s-CEA level do worse than those with normal levels and might constitute a group to evaluate for adjuvant chemotherapy. Further studies on the effect of adjuvant chemotherapy in this group are needed.
    Annals of Surgical Oncology 06/2013; · 3.94 Impact Factor
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    ABSTRACT: : Neoadjuvant chemoradiotherapy before total mesorectal excision for rectal cancer is associated with improved local tumor control, primary tumor regression, and pathologic downstaging. Therefore, tumor response in the bowel wall has been proposed to be used to identify patients for organ-preserving strategies. : The aim of this study was to determine the rate of residual lymph node involvement following neoadjuvant chemoradiotherapy among patients with ypT0-2 residual bowel wall tumor and to comparatively assess their oncologic outcomes following total mesorectal excision. : This is a retrospective consecutive cohort study, 1993 to 2008. : Patients with stage cII to III rectal carcinoma treated with preoperative chemoradiotherapy and total mesorectal excision were included. : The primary outcomes measured were the rate of lymph node metastasis by ypT stage, recurrence-free survival, and the frequencies of distant metastasis and local recurrence. : Among all 406 ypT0-2 patients, 66 (16.3%) had lymph node metastasis: 20.8% among ypT2, 17.1% among ypT1, and 9.1% among ypT0 patients. Local recurrences (2.0% vs 5.5%; p = 0.038) but not distant metastases (9.3% vs 13.5%; p = 0.38) occurred more frequently in ypN+ than in ypN0 patients. Recurrence-free survival was 85.2% among ypT0-2N0 and 79.6% for ypT0-2N+ patients (p = 0.28). The lack of difference in recurrence-free survival persisted after covariate adjustment (HR, 1.29; 95% CI, 0.77-2.16; p = 0.37). However, among ypT3-4patients, 5-year recurrence-free survival was significantly lower with lymph node metastasis (HR, 1.51; 95% CI, 1.07-2.12; p = 0.019). : Low local recurrence event rate limited further comparison by ypT0-2 subgroups. : Residual mesorectal lymph node metastasis risk remains high even with good neoadjuvant chemoradiotherapy response within the bowel wall. Complete removal of the mesorectal burden results in excellent disease control. Given the uniquely good outcomes with standard therapy among patients with ypT0-2 disease, the use of ypT stage to stratify patients for local excision risks undertreatment of an unacceptably high proportion of patients.
    Diseases of the Colon & Rectum 02/2013; 56(2):135-41. · 3.20 Impact Factor
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    ABSTRACT: The role of autophagy in tumor development is paradoxical. Although some genetic evidence has indicated that autophagy has as a tumor suppressor function, it also provides some advantages to tumors under metabolic stress conditions. Autophagy is regulated by several autophagy-related gene (ATG) proteins. In mammals, 16 different ATG genes have been identified. To investigate the clinicopathological role of ATG5 in colorectal cancer, we firstly investigated its expression in patients with sporadic colorectal cancer. Expression analysis revealed ATG5 to be strongly down-regulated in colorectal cancer (38/40 patients). Interestingly, immunohistochemical analysis of colorectal cancer tissues indicated that increased ATG5 expression is associated with lymphovascular invasion (p=0.035). The findings in our limited clinical cohort indicate that ATG5 could be a potential prognostic or diagnostic biomarker.
    Anticancer research 09/2012; 32(9):4091-6. · 1.87 Impact Factor
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    ABSTRACT: Neoadjuvant chemoradiotherapy for rectal cancer is associated with improved local control and may result in complete tumor response. Associations between tumor response and disease control following radical resection should be established before tumor response is used to evaluate treatment strategies. The purpose of this study was to assess and compare oncologic outcomes associated with the degree of pathologic response after chemoradiotherapy. All patients with locally advanced (cT3-4 or cN+ by endorectal ultrasonography, computed tomography, or magnetic resonance imaging) rectal carcinoma diagnosed from 1993 to 2008 at our institution and treated with preoperative chemoradiotherapy and radical resection were identified, and their records were retrospectively reviewed. The median radiation dose was 50.4 Gy with concurrent chemotherapy. Recurrence-free survival (RFS), distant metastasis (DM), and local recurrence (LR) rates were compared among patients with complete (ypT0N0), intermediate (ypT1-2N0), or poor (ypT3-4 or N+) response by using Kaplan-Meier survival analysis and multivariate Cox proportional hazards regression. In all, 725 patients were classified by tumor response: complete (131; 18.1%), intermediate (210; 29.0%), and poor (384; 53.0%). Age, sex, cN stage, and tumor location were not related to tumor response. Tumor response (complete v intermediate v poor) was associated with 5-year RFS (90.5% v 78.7% v 58.5%; P < .001), 5-year DM rates (7.0% v 10.1% v 26.5%; P < .001), and 5-year LR only rates (0% v 1.4% v 4.4%; P = .002). Treatment response to neoadjuvant chemoradiotherapy among patients with locally advanced rectal cancer undergoing radical resection is an early surrogate marker and correlate to oncologic outcomes. These data provide guidance with response-stratified oncologic benchmarks for comparisons of novel treatment strategies.
    Journal of Clinical Oncology 04/2012; 30(15):1770-6. · 17.88 Impact Factor
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    ABSTRACT: Use of rectal MRI evaluation of patients with rectal cancer for primary tumor staging and for identification for poor prognostic features is increasing. MR imaging permits precise delineation of tumor anatomy and assessment of mesorectal tumor penetration and radial margin risk. The aim of this study was to evaluate the ability of pretreatment rectal MRI to classify tumor response to neoadjuvant chemoradiation. This study is a retrospective, consecutive cohort study and central review. This study was conducted at a tertiary academic hospital. Sixty-two consecutive patients with locally advanced (stage cII to cIII) rectal cancer who underwent rectal cancer protocol high-resolution MRI before surgery (December 2009 to March 2011) were included. The primary outcomes measured were the probability of good (ypT0-2N0) vs poor (≥ypT3N0) response as a function of mesorectal tumor depth, lymph node status, extramural vascular invasion, and grade assessed by uni- and multivariate logistic regression. Tumor response was good in 25 (40.3%) and poor in 37 (59.7%). Median interval from MRI to surgery was 7.9 weeks (interquartile range, 7.0-9.0). MRI tumor depth was <1 mm in 10 (16.9%), 1 to 5 mm in 30 (50.8%), and >5 mm in 21 (33.9%). Lymph node status was positive in 40 (61.5%), and vascular invasion was present in 16 (25.8%). Tumor response was associated with MRI tumor depth (p = 0.001), MRI lymph node status (p < 0.001) and vascular invasion (p = 0.009). Multivariate regression indicated >5 mm MRI tumor depth (OR = 0.08; 95% CI = 0.01-0.93; p = 0.04) and MRI lymph node positivity (OR = 0.12; 95% CI = 0.03-0.53; p = 0.005) were less likely to achieve a good response to neoadjuvant chemoradiotherapy. Generalizability is uncertain in centers with limited experience with MRI staging for rectal cancer. MRI assessment of tumor depth and lymph node status in rectal cancer is associated to tumor response to neoadjuvant chemoradiotherapy. These factors should therefore be considered for stratification of patients for novel treatment strategies reliant on pathologic response to treatment or for the selection of poor-risk patients for intensified treatment regimens.
    Diseases of the Colon & Rectum 04/2012; 55(4):371-7. · 3.20 Impact Factor
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    ABSTRACT: The robotic system offers potential technical advantages over laparoscopy for total mesorectal excision with radical lymphadenectomy for rectal cancer. However, the requirement for fixed docking limits its utility when the working volume is large or patient repositioning is required. The purpose of this study was to evaluate short-term outcomes associated with a novel setup to perform total mesorectal excision and radical lymphadenectomy for rectal cancer by the use of a "reverse" hybrid robotic-laparoscopic approach. This is a prospective consecutive cohort observational study of patients who underwent robotic rectal cancer resection from January 2009 to March 2011. During the study period, a technique of reverse-hybrid robotic-laparoscopic rectal resection with radical lymphadenectomy was developed. This technique involves reversal of the operative sequence with lymphovascular and rectal dissection to precede proximal colonic mobilization. This technique evolved from a conventional-hybrid resection with laparoscopic vascular control, colonic mobilization, and robotic pelvic dissection. Perioperative and short-term oncologic outcomes were analyzed. Thirty patients underwent reverse-hybrid resection. Median tumor location was 5 cm (interquartile range 3-9) from the anal verge. Median BMI was 27.6 (interquartile range 25.0-32.1 kg/m). Twenty (66.7%) received neoadjuvant chemoradiation. There were no conversions. Median blood loss was 100 mL (interquartile range 75-200). Total operation time was a median 369 (interquartile range 306-410) minutes. Median docking time was 6 (interquartile range 5-8) minutes, and console time was 98 (interquartile range 88-140) minutes. Resection was R0 in all patients; no patients had an incomplete mesorectal resection. Six patients (20%) underwent extended lymph node dissection or en bloc resection. Reverse-hybrid robotic surgery for rectal cancer maximizes the therapeutic applicability of the robotic and conventional laparoscopic techniques for optimized application in minimally invasive rectal surgery.
    Diseases of the Colon & Rectum 02/2012; 55(2):228-33. · 3.20 Impact Factor
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    ABSTRACT: Autophagy has paradoxical and complex functions in cancer development, and autophagy-related genes (ATG) are key regulators in autophagy. Until now, more than 30 different ATG proteins have been identified in yeast, and their mammalian counterparts also have been reported. Although the roles of a few ATG proteins in cancer have been characterized, the role of ATG10 is almost completely unknown. To investigate the clinicopathological role of ATG10 in colorectal cancer, we analyzed ATG10 expression in colorectal cancer tissues and cell lines. Protein expression analysis showed that ATG10 is highly increased in colorectal cancer (tissue - 18/37 cases, 48%; cell line -8/12 cell lines, 66%). Immunohistochemical analysis with clinicopathological features indicated a strong association of the up-regulation of ATG10 with tumor lymph node metastasis (p = 0.005) and invasion (p<0.001). Moreover, both 5-year disease free survival and overall survival rates of patients bearing tumors that did not express ATG10 were significantly higher than those of patients bearing ATG10-expressing tumors (p = 0.012). Increased expression of ATG10 in colorectal cancer is associated with lymphovascular invasion and lymph node metastasis indicating that ATG10 may be a potential prognostic maker in colorectal cancer.
    PLoS ONE 01/2012; 7(12):e52705. · 3.53 Impact Factor
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    ABSTRACT: To determine whether ultralow anterior resection with levator-sphincter reinforcement (uLAR-LSR), which is first introduced in the current study, offers functional preservation in patients with low rectal cancer. We assessed the functional outcomes in 56 of 61 consecutively enrolled patients who underwent uLAR-LSR. After rectal resection, levator-sphincter reinforcement (LSR) was performed by approximation of the dissected muscles. The functional outcomes were assessed preoperatively, and then 3, 12, and 24 months postoperatively. There were no significant differences in the sphincter or high-pressure zone length between the preoperative and postoperative periods in the uLAR-LSR group (P = 0.298-0.981), which indicated functional preservation by the LSR. The percentage of patients with moderate to severe incontinence (>10 using the Wexner score) was significantly decreased at 24 months as compared to 3 months postoperatively (15.7 vs, 39.6%, P < 0.001). At the limited mean follow-up of 41 months, local recurrence had been detected in one patient (1.8%). The uLAR-LSR method is a novel technical option, which maintains the anorectal function as well as accomplishing oncological safety during a short-term evaluation.
    Surgery Today 11/2011; 42(6):547-53. · 1.21 Impact Factor
  • In Ja Park
    Annals of surgery 09/2010; 252(3):569-70. · 7.19 Impact Factor
  • In Ja Park, Gyu-Seog Choi
    Surgical Endoscopy 08/2010; · 3.31 Impact Factor
  • In Ja Park
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    ABSTRACT: Anastomotic leakages are one of the most serious complications of postoperative recovery among patients that undergo rectal cancer resection. Some investigators have suggested that anastomotic leakages have an impact on the oncological outcome; however, this is currently controversial. Considering the increase of sphincter-preserving procedures for rectal cancer, anastomotic leakage, and its impact on oncological outcomes has become an important issue. The rates of anastomotic leakage are reported to range between 0.6% and 17.4%, depending on the definitions used. Here, we review the available information on anastomotic leakage and its association with oncological outcome.
    Journal of Gastrointestinal Surgery 07/2010; 14(7):1190-6. · 2.36 Impact Factor

Publication Stats

532 Citations
123.03 Total Impact Points


  • 2004–2014
    • Ulsan University Hospital
      Urusan, Ulsan, South Korea
  • 2013
    • University of Texas MD Anderson Cancer Center
      • Department of Surgical Oncology
      Houston, TX, United States
  • 2012
    • Kyung Hee University
      • Graduate School of East-West Medical Science
      Seoul, Seoul, South Korea
  • 2005–2011
    • Asan Medical Center
      Sŏul, Seoul, South Korea
  • 2008–2009
    • Kyungpook National University
      • School of Medicine
      Sangju, North Gyeongsang, South Korea