Hyeong Rok Kim

Chonnam National University, Gwangju, Gwangju, South Korea

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Publications (83)225.51 Total impact

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    ABSTRACT: Approximately 20 % of all patients with colorectal cancer are diagnosed as having Stage IV cancer; 80 % of these present with unresectable metastatic lesions. It is controversial whether chemotherapy with or without primary tumor resection (PTR) is effective for the treatment of patients with colorectal cancer with unresectable metastasis. Primary tumor resection could prevent tumor-related complications such as intestinal obstruction, perforation, bleeding, or fistula. Moreover, it may be associated with an increase in overall survival. However, surgery delays the use of systemic chemotherapy and affects the systemic spread of malignancy. Patients with colon and upper rectal cancer patients with asymptomatic, synchronous, unresectable metastasis will be included after screening. They will be randomized and assigned to receive chemotherapy with or without PTR. The primary endpoint measure is 2-year overall survival rate and the secondary endpoint measures are primary tumor-related complications, quality of life, surgery-related morbidity and mortality, interventions with curative intent, chemotherapy-related toxicity, and total cost until death or study closing day. The authors hypothesize that the group receiving PTR following chemotherapy would show a 10 % improvement in 2-year overall survival, compared with the group receiving chemotherapy alone. The accrual period is 3 years and the follow-up period is 2 years. Based on the inequality design, a two-sided log-rank test with α-error of 0.05 and a power of 80 % was conducted. Allowing for a drop-out rate of 10 %, 480 patients (240 per group) will need to be recruited. Patients will be followed up at every 3 months for 3 years and then every 6 months for 2 years after the last patient has been randomized. This randomized controlled trial aims to investigate whether PTR with chemotherapy shows better overall survival than chemotherapy alone for patients with asymptomatic, synchronous unresectable metastasis. This trial is expected to provide evidence so support clear treatment guidelines for patients with colorectal cancer with asymptomatic, synchronous unresectable metastasis. Trial registration Clinicaltrials.gov NCT01978249.
    Preview · Article · Dec 2016 · Trials
  • Chang Hyun Kim · Soo Young Lee · Hyeong Rok Kim · Young Jin Kim
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    ABSTRACT: Due to selection bias, the oncologic outcomes of APR and ISR have not been compared in an interpretable manner, especially in patients treated with preoperative CRT. To assess factors influencing oncologic outcomes in patients with locally advanced low rectal cancer treated with preoperative chemoradiotherapy (CRT) followed by abdominoperineal resection (APR) or intersphincteric resection (ISR). Between 2006 and 2011, 202 consecutive patients who underwent APR or ISR after preoperative CRT for locally advanced rectal cancer were enrolled in this study. The median follow-up period was 45.3 months (range: 5–85.2 months). Multivariate and propensity score matching (PSM) analyses were performed to reduce selection bias. Of the 202 patients, 40 patients (19.8%) underwent APR and 162 (80.2%) required ISR. In unadjusted analysis, patients undergoing APR had a higher 5-year local recurrence (P < 0.001) and distant metastasis rate (P = 0.01), respectively. However, the higher local recurrence rate for APR persisted even after PSM, and these findings were verified in the multivariate analyses. Moreover, patients with advanced tumors, as assessed by restaging magnetic resonance imaging and luminal circumferential involvement, had a significantly higher local recurrence rate after APR compared with ISR. This is the first PSM based analysis providing evidence of a worse oncologic outcome after APR compared with ISR. In addition, the results of the subgroup analysis suggest that a more radical modification of the current APR is required in cases of advanced cancer.
    No preview · Article · Nov 2015 · Medicine
  • Soo Young Lee · Chang Hyun Kim · Young Jin Kim · Hyeong Rok Kim
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    ABSTRACT: Objective: This study aimed to compare the oncologic outcomes between treatment strategies for rectal cancer [radical surgery, local excision (LE), and the wait-and-see approach] in radiologic complete responders after neoadjuvant chemoradiation (nCRT). Methods: We retrospectively reviewed rectal cancer patients and included 52 radiologic complete responders after nCRT defined as no residual tumor or residual fibrosis and no suspicious metastatic lymph nodes on magnetic resonance imaging (MRI). Clinicopathologic features and oncologic outcomes were compared according to the treatment strategies. Results: The median follow-up period was 41 months (range, 6-80). Twenty-eight patients underwent radical surgery, whereas 16 underwent LE, and 8 were closely monitored without initial surgery. The pathologic complete response rate was 40.9%. Patients who underwent radical surgery showed better prognosis compared to those who underwent LE or wait-and-see (3-year disease-free survival: radical surgery 85.0% vs. LE 62.5%, wait-and-see 75.0%, p = 0.019; 3-year local recurrence-free survival: radical surgery 96.4% vs. LE 67.0%, wait-and-see 75.0%, p = 0.009). After recurrence, patients who underwent salvage surgery showed a relatively good oncologic outcome. Conclusion: Pursuing LE or the wait-and-see approach instead of radical surgery in rectal cancer patients undergoing nCRT may bring about a detrimental oncologic outcome if clinical complete response is solely determined by MRI.
    No preview · Article · Oct 2015 · Oncology
  • Soo Young Lee · Chang Hyun Kim · Young Jin Kim · Hyeong Rok Kim
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    ABSTRACT: The effectiveness of a transanal drainage tube for the prevention of anastomotic leakage (AL) is still uncertain. This study aimed to investigate the impact of anal decompression on AL after rectal cancer surgery. We retrospectively reviewed 536 rectal cancer patients who underwent low anterior resection without diverting stoma, with (n = 154) or without (n = 382) placing of a transanal drainage tube, between January 2005 and December 2014. Risk factors for AL were analyzed, and propensity score matching analysis was used to compensate for the differences in baseline characteristics. AL occurred in 50 (9.3 %) of the patients. Male sex (odds ratio [OR] 3.097, p = 0.005), high ASA score (OR 3.505, p = 0.025), and neoadjuvant chemoradiation (OR 2.506, p = 0.018) were independent predictors of AL on multivariable analysis. After propensity score matching, transanal drainage tube tended to lessen rates of grade C AL with definite peritonitis (1.9 vs. 5.8 %, p = 0.077), although there was no difference in the incidence of AL in patients with or without transanal drainage tubes (5.8 vs. 9.1 %, p = 0.278). Placement of a transanal drainage tube was not associated with a reduction in the total incidence of AL after low anterior resection for rectal cancer.
    No preview · Article · Aug 2015 · Langenbeck s Archives of Surgery
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    Chang Hyun Kim · Soo Young Lee · Hyeong Rok Kim · Young Jin Kim
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    ABSTRACT: Many studies have reported the prognostic value of pretreatment serum carcinoembryonic antigen (pre-CEA) levels on colorectal cancer outcomes. However, controversy remains concerning the significance of pre-CEA levels in patients with rectal cancer treated with neoadjuvant chemoradiotherapy (CRT). Our aim in this study was to investigate the prognostic role of the pre-CEA level in patients with locally advanced rectal cancer undergoing neoadjuvant CRT followed by total mesorectal excision (TME).A total of 419 patients with stages II and III rectal cancer treated with neoadjuvant CRT followed by TME with available pre-CEA data were included. The outcomes studied were 5-year local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and disease-free survival (DFS). Optimal pre-CEA cutoff values to predict DMFS were determined based on current smoking history.The median pre-CEA level of smokers was 3.8 ng/mL, and that of nonsmokers was 2.8 ng/mL (P < 0.01). Pre-CEA levels of 6.6 ng/mL for nonsmokers and 11.4 ng/mL for smokers were determined to best separate patients on the basis of time to distant metastasis by using log-rank statistics. The pre-CEA level was associated with DMFS (hazard ratio = 1.743, 95% confidence interval = 1.129-2.690, P = 0.01). The pre-CEA level was not associated with LRFS or DFS.The pre-CEA level appears to be a significant preoperative prognostic factor. Moreover, it is as valuable as any known pathologic factor. Future studies evaluating oncologic outcomes should take into consideration the pre-CEA level.
    Preview · Article · Aug 2015 · Medicine
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    Preview · Article · Jun 2015
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    ABSTRACT: This study aimed to investigate prognostic factors for low rectal cancer patients undergoing intersphincteric resection (ISR) following neoadjuvant chemoradiation (CRT). We retrospectively reviewed 163 primary rectal cancer patients without distant metastasis who underwent ISR following neoadjuvant CRT between January 2006 and December 2011. Prognostic factors for disease-free survival (DFS) and local recurrence-free survival (LRFS) were evaluated. The median follow-up period was 53 months (range, 0-82 months). Kaplan-Meier survival analysis indicated different 3-year DFS (stage 0, 96.2%; I, 84.8%; II, 72.9%; III, 38.0%) and 3-year LRFS (stage 0, 100.0%; I, 92.4%; II, 91.1%; III, 70.9%) according to pathologic TNM stages, particularly stage III. Multivariable Cox regression analysis suggested that DFS was associated with ypT (3/4 vs. 0/1/2) and ypN (1/2 vs. 0) stages, whereas LRFS with ypN stage (1/2 vs. 0), tumor size (≥3.5 cm vs. <3.5 cm), and tumor height from the anal verge (≤2 cm vs. >2 cm). ISR following CRT could be feasible in stage-I and II low rectal cancer patients, but might be related to poor oncologic outcomes in those with stage-III disease. The indication for ISR or abdominoperineal resection should be carefully evaluated in cases of low rectal cancer with suspicious lymph node metastasis after CRT. J. Surg. Oncol. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.
    No preview · Article · May 2015 · Journal of Surgical Oncology
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    ABSTRACT: CD44 and CD133 mRNA expression as cancer stem cell markers in colorectal cancer were correlated with synchronous hepatic metastases and the clinicopathological factors, including patient survival. The CD44 and CD133 mRNA levels in 36 primary colorectal adenocarcinomas with synchronous hepatic metastasis were analyzed by reverse transcriptase polymerase chain reaction, with normalization relative to glyceraldehyde-3-phosphate dehydrogenase (GAPDH). Immunohistochemical analysis was performed on samples with typical mRNA expression patterns to investigate protein expression. Both CD44 and CD133 gene expressions were highest in hepatic metastasis tissue, followed by colorectal cancer and normal mucosa. The differences were statistically significant among groups of normal mucosa, colorectal cancer and hepatic metastasis tissue. CD44 mRNA expression was significantly associated with the tumor location (P=0.019) and histology (P=0.026). With a median follow-up period of 38 months, the 5-year disease-free survival rate of the patients with high CD44 mRNA expression in the CD44 hepatic metastasis tissue group was significantly lower than that of the patients with low expression (P=0.002). While the mRNA expressions in groups of CD44 colorectal tumor, CD133 colorectal tumor, and CD133 hepatic metastasis tissue were not significant. CD44 and CD133 mRNA were highly correlatively co-expressed in colorectal cancer with hepatic metastases. CD44 expression was an independent factor associated with patient survival, while CD133 did not show this pattern. Thus, CD44 is a more reliable marker for predicting hepatic metastases and survival. Larger prospective studies are required to confirm these findings.
    No preview · Article · Jan 2015 · International Journal of Oncology
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    ABSTRACT: Downstaging after chemoradiotherapy (CRT) for rectal cancer usually occurs. The present study aimed to evaluate pathologic y-stage (yp-stage) and its influence on local recurrence and systemic recurrence in rectal cancer patients treated with CRT followed by surgical resection. We retrospectively analyzed 261 patients underwent preoperative CRT and radical resection for rectal cancer between August 2004 and December 2010. Patients received preoperative CRT consisting of 5-fluorouracil and leucovorin delivered with concurrent pelvic radiation of 45.0-50.4 Gy, followed by radical surgery at 6-8 weeks after CRT. Of the 261 patients, 24 (9.2%) had yp-stage 0, 83 (31.8%) had yp-stage I, 86 (32.9%) had yp-stage II, and 68 (26.1%) had yp-stage III. Patients with yp-stage III had a greater prevalence of preoperative CEA, poorly differentiated tumor, lymphovascular invasion (LVI) and perineural invasion (PNI) than patients with lower yp-stages. We found that yp-stage, preoperative CEA, LVI, PNI and tumor regression grade were significant prognostic factors for both local and systemic recurrence. In multivariate analysis, yp-stage, LVI and PNI were significant factors for local and systemic recurrence. During the median follow-up of 37.5 months, the five-year local recurrence-free survival rate was 100.0%, 95.0%, 89.3%, and 80.6% of yp-stage 0-III, respectively. The five-year systemic recurrence-free survival was 95.8%, 75.3%, 71.4%, and 48.8% of yp-stages 0-III, respectively. The yp-stage after preoperative CRT for rectal cancer is closely correlated with local and systemic recurrence-free survival. Therefore, yp-stage should be considered as a prognostic factor for rectal cancer patients having a course of preoperative CRT.
    Full-text · Article · Jan 2015 · Annals of Surgical Treatment and Research
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    ABSTRACT: Background Experience in terms of surgical case numbers required to develop proficiency for oncologic adequacy after sphincter-saving laparoscopic rectal cancer surgery has not been established.Method Three hundred seventeen consecutive patients underwent sphincter-saving laparoscopic rectal cancer surgery with curative intent performed by single surgeon. The learning curve was estimated using risk-adjusted cumulative sum (RA-CUSUM) and the graph of 195 consecutive patients who were treated by another surgeon was used to evaluate inter-surgeon variability in the learning curve.ResultsOverall, the 3-year local recurrence rate was 7.7% (95% confidence interval [CI], 6.4%–9.0%). The RA-CUSUM analysis demonstrated a learning curve of 110 cases for local recurrence for both of surgeons and 50–70 cases for CRM involvement. The 3-year local recurrence-free rate was better during the experienced period than during the learning period (95.1% [95% CI, 91.6%–97.1%] vs. 89.5% [95% CI, 84.4%–93.0%]; P = 0.029). These differences were obvious in subgroup analysis of stage III tumors (93.4% [95% CI, 86.6%–96.8%] vs. 78.6% [95% CI, 68.5%–85.3%]; P = 0.013).Conclusions Local recurrence rates decreased with increasing surgeon experience, as did other short-term outcomes, especially in advanced disease cases. J. Surg. Oncol. © 2014 Wiley Periodicals, Inc.
    No preview · Article · Dec 2014 · Journal of Surgical Oncology
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    ABSTRACT: Purpose: To examine the association between the number of lymph nodes retrieved and oncologic outcome after preoperative chemoradiation for rectal cancer according to tumor regression grade. Methods: Patients with rectal cancer who underwent curative surgery between May 2004 and December 2012 were analyzed retrospectively. Using multivariate analysis, the correlation between clinicopathologic variables and the number of lymph nodes retrieved was evaluated. The associations between the oncologic outcome and number of lymph nodes retrieved were also investigated according to the tumor regression grade. Results: In total, 1,332 patients were identified, of whom 433 (32.8 %) received preoperative chemoradiation. Multivariate analysis revealed that preoperative chemoradiation was an independent predictor of the number of lymph nodes retrieved (P = 0.002). After chemoradiation, the number of total and positive lymph nodes retrieved was inversely correlated with tumor regression. Retrieval of ≥12 lymph nodes was not an independent prognostic factor for disease-free survival; however, among patients with a good tumor response, those with <12 lymph nodes retrieved had a significantly better 3-year disease-free survival (P = 0.030) than those with ≥12 lymph nodes retrieved. Conclusions: Reduced lymph node yield after preoperative chemoradiation for rectal cancer does not indicate inadequate oncologic surgery. It may represent good treatment response and better prognosis, especially in patients with good pathologic tumor regression after chemoradiation.
    No preview · Article · Nov 2014 · Annals of Surgical Oncology
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    ABSTRACT: Purpose: The aim of this study is to investigate the clinicopathologic features and oncologic outcomes of colorectal cancer patients with extremely elevated (≥50 ng/mL) preoperative serum carcinoembryonic antigen (CEA) levels. Methods: We enrolled 756 primary colorectal cancer patients with elevated preoperative CEA levels (≥5 ng/mL) who underwent surgery between 2004 and 2010 and compared clinicopathologic features according to preoperative CEA levels of 5-50 ng/mL (n = 676) and ≥50 ng/mL (n = 80). The impact of extremely elevated CEA on overall survival (OS) and disease-free survival (DFS) was analyzed using Kaplan-Meier analysis and the Cox proportional hazards model. Results: The median follow-up period was 43 months (range, 0-121). Patients with preoperative CEA ≥50 ng/mL demonstrated higher rates of advanced T stage (97.3 vs. 88.6%, p = 0.016) and distant metastasis (33.8 vs. 17.9%, p = 0.002), but not lymph node metastasis (54.1 vs. 52.2%, p = 0.807). The 5-year OS rate was 69.1%, and the 3-year DFS rate of curatively resected patients (n = 641; 84.8%) was 68.9%. In multivariate analysis, preoperative CEA ≥50 ng/mL, as well as age, N stage, vascular invasion, perineural invasion, post/preoperative CEA ratio ≥0.32, and palliative resection, was an independent predictor of OS. However, for patients treated with curative resection, preoperative CEA ≥50 ng/mL was not significantly associated with DFS or OS (p = 0.053 and 0.157, respectively). Conclusions: Colorectal cancer patients with extremely elevated (≥50 ng/mL) preoperative CEA had advanced disease more frequently but comparable oncologic outcomes if curative resection was performed.
    No preview · Article · Nov 2014 · International Journal of Colorectal Disease
  • Jung Wook Huh · Seong Young Kwon · Jae Hyuk Lee · Hyeong Rok Kim
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    ABSTRACT: Purpose The aim of this study was to compare the restaging accuracy of repeat fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) scan with pelvic magnetic resonance imaging (MRI) in patients with rectal cancer who have undergone preoperative chemoradiation. Methods One hundred and eighty-one consecutive patients with locally advanced rectal cancer who underwent a total mesorectal excision after preoperative chemoradiation were prospectively enrolled. All the patients underwent FDG-PET/CT and pelvic MRI before chemoradiation and 5 weeks after the completion of chemoradiation. We evaluated the measurements of the FDG uptake (SUVmax) and the percentage of SUVmax difference (Response Index = RI) between the pre- and postchemoradiation FDG-PET/CT scans. The accuracy of repeat FDG-PET/CT and pelvic MRI for predicting pathologic CR were compared. Results The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of pelvic MRI for predicting pathologic CR were 38.5, 58.1, 13.3, 84.9, and 55.2 %, respectively. In terms of FDG-PET/CT, pretreatment tumor size and pathologic stage were significantly correlated with the RI values. Using a RI value of 63.6 % as the cutoff threshold, it was possible to discriminate the CR from the non-CR with a sensitivity of 73.1 %, a specificity of 64.5 %, a PPV of 25.7 %, a NPV of 93.5 %, and an accuracy of 65.7 % (area under the curve = 0.723, 95 % confidence interval 0.619–0.828, P
    No preview · Article · Sep 2014 · Journal of Cancer Research and Clinical Oncology
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    Sang Woo Lim · Hyeong Rok Kim · Young Jin Kim
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    ABSTRACT: Purpose The aim of this retrospective study was to evaluate the feasibility of single incision laparoscopic surgery (SILS), and to compare the short-term surgical outcomes with those of conventional laparoscopic surgery for colorectal cancer. Methods Forty-four patients who underwent SILS were compared with 263 patients who underwent conventional laparoscopic surgery for colorectal adenocarcinoma between November 2011 and September 2012. Results In the SILS group, eleven cases (25.0%) of right hemicolectomy, 15 (34.1%) anterior resections, and 18 (40.9%) low anterior resections were performed. Additional ports were required in 10 rectal patients during SILS operation. In the 32 patients with rectosigmoid and rectal cancer in the SILS group, patients with mid and lower rectal cancers had a tendency to require a longer operation time (168.2 minutes vs. 223.8 minutes, P = 0.002), additional ports or multiport conversion (P = 0.007), than those with rectosigmoid and upper rectal cancer. Both SILS and conventional groups had similar perioperative outcomes. Operation time was longer in the SILS group than in the conventional laparoscopic surgery group (185.0 minutes vs. 139.2 minutes, P < 0.001). More diverting stoma were performed in the SILS group (64.7% vs. 24.2%, P = 0.011). Multivariate analysis showed that tumor location in the rectum (95% confidence interval [CI], 1.858-10.560; P = 0.001), SILS (95% CI, 3.450-20.233; P < 0.001), diverting stoma (95% CI, 1.606-9.288; P = 0.003), and transfusion (95% CI, 1.092-7.854; P = 0.033) were independent risk factors for long operation time (>180 minutes). Conclusion SILS is a feasible, not inferior treatment option for colorectal cancer, and appears to have similar results as standard conventional multiport laparoscopic colectomy, despite the longer operative time.
    Preview · Article · Sep 2014 · Annals of Surgical Treatment and Research
  • Chang Hyun Kim · Jung Wook Huh · Hyeong Rok Kim · Young Jin Kim
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    ABSTRACT: Background: Chest computed tomographic (CT) scans frequently detect indeterminate pulmonary nodules (IPNs) in patients with colorectal cancer. The discovery of such nodules creates a clinical dilemma. Purpose: This study was performed to identify clinical characteristics of IPNs and develop a predictive model to predict the risk of progression to pulmonary metastases in patients with colorectal cancer. Methods: We analyzed data from a prospectively collected database involving 1195 patients with colorectal carcinoma who underwent curative surgery between January 2008 and June 2010. A predictive model was constructed on the basis of the probability risk score and validated in 115 patients collected from a separate treatment period. Results: Of the 1195 patients who underwent a baseline staging chest computed tomography, 326 (27.2%) had IPNs. During a median follow-up of 26.7 months (interquartile range: 18.0-37.2), 74 (28.1%) showed pulmonary metastases. Five variables maintained prognostic significance after multivariate analysis: metachronous nodule, bilateral involvement, positive perineural invasion, increased number of positive lymph nodes, and rectal location of cancer. The 2-year progression-free survival rates for the very low-, low-, intermediate-, and high-risk groups were 96%, 82%, 46%, and 16%, respectively (P < 0.001), with a concordance index of 0.81 (95% confidence interval, 0.75-0.86). This model was validated in a separate patient set (P < 0.001), with a C-index of 0.83 (95% confidence interval, 0.77-0.88). Conclusions: A predictive model for progression of IPNs may be clinically useful in discriminating patients who might benefit from an aggressive surveillance program and early pulmonary metastasectomies.
    No preview · Article · Aug 2014 · Annals of Surgery
  • Chang Hyun Kim · Jae Kyun Joo · Hyeong Rok Kim · Young Jin Kim
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    ABSTRACT: Background: Early postoperative small bowel obstruction is associated with considerable morbidity and mortality but has not been well documented in the era of laparoscopic surgery for colorectal cancer. Subjects and methods: Consecutive patients who had undergone laparoscopic resection for colorectal cancer were studied. Results: In total, 1787 patients (105 with and 1682 without early postoperative small bowel obstruction) with colorectal cancer requiring laparoscopic colorectal surgery were evaluated in this study. Ten patients (0.56% among the total patient population, 9.5% among patients who experienced early postoperative small bowel obstruction) who did not respond to conservative treatment for more than 14 days required surgical intervention. Multivariate analysis showed that male sex (adjusted odds ratio [AOR]=2.27), combined operation (AOR=2.23), and diverting stoma (AOR=4.79) were associated with a higher early postoperative small bowel obstruction rate. For factors related to surgical difficulty, open conversion (AOR=2.85), blood transfusion (AOR=3.51), and an operation time longer than 180 minutes (AOR=1.91) were independent factors associated with an increased early postoperative small bowel obstruction rate. Conclusions: Early postoperative small bowel obstruction following laparoscopic resection for colorectal cancer occurred in 5.9% of patients. Factors for predicting the development of early postoperative small bowel obstruction in patients with colorectal cancer are variables reflective of a more difficult surgery, rather than pathologic disease severity or anatomical location. In addition, most patients with early postoperative small bowel obstruction improved with conservative treatment, and surgical treatment was rarely needed.
    No preview · Article · Aug 2014 · Journal of Laparoendoscopic & Advanced Surgical Techniques
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    ABSTRACT: METHODOLOGY/AIMS: This study was conducted to compare the oncologic outcomes of transanal excision and radical resection in pathologic stage I rectal cancer. Ninety-six consecutive patients with stage I rectal cancer treated surgically between January 2000 and December 2009 were enrolled. Thirty-one patients underwent full-thickness transanal excision (TAE) and 65 patients underwent conventional radical resection (RR) (45 low anterior resections and 20 abdominoperineal resections). For all 96 study subjects, median follow up was 58.0 months. Patients in the TAE group had smaller tumors and less advanced preoperative stages than patients in the RR group. By multivariate analysis in all study subjects, the presence of lymphovascular invasion (P = 0.014) and a positive resection margin (P = 0.028) were significantly associated with local recurrence free survival, and lymphovascular invasion (P = 0.039) and a positive resection margin (P < 0.001) were significantly associated with disease free survival. In patients with pathologic stage I rectal cancer, lymphovascular invasion and a positive resection margin were found to be independent risk factors of recurrence. Furthermore, local excision was found to have an adverse effect on disease free survival rate as compared with radical surgery.
    No preview · Article · May 2014 · Hepato-gastroenterology
  • Chang Hyun Kim · Jung Wook Huh · Hyeong Rok Kim · Young Jin Kim
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    ABSTRACT: Lymph node metastasis is the most important prognostic indicator for colon cancer patients. We compared the prognostic significance of the number of lymph node metastases (LNN) and the distribution of lymph node metastases (LND). A total of 187 patients underwent curative resection for stage III right-sided colon cancer between 2000 and 2010. We evaluated the oncologic outcomes according to LNN (N1 1-3, N2 4-6, N3 >6) and LND (LND1 metastases in pericolic nodes, LND2 metastases along the major vessels, N3 metastases around the origin of a main artery). A Cox proportional hazards model, with backward stepwise analysis was used to determine the effects of covariates on 5-year, disease-free survival (DFS) and 5-year overall survival (OS). Akaike's information criterion (AIC), and Harrell's concordance index (C-index) were compared for each developed model. During the median follow-up of 42.2 months, 5-year DFS and OS were 68 and 79.3 %, respectively. Multivariate analysis showed that both LNN and LND3 were independent prognostic factor for both 5-year DFS and OS. However, the prognostic model incorporating number of LNM was more precise than that of LND, with a lower AIC (5-year DFS, 554.2 vs. 566.9; 5-year OS, 318.1 vs. 337.9) and higher C-index (5-year DFS, 0.706 vs. 0.667; 5-year OS, 0.778 vs. 0.743). Our results show that the staging system incorporating LNN predicted prognosis better than LND.
    No preview · Article · Dec 2013 · Annals of Surgical Oncology
  • Hun Jin Kim · Jung Wook Huh · Hyeong Rok Kim · Young Jin Kim
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    ABSTRACT: The oncologic impact of anastomotic leakage after rectal cancer surgery remains controversial. Between January 1999 and December 2010, 1,148 patients with rectal cancer who underwent curative surgery with sphincter preservation were retrospectively reviewed. Using the propensity score matching method, 328 patients with fibrin glue were matched to 328 patients without fibrin glue, and oncologic outcomes were compared in the matched groups. Anastomotic leakage was diagnosed in 76 patients (6.6%). On multivariate analysis, fibrin glue was the independent predictor of prevention of anastomotic leakage. In the 656 matched groups, patients with anastomotic leakage had significantly worse 5-year local recurrence-free survival and disease-free survival than those without leakage. Multivariate analysis confirmed that anastomotic leakage was an independent prognostic factor of both local recurrence and disease-free survival, but the use of fibrin glue was not associated with the long-term outcomes when controlling for confounders. Anastomotic leakage is a major independent prognostic factor for long-term outcomes. Fibrin glue has a protective effect of anastomosis, without oncologic advantages.
    No preview · Article · Nov 2013 · American journal of surgery
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    ABSTRACT: The aim of this study was to investigate the clinical outcomes after gamma knife surgery (GKS) or surgery as the first treatment for brain metastases in colorectal cancer (CRC). Of the 4350 patients diagnosed with CRC at our institution identified from 1987 to 2009, 27 patients who underwent GKS (GKS group) and 11 who underwent surgery (surgery group) were included. The oncologic outcomes were compared between the two groups. Local control was significantly better in the surgery group than in the GKS group (90% versus [vs.] 71.4%, respectively; p=0.006). The rate of symptom relief after 3months was significantly higher in the surgery group than in the GKS group (72.7 vs.18.5%, respectively; p=0.005). The median survival after GKS was 5.6months and surgery was 16.2months. In multivariate analysis, controlled primary tumor (p=0.038) and solitary metastasis (p=0.028) were correlated with prolonged overall survival, whereas surgery (p=0.034) was associated with longer local control. Surgery for brain metastasis from CRC is more advantageous in local control and neurologic symptom palliation than GSK. In multivariate analysis, overall survival was associated with controlled primary tumor and solitary metastasis.
    No preview · Article · Aug 2013 · Journal of Clinical Neuroscience