• Annals of Hepato-Biliary-Pancreatic Surgery
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• v.28 no.2
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• pp.155-160
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• 2024

Backgrounds/Aims: No reports to compare incisional hernia (IH) incidence between laparoscopic and open colorectal liver metastases (CRLM) resections have previously been made. This is the first comparative study. Methods: Single-center retrospective review of patients who underwent CRLM surgery between January 2011 and December 2018. IH relating to liver surgery was confirmed by computed tomography. Patients were divided into laparoscopic liver resection (LLR) and open liver resection (OLR) groups. Data collection included age, sex, presence of diabetes mellitus, steroid intake, history of previous hernia or liver resection, subcutaneous and peri-renal fat thickness, preoperative creatinine and albumin, American Society of Anesthesiologists (ASA) score, major liver resection, surgical site infection, synchronous presentation, and preoperative chemotherapy. Results: Two hundred and forty-seven patients were included with a mean follow-up period of 41 ± 29 months (mean ± standard deviation). Eighty seven (35%) patients had LLR and 160 patients had OLR. No significant difference in the incidence of IH between LLR and OLR was found at 1 and 3 years, respectively ([10%, 19%] vs. [10%, 19%], p = 0.95). On multivariate analysis, previous hernia history (hazard ratio [HR], 2.22; 95% confidence interval [CI], 1.56-4.86) and subcutaneous fat thickness (HR, 2.22; 95% CI, 1.19-4.13) were independent risk factors. Length of hospital stay was shorter in LLR (6 ± 4 days vs. 10 ± 8 days, p < 0.001), in comparison to OLR. Conclusions: In CRLM, no difference in the incidence of IH between LLR and OLR was found. Previous hernia and subcutaneous fat thickness were risk factors. Further studies are needed to assess modifiable risk factors to develop IH in LLR.

• Journal of Korea Association of Health Promotion
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• v.4 no.1
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• pp.49-59
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• 2006

"본 논문은 대한영상의학회지 2005년 제52권 제1호에 실렸던 논문으로 대한영상의학회의 승인을 득하고 본 협회지에 게재함. Purpose: We wished to compare CT colonography with conventional colonoscopy for the detection of colorectal poiypoid lesions, and we wanted to evaluate the role of IV contrast-enhanced CT colonography for the differentiation between benign polypoid lesions and malignant polypoid lesions. Materials and Methods: Thirty-four consecutive patients underwent CT colonography prior to conventional colonoscopy, Precontrast prone-position CT images and post contrast supine position CT images were obtained and the virtual colonoscopic images were reconstructed, Axial, sagittal and presence, size and morphologic features of colorectal polypoid lesions, and thor these findings were compared with the colonoscopic findings. The degree of enhancement of colorecralpolypoid lesions was measured by subtracting the attenuation valves obtained with precontrastand postcontrast CT images for the differentiation of benignity and malignancy of the colorectal polypoid lesions. Results. Among 75 colorectal polypoid lesions identified on conventional colonoscopy, 49neoplasms were found on CT coloaographv, and the overall detection rate was 65,3%.Detection rate of lesions smaller than l0mm was 52.1%(24/46), and the detection rate for lesions equal to or larger than 10mm was 86.2%(25/29), Morphologic features of the sessile type lesions on CT colonography were well correlated with those noted on colonoscopy, but the stalks were not identified in 6 of 13 polyps on CT colonography. There was no statistical correlation between benignity and malignancy and the degree of contrast enhancement on CT colonography, Conclusion CT colonography is a useful modality for the detection of colorectal polypoid lesionsequal to or polyps. However, CT colonography cannot differentiate benignity from malignancy.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.8
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• pp.4839-4842
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• 2013

Aims and Background: To improve understanding of the relationship between schistosome-related enteropathy and colorectal carcinoma with particular focus on endoscopic findings and clinicopathological characteristics of colonic schistosomiasis. Materials and Methods: All cases of intestinal schistosomiasis diagnosed at West China Hospital, Chengdu, China, between October 2006 and October 2012 were included in this study. A total of 179 cases of colonic schistosomiasis diagnosed through colonoscopy and pathological examinations were collected for analysis and the demographics, symptoms, endoscopic findings and clinicopathological characteristics were retrospectively evaluated. Results: Of the 179 colonic schistosomiasis patients, 32 combined with colorectal cancer (CRC) were found, between the ages of 44 and 85 years (24 males, 75%). These 32 lesions were classified as 12 endophytic/ulcerative (37.5%), 10 exophytic/fungating (31.2%), 4 annular (12.5%), 3 giant polypus (9.4%), and 3 IIc (superficial depressed type) (9.4%). The segments of rectum and sigmoid colon were involved in 19 patients (59.4%) and 6 patients (18.8%), respectively. The histopathologic types were classified as follows: 30 welldifferentiated adenocarcinomas, one mucinous adenocarcinoma and one poorly differentiated adenocarcinoma. The pathological findings suggest colorectal malignancy with deposited schistosome ova. Conclusions: Chronic schistosomal infestation has a probable etiological role in promoting genesis of colorectal neoplasms.

• Korean Journal of Clinical Oncology
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• v.14 no.2
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• pp.128-134
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• 2018

Purpose: Previous studies have addressed the role of the hypercoagulable state in the pathogenesis of cancer progression and metastasis. In this study, we investigated the association between coagulation factors, including tissue factor (TF) expression, platelet count, and fibrinogen level, and disease recurrence in patients with non-metastatic colorectal cancer. Methods: Patients who underwent curative resection for stage II or III colorectal cancer between 2000 and 2007 were included in this study. Data from a prospectively maintained database were retrospectively reviewed. TF expression was determined by immunohistochemistry using an anti-TF monoclonal antibody. The Kaplan-Meier method was used to estimate 5-year disease-free survival. Results: TF was highly expressed in 257 of 297 patients (86.5%). TF expression was not significantly associated with the platelet counts (P=0.180) or fibrinogen level (P=0.281). The 5-year disease-free survival rate was lower in patients with high TF expression than in patients with low TF expression (72.3% vs. 83.9%, P=0.074). In Cox hazard analysis, high TF expression was an independent risk factor for tumor recurrence (hazard ratio [HR] 2.446; 95% confidence interval [CI], 1.054-5.674; P=0.037). Undifferentiated histologic type (HR, 2.911; 95% CI, 1.308-6.481; P=0.009), venous invasion (HR, 2.784; 95% CI, 1.431-5.417; P=0.003), and lymph node metastasis (HR, 2.497; 95% CI, 1.499-4.158; P<0.001), were also significantly associated with disease recurrence. Conclusion: TF expression is associated with a recurrence in patients with non-metastatic colorectal cancer. However, further studies are required to clarify the underlying mechanisms relating TF expression with oncologic outcomes and its potential role as a therapeutic target.

• Journal of Digestive Cancer Research
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• v.11 no.1
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• pp.49-54
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• 2023

Colorectal cancers often invade adjacent organs; however, direct duodenal invasion is rare. Adenocarcinoma is the most common type of colorectal cancer, but an undifferentiated carcinoma type is unusual. Herein, we present a case of undifferentiated carcinoma of the colon that directly invaded the duodenum and metastasized to distant lymph nodes. An 85-year-old female patient was admitted with a 7-cm-sized colonic mass invading the duodenum, detected by computed tomography. Positron emission tomography revealed fluorodeoxyglucose uptake in the colon, duodenum, and aortocaval lymph nodes. A large encircling mass in the ascending colon and an ulcerated mass in the duodenum were revealed by colonoscopy and esophagogastroduodenoscopy, respectively. Pathologic examinations of the colon and the duodenum revealed nonglandular, diffusely infiltrating atypical round cells, confirming undifferentiated carcinoma of the colon. The histologic type of this tumor was distinguished using immunohistochemical (IHC) markers. Finally, microscopic characteristics and IHC markers aided in identifying the histologic type of colorectal cancer.

• Journal of Digestive Cancer Research
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• v.10 no.2
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• pp.65-73
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• 2022

A breakthrough in immunotherapy has changed the outlook for metastatic colorectal cancer (mCRC) treatment as the immune surveillance evasion mechanism of tumor cells has been continuously elucidated. Immune checkpoint inhibitors (ICI), such as pembrolizumab, nivolumab, and ipilimumab, which block immune checkpoint receptors or ligands have been approved for the treatment of mismatch repair deficient (dMMR)/microsatellite instability-high (MSI-H) mCRC based on numerous clinical studies. However, 50% of dMMR/MSI-H mCRC and most mismatch repair proficient/microsatellite stable mCRC remained unresponsive to current immunotherapy. Clinical trials on combination therapy that adds various treatments, such as target agents, chemotherapy, or radiation therapy to ICI, have been actively conducted to overcome this immunotherapy limitation. Further studies on safety and efficacy are needed although several trials presented promising data. Additionally, dMMR/MSI-H, tumor mutation burden, and programmed cell death ligand-1 expression have been studied as biomarkers for predicting the treatment response to immunotherapy, but the discovery and validation of more sensitively predictable biomarkers remained necessary. Thus, this study aimed to review recent studies on immunotherapy in mCRC, summarize the efficacy and limitation of immunotherapy, and describe the biomarkers that predict treatment response.

• Journal of Digestive Cancer Research
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• v.11 no.2
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• pp.85-92
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• 2023

Colorectal cancer (CRC) is one of the most prevalent cancers and is the leading cause of cancer-related mortality worldwide. Based on the current screening guidelines by the American Cancer Society and Korean multi-society expert committee, CRC screening is recommended in asymptomatic adults starting at the age of 45 years. Fecal immunochemical test-based screening programs reduce the development of CRC and related mortality in the general population. However, this most popular CRC screening strategy demonstrates a crucial limitation due to modest diagnostic accuracy. Colonoscopy may be considered as an alternative primary method for CRC screening; however, its implementation can still be challenging due to concerns regarding invasiveness, low adherence, cost-effectiveness, and quality assurance. To overcome the limitations of current screening tests, innovative noninvasive tests for CRC screening have been developed with advances in molecular biology, genetics, epigenetics, and microbiomics for detecting CRC, which may enhance the approach to CRC screening and diagnosis in clinical practice in the near future. This review explores the emerging screening methods and discusses their potential for integration into current practice.

• Journal of Preventive Medicine and Public Health
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• v.51 no.6
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• pp.281-288
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• 2018

Objectives: We investigated the association between cholecystectomy or appendectomy and the subsequent risk of colorectal cancer (CRC) in the Korean population. Methods: A retrospective cohort study was conducted with the National Health Insurance Service-National Sample Cohort of Korea; this sample was followed up from January 1, 2002, until the date of CRC incidence, loss to follow-up, or December 31, 2015. The exposure status of cholecystectomy and appendectomy was treated as a time-varying covariate. The calculated risk of CRC was stratified by follow-up period, and the association between these surgical procedures and CRC was investigated by a Cox regression model applying appropriate lag periods. Results: A total of 707 663 individuals were identified for analysis. The study population was followed up for an average of 13.66 years, and 4324 CRC cases were identified. The hazard ratio (HR) of CRC was elevated in the first year after cholecystectomy (HR, 1.71; 95% confidence interval [CI], 1.01 to 2.89) and in the first year and 2-3 years after appendectomy (HR, 4.22; 95% CI, 2.87 to 6.20; HR, 2.34; 95% CI, 1.36 to 4.03, respectively). The HRs of CRC after applying 1 year of lag after cholecystectomy and 3 years of lag after appendectomy were 0.80 (95% CI, 0.57 to 1.13) and 0.77 (95% CI, 0.51 to 1.16), respectively. Conclusions: The risk of CRC increased in the first year after cholecystectomy and appendectomy, implying the possibility of bias. When appropriate lag periods after surgery were applied, no association was found between cholecystectomy or appendectomy and CRC.

• Journal of Chest Surgery
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• v.55 no.1
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• pp.37-43
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• 2022

Background: The surgical strategy for single-stage resection of primary colorectal cancer (CRC) and synchronous pulmonary metastases remains a matter of debate. Methods: Perioperative data of patients who underwent single-stage resection of primary CRC and synchronous pulmonary metastases were compared to those of patients who underwent 2-stage resections. The demographic data, number of metastases, type of pulmonary and colorectal resections, operation time, blood loss, postoperative complications, morbidities, mortality, medical costs, and length of hospital stay were analyzed. Results: Twenty-two patients underwent single-stage resection of primary CRC and pulmonary metastases, while 27 patients underwent 2-stage resection. Tumor size and the number of pulmonary metastases were not significantly different between the 2 groups. The extent of pulmonary metastasectomy and abdominal procedures were similar in both groups, as was the thoracic surgical approach (video-assisted thoracic surgery vs. thoracotomy). However, open laparotomy was performed more frequently in the 2-stage group than in the single-stage group (p=0.045), which also had a longer total anesthetic time (p=0.013). The operation time, medical costs, estimated blood loss, complication rates, and severity were similar in both groups, but the length of hospital stay was shorter in the single-stage group (p<0.001). Conclusion: Single-stage colorectal and pulmonary resection shortened the overall hospital stay, with no significant changes in operation time, medical costs, hospital mortality, and morbidity. Therefore, single-stage resection could be a good surgical strategy in selected patients.

• Clinical Endoscopy
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• v.56 no.6
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• pp.778-789
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• 2023

Background/Aims: Hybrid endoscopic submucosal dissection (ESD), in which an incision is made around a lesion and snaring is performed after submucosal dissection, has some advantages in colorectal surgery, including shorter procedure time and preventing perforation. However, its value for rescue resection in difficult colorectal ESD cases remains unclear. This study evaluated the utility of rescue hybrid ESD (RH-ESD). Methods: We divided 364 colorectal ESD procedures into the conventional ESD group (C-ESD, n=260), scheduled hybrid ESD group (SH-ESD, n=69), and RH-ESD group (n=35) and compared their clinical outcomes. Results: Resection time was significantly shorter in the following order: RH-ESD (149 [90-197] minutes) >C-ESD (90 [60-140] minutes) >SH-ESD (52 [29-80] minutes). The en bloc resection rate increased significantly in the following order: RH-ESD (48.6%), SH-ESD (78.3%), and C-ESD (97.7%). An analysis of factors related to piecemeal resection of RH-ESD revealed that the submucosal dissection rate was significantly lower in the piecemeal resection group (25% [20%-30%]) than in the en bloc resection group (40% [20%-60%]). Conclusions: RH-ESD was ineffective in terms of curative resection because of the low en bloc resection rate, but was useful for avoiding surgery.