In Ja Park

Ulsan University Hospital, Urusan, Ulsan, South Korea

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Publications (46)121.47 Total impact

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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 : official journal of the Society for Surgery of the Alimentary Tract. 08/2014;
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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. · 2.55 Impact Factor
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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; · 4.12 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. · 3.34 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. · 1.71 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. · 18.04 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. · 3.34 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. · 3.34 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. · 0.96 Impact Factor
  • In Ja Park
    Annals of surgery 09/2010; 252(3):569-70. · 7.90 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
  • In Ja Park, Jin Cheon Kim
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    ABSTRACT: The distal resection margin (DRM) has been considered an important factor for the oncological outcome of rectal cancer surgery. However, the optimal distal margins required to achieve safe oncological outcome remains to be controversial. More recently, as circumferential resection margin or mesorectal margin has been additionally reported to be more important factors predicting patient outcome than the distal mucosal margin, a re-evaluation of the impact of DRM on patient outcome is needed. The extent of distal tumor spread is known to be influenced by a variety of factors such as tumor location, lymph node metastasis, and tumor size. DRM might affect survival more than a local recurrence. Because distal intramural tumor spread rarely exceeds 1 to 2 cm in most rectal cancers, and local control and survival do not seem to be compromised by shorter distal resection margins, the generally accepted practice is to aim for a 2-cm DRM. However, in the recent trend of curative resection after preoperative chemoradiotherapy, with an otherwise favorable tumor such as well-differentiated tumor and no lymph node metastasis, a DRM at < or =1 cm does not necessarily portend a poor prognosis. In cases with preoperative chemoradiotherapy, distal resection margins need to be evaluated individually. It has been suggested that down-staging of low-lying rectal cancers after preoperative radiation might well include the pathological clearance of distal intramural microscopic spread. Moreover, the measurement of DRM varies with respective study, making it difficult to compare. We need an applicable intraoperative method to accurately measure distal resection margin, enabling comparative outcome.
    Journal of Gastrointestinal Surgery 02/2010; 14(8):1331-7. · 2.36 Impact Factor
  • In Ja Park, Gyu-Seog Choi
    Surgical Endoscopy 01/2010; · 3.43 Impact Factor
  • In Ja Park, Gyu-Seog Choi, Soo Han Jun
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    ABSTRACT: CA19-9 was evaluated as a prognostic marker for colorectal cancer and whether it could be helpful in addition to surveillance using CEA was also tested. Serum CA19-9 levels were measured preoperatively in 1109 patients and monitored at 3-month intervals for the first 2 years postoperatively, and at 6-month intervals thereafter in 700 patients. Preoperative high CA19-9 was independent prognostic factor for recurrence. Among patients with recurrence, 21.4% had a high postoperative CA19-9. High postoperative CA 19-9 levels were more likely in patients with high preoperative levels. Postoperative CA19-9 increased more in patients with a peritoneal recurrence than in those with liver metastasis (p=0.002). Among patients with recurrence, CA19-9 increased in 7.8% of the patients with a normal follow-up CEA. Postoperative CA19-9 was more frequently elevated when peritoneal recurrence occurred. Data on CA19-9 levels provided 7.8% of additional information in predicting recurrence in this study.
    Anticancer research 10/2009; 29(10):4303-8. · 1.71 Impact Factor
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    ABSTRACT: We evaluated preoperative serum carcinoembryonic antigen (CEA) as a prognostic factor for colorectal cancer and determined when surveillance of this marker was useful. Serum CEA was measured preoperatively in 1,263 patients who underwent curative resection for colorectal cancer at 3-month intervals for the first 2 postoperative years and at 6-month intervals thereafter. Mean follow-up was 48 months (range 1-156 months). The 5-year disease-free survival was less in patients with a high preoperative serum CEA level (P<0.0001). Among patients with a tumor recurrence, 38.5% had high follow-up serum CEA levels. The number of patients with high postoperative serum CEA levels exceeded the number of patients with high preoperative levels. High preoperative and follow-up serum CEA levels were independent prognostic factors for tumor recurrence (P=0.003 and P<0.001, respectively). In patients with high preoperative serum CEA levels, CEA surveillance had a 92.3% positive predictive value (PPV) and a 96.1% negative predictive value (NPV). The mean interval between postoperative serum CEA elevation and the diagnosis of a tumor recurrence [diagnostic interval (DI)] was 2.5 months (range 5-17 months). The DI was 0 in 18.8% of patients with a tumor recurrence. High serum CEA levels preoperatively and at follow-up are prognostic factors for colorectal cancer. Postoperative serum CEA surveillance is used most effectively when patients have high preoperative serum CEA levels. Considering the DI of 0 in 18.8% of the patients, the current CEA surveillance schedule might be changed.
    Annals of Surgical Oncology 08/2009; 16(11):3087-93. · 4.12 Impact Factor
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    ABSTRACT: We analyzed metastases to the sigmoid and sigmoid mesenteric lymph nodes from rectal cancer. It has been reported that rectal cancer spreads upward and lateral. However, metastasis to the sigmoid mesenteric or sigmoid nodes from rectal cancer has been rarely reported. We enrolled 347 patients who underwent curative resection for rectal cancer with proven lymph node metastases and dissection of the sigmoid and sigmoid mesenteric lymph nodes. Lymph node classification was performed by the colorectal surgeon and the lymph nodes were sent to pathology. Two hundred ninety sigmoid mesenteric and 248 sigmoid lymph node dissections were confirmed by pathologic examination. There were 185 and 162 patients with extraperitoneal and intraperitoneal rectal cancers, respectively. The T categories were T1 in 4 patients (1.2%), T2 in 25 patients (7.2%), T3 in 252 patients (72.6%), and T4 in 66 patients (18.8%). The N categories were N1 in 216 patients (62.2%) and N2 in 131 patients (37.8%). Metastases to the sigmoid and sigmoid mesenteric lymph nodes occurred in 60 (20.7%) and 28 patients (11.3%), respectively. Metastases to the sigmoid or sigmoid mesenteric lymph nodes, without metastases to the superior rectal and inferior mesenteric lymph nodes, developed in 18 patients (5.2%). Compared with patients without sigmoid mesenteric lymph node metastases, N2 category disease, and poor differentiation, overall recurrence was more common in patients with sigmoid mesenteric lymph node metastases. Patients with sigmoid lymph node metastases were common in the N2 category of disease. However, the number of retrieved lymph nodes, and the overall and local recurrence rates were not significantly different. Seventeen of 18 patients with only sigmoid mesenteric or sigmoid lymph node metastases had N1 category disease; 8 and 10 patients had extraperitoenal and intraperitoneal rectal cancers, respectively. For patients with N1 category disease, there was no difference in the overall and local disease recurrence rates among the patients. Sigmoid mesenteric or sigmoid lymph node metastases developed in 23.2% of patients in the present study. But, there were no differences in the cancer-specific survival, overall and local disease recurrence rates in the patients with sigmoid mesenteric or sigmoid lymph node metastases.
    Annals of surgery 07/2009; 249(6):960-4. · 7.90 Impact Factor
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    ABSTRACT: The surgical robot (da Vinci S) is superior to conventional laparoscopy; it provides clearer, three-dimensional images and an extended range of motion for the instruments. We used this robot for laparoscopic surgery to perform a totally intracorporeal resection of the rectum and colorectal anastomosis, with transanal or transvaginal retrieval of specimens. We prospectively collected data on 13 patients who underwent robot-assisted rectal surgery by a single surgeon from January to March 2008. For low anterior resection (LAR), the splenic flexure was mobilized laparoscopically, followed by robotic rectal resection and anastomosis, and transanal removal of specimens in both male and female patients. We retrieved the specimen through the vagina in some female patients. Eleven and two patients underwent LAR and anterior resection (AR), respectively. Mean operative time was 260.8 ± 62.9 (range 210-390) min with median robotic time of 118 ± 43.6 (range 122-186) min. There were three postoperative complications, in two patients. One patient had anastomotic bleeding and the other had anastomotic leakage following inferior mesenteric artery bleeding. The circumferential margins were clear. The tumor stage was I in four, II in two, and III in seven patients. In one patient, the distal resection margin was involved. The patients resumed an oral diet and were discharged on the third and seventh day after surgery. Robotic-assisted laparoscopic methods were safe for AR in patients with colorectal cancer. This approach made it easier to perform a total mesorectal excision, anastomosis, and closure of the vaginal wall, and avoided the traditional abdominal incision.
    Surgical Endoscopy 06/2009; 23(12):2831-5. · 3.43 Impact Factor
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    In Ja Park, Gyu-Seog Choi, Soo Han Jun
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    ABSTRACT: We assessed which classification of lymph node metastasis better predicted outcomes in patients with colorectal carcinoma. We identified 318 patients (176 men) with stage III colon cancer who underwent curative resection. The number of LNs dissected, LNR, and disease-free survival time, were analyzed. Lymph node disease was stratified by the American Joint Committee on Cancer staging and LNR, with the latter categorized into groups with LNR <0.059 (n = 67), 0.059-0.23 (n = 171), and >0.23 (n = 80). Median follow-up time was 37 (range, 1-122) months. LNR significantly increased with the number of metastatic LNs (P < 0.0001). Three-year disease-free survival (DFS) rates differed significantly in the three LNR groups. Within each TNM stage, 3-year DFS rates differed according to LNR, but, within each LNR subgroup, 3-year DFS did not differ according to TNM stage. When both TNM stage and LNR subgroup were considered, 3-year DFS was stratified into four groups, which differed significantly (P < 0.0001). Considering number of retrieved lymph nodes, this stratification was not found when <12 lymph nodes retrieved. Re-stratified lymph node staging, reflecting both LNR and TNM stage, can predict survival in patients with LN-positive colon cancer, especially when more than 12 lymph nodes harvested.
    Journal of Surgical Oncology 04/2009; 100(3):240-3. · 2.64 Impact Factor

Publication Stats

472 Citations
121.47 Total Impact Points

Institutions

  • 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