Annals of Coloproctology

Volume 18(5); October 2002

Original Articles

Transanal Posterior Anorectoplasty of Rectal Prolapse.: Kim, Jong Duck , Ye, Byung Kuk , Jo, Hong Jae , Oh, Nahm Gun; J Korean Soc Coloproctol. 2002;18(5):269-273.

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Abstract PDF: PURPOSE
Many different procedures for rectal prolapse have been described, but optional surgical treatment remains controversial. The aim of this report is to introduce an innovative and effective method of surgical treatment to restore anal continence and anatomic correction of rectal prolapse.
METHODS
Data were retrospectively collected and analyzed on 11 patients (7 male and 4 female) who underwent transanal posterior anorectoplasty for complete rectal prolapse between Jan. 1995 to Dec. 2000. This procedure is summarized to five steps as follows: 1. Partial resection of posterior rectal ampulla. 2. Longitudinal plication with posterior fixation. 3. Posterior levatorplasty. 4. One layer suture as longitudinal fashion. 5. Gant-Miwa operation-like procedure on anterior rectum.
RESULTS
There were no cases of postoperative infection and bleeding. There were no cases of recurrence of the rectal prolapse except 1 case of ant. mucosal prolapse which was successfully treated with one more Gant-Miwa operation-like procedure at postoperative 3 months. Fecal incontinence were in two cases at postoperative 12 months which were estimated as grade 2 by assessment of bowel function by Kirwan.
CONCLUSIONS
Although, the best operation for rectal prolapse remains controversial subject, authors believe that transanal posterior anorectoplasty should be considered as effective new surgical procedure for the treatment of rectal prolapse.

Clinical Analysis of Acute Appendicitis in the Elderly.: An, Sang Su , Soh, Yoon Seop , Cho, Ik Haeng , Back, Hyeon Myeong , Lee, Seong Yeol; J Korean Soc Coloproctol. 2002;18(5):274-280.

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Abstract PDF: PURPOSE
Surgeons are confronted frequently with the diagnostic and therapeutic challenges in the cases of acute appendicitis in the elderly. Despite the improvements in management, the morbidity and mortality remain high. In order to verify contributing factors of high morbidity and mortality and establish more proper diagnostic and therapeutic strategies, we compared the clinical characteristics and outcomes of acute appendicitis in the elderly with those of younger people.
METHODS
We retrospectively reviewed medical records of 30 elderly and 248 younger people who were pathologically diagnosed as appendicitis after an appendectomy.
RESULTS
There was no difference in the rates of occurrence of right lower abdominal pain and tenderness between the two people. The rate of appendiceal perforation was significantly higher in the elderly. Prehospital delay was significantly longer in the elderly. Concomitant diseases were more prevalent in the elderly. The hospital stay was significantly longer and the rate of complication was relatively higher in the elderly also.
CONCLUSIONS
When a vague and unexplained abdominal discomfort occurs in the elderly, we should suspect and rule out acute appendicitis as the cause of the discomfort. Early aggressive diagnostic and therapeutic interventions are essential components in managing acute appendicitis in the elderly. In addition, perioperative evaluation and prophylactic measures for concomitant diseases are needed to decrease morbidity and mortality in the elderly.

The Causes and Clinical Significance of Hyperamylasemia Following Colorectal Surgery.: Chun, Kwang Sik , Yoon, Wan Hee; J Korean Soc Coloproctol. 2002;18(5):281-286.

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Abstract PDF: PURPOSE
Postoperative hyperamylasemia and pancreatitis may sometimes follow abdominal surgery but the significance and cause of hyperamylasemia after colorectal surgery were not studied enoughly. Our study was designed to identify the incidence of hyperamylasemia after colorectal surgery, to investigate the effect of hyperamylasemia on postoperative hospital course, and to clarify the causes such as extent of colorectal resection or intraoperative events.
METHODS
The serum amylase was determined in post operative first day in random sampled 72 patient among whom underwent elective colorectal resection from March 2000 to July 2001. If a hyperamylasemia was evident, repeated check the level till it returned to within normal range. Other factors that seemed to affect serum amylase such as traction of pancreas during operative manupulation, intraoperative hypotensive episode or infused drug and volume expanders etc. were reviewed and analysed.
RESULTS
Hyperamylasemia occurred in 25 patients (34.7%) after colorectal surgery. Serum amylse level returned to normal in all but nine patients (12.4%) by third postoperative day, two patients (2.8%) by the fifth postoperative day. Pancreas manupulation and intraoperative use of volume expander, amylopectin were found to be significantly associated with postoperative hyperamylasemia by 2-test and pearson correlation analysis. The developement of hyperamylasemia did not adversely influence the postoperative hospital course.
CONCLUSIONS
Twenty-five (34.7%) in seventy-two patients who underwent colorectal surgery developed hyperamylasemia after operation. The incidence was significantly high in a group who underwent surgical procedure with more pancreas manupulation and infused hydroxyethyl starch (amylopectin) containing volume expander. The development of postoperative hyperamylasemia did not seem to influence adversely the postoperative hospital course in this study.

Assessment of Sexual and Voiding Function after Total Mesorectal Excision with Pelvic Autonomic Nerve Preservation in Male Rectal Cancer Patients.: Kim, Nam Kyu , Aahn, Tae Wan , Park, Jea Kun , Lee, Kang Young , Lee, Wong Hee , Sohn, Seung Kook , Min, Jin Sik; J Korean Soc Coloproctol. 2002;18(5):287-293.

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Abstract PDF: PURPOSE
The aim of this study was to assess the safety of TME with pelvic autonomic nerve preservation in male rectal cancer patients in terms of voiding and sexual function.
METHODS
We performed uroflowmetry using Urodyn (Dantec, Denmark) and a standard questionnaire employing the IIEF (International Index of Erectile Function) and the IPSS (International Prostate Symptom Score) pre- and postoperatively in 68 male rectal cancer patients.
RESULTS
There were significant differences of mean maximal flow rate and voided volume before and after surgery (18.9+/-5.7 vs 13.7+/-7.0, 240+/-91.9 vs 143+/-78, P<0.05, P<0.05), respectively. But, there was no difference of residual volume before and after surgery (4.4 2.6 vs 8.1 4.4, P>0.05). The total IPSS (International Prostate Symptom Score) was increased after surgery from 6.2+/-5.8 to 9.8+/-5.9 (P<0.05). There were no changes of score for one of each seven IPSS items in from 49 patients (73.5 percent) to 61 patients (89.7 percent). Five IIEF (International Index of Erectile Function) domain score (erectile function, intercourse satisfaction, orgasmic function, sexual desire and overall satisfaction) was statistically decreased after surgery (18.2+/-9.3 vs 13.5+/-9.0, 8.4+/-4.2 vs. 4.4+/-2.9, 5.8+/-2.9, vs. 4.4+/-2.9, 6.1+/-2.4 vs. 4.8+/-2.0, 6.1+/-2.2 vs. 4.5+/-2.3, P<0.05, respectively. Erection was possible in 55 patients (80.9 percent), but penetration ability was possible in 51 patients (75 percent). Complete inability for erection and intercourse was observed in 3 patients (5.5 percent). Retrograde ejaculation was noted in 9 patients (13.2 percent). IIEF domains such as sexual desire and overall satisfaction were markedly decreased in 39 patients (57.4 percent), 43 patients (63.2 percent), respectively. Multiple regression analysis of factors affecting postoperative sexual dysfunction showed that over 60 years (sexual desire: P=0.019), within 6 months (erectile function: P=0.04, intercourse satisfaction: P=0.011, orgasmic function: P=0.03), lower rectal cancer (erectile function: P=0.02, intercourse satisfaction: P=0.036, orgasmic function: P=0.027) were significant factors.
CONCLUSIONS
TME with pelvic autonomic nerve preservation technique showed a safety and comparable data in preserving sexual and voiding function. The IPSS and IIEF questionnaire were useful and more investigative in assessing urinary and sexual function.

Treatment Outcome in Patients with Pediatric Encopresis.: Kim, Jeong Eun , Chung, Soon Sup , Park, Ung Chae; J Korean Soc Coloproctol. 2002;18(5):294-299.

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Abstract PDF: PURPOSE
The causes of encopresis are complex and multifactorial. Through application of new sophisticated techniques and armamentarium, it has been possible to find more specific aspects of the anorectal function in pediatric patients with refractory defecation disorders. However, quality research of which therapeutic option could be suitable, is still lacking. The current study was designed to assess outcome of treatment according to the treatment algorithm based on the clinical and physiologic findings.
METHODS
22 patients (15 boys, 7 girls) with encopresis were analyzed, retrospectively. For exclusion of the organic cause, barium contrast study and anoscopy were carried out in all cases. Patients were categorized and made treatment algorithm by using leading symptoms and findings of anorectal physiologic tests. Treatment outcomes were analysed in the basis of respective therapeutic options.
RESULTS
Patients were categorized as constipation dominant group (n=15) and incontinence dominant group (n=7). Suggested etipathogeneses were as follows; fecal impaction and/or motility disorder (n=7), overflow incontinence (n=6), sensory defect of the rectum (n=4), puborectalis incoordination (n=3), anal hypertonia (n=2). Treatment options were as follows; conventional therapy (CT) only (n=7), CT plus biofeedback (n=9), CT plus balloon sensory retraining (n=4), and CT plus internal sphincterotomy or Nitroglycerine application (n=2). All patients were undertaken a toilet training and psychologic consultation. Regarding to the therapeutic outcome, 19 (86 percent) of overall 22 patients were improved in the mean period of 2.5 (range, 0.1-7) years follow-up.
CONCLUSIONS
If therapy could be undertaken according to the optional algorithm based on the clinical and physiologic findings, it could be useful guide for clinical decision making to help the therapy. Moreover, through the combination therapy including medication, psychological consultation, and biofeedback treatment, encopretic children achieve acceptable outcome with a long-term compliance.

Clinical Results of Coloanal Anastomosis in Radiation-induced Rectovaginal Fistula.: Lee, Il Kyun , Hah, Hyun Su , Sohn, Seung Kook , Lee, Kang Young , Kim, Nam Kyu; J Korean Soc Coloproctol. 2002;18(5):300-304.

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Abstract PDF: PURPOSE
Generally speaking, permanent colostomy has been frequently used as a treatment for radiation-induced rectovaginal fistula. In order to administer an operation accurately, at least two-staged operations have been performed. If anastomosis were to be performed between normal, healthy tissues after removal of irradiation-damaged tissues definite operation could be performed in one stage. We reviewed clinical records to evaluate postoperative recurrence and anal functions in patients who underwent coloanal anastomosis without diverting colostomy as one step due to radiation-induced rectovaginal fistula.
METHOD
From Sep. 1994 to Jun. 2000 we did a retrospective study with clinical data of 8 patients who underwent operations due to radiation-induced rectovaginal fistula in Yongdong Severance Hospital.
RESULTS
The mean age was 49 years (range 31-61). All patients concurrently received irradiation and induction chemotherapy due to primary, gynecologic malignancies. The total dosage of exposure to radiation was 8,400 cGy in 6 of 8 cases and 8,940 cGy in the remaining 2 cases. TAH with BSO had been undergone before concurrent chemoradiation in 2 cases. The median duration from diagnosis to operation was 29 months (range 16-131) in cases without previous colostomy (n=7) and 7 months in cases with colostom y (n=1). Before the operation, previous surgery had been undergone in 2 cases due to rectovaginal fistula. No recurrences were noted for gynecologic malignancies. The mean distance of fistula opening from anal verge was 3.9 cm (range 2.0-7.0). For 7 out of 8 cases, patients underwent LAR with handsewn coloanal anstomosis and the remaining patient underwent anterior resection. No diverting colostomy was performed for all cases. During the median follow-up period of 25 months (range 7-71), two patients developed anal stenosis. One patient experienced postoperative recurrence for the follow-up period. In terms of sphincter function (n=6) (f/u period>12 months), there were 1 urgency, 1 gas incontinence and 1 night staining.
CONCLUSIONS
Although this study is a small scale research in terms of the number of subjects involved, one-staged, handsewn coloanal anastomosis after LAR without colostomy may be proved to be helpful for the patients with radiation-induced rectovaginal fistula. If case selection performed properly, unnecessary operation can be avoided and psychologic resistance can be reduced by this procedure.

Local Excision for Rectal Cancer.: NamGung, Hwan , Yu, Chang Sik , Kim, Hee Cheol , Cho, Young Kyu , Ryu, Jang Hak , Cho, Moon Kyung , Kim, Jin Cheon; J Korean Soc Coloproctol. 2002;18(5):305-310.

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Abstract PDF: PURPOSE
Local excision of early rectal cancers with favorable histologic features can provide comparable survival rate to radical surgery with minimal morbidity and mortality, showing excellent functional results. But, still worried about high local recurrence rate and poor survival rates for local excision. This study was performed to investigate complications and evaluate oncological out comes after local excision for rectal cancers.
METHODS
We evaluated 80 cases underwent local excision among 1681 patients with rectal cancer between January 1989 and December 2000. The mean age was 58+/-11 years and median follow up period was 24 (range: 1-82) months. Type of surgery for early rectal cancer were transanal excision in 51 cases (63.8%), transsphincteric approach in 12 cases (15%) and endoscopic submucosal resection alone in 17 cases (21.2%).
RESULTS
The distance from the anal verge was 5.9+/-2.6 cm and the mean tumor size was 2.5+/-2.0 cm. Pathological depth of invasion revealed 52 Tis, 21 T1, 6 T2, and 1 T3 tumors. Cellular differentiation was well-differentiated tumor in 73% and moderately-differentiated in 27%. On histologic examination, 65% of them comprised underlying adenoma component. Leakage from the closure site was observed in two cases of transsphincteric approach. One case required abdominoperineal resection and the other was managed by temporary colostomy. Adjuvant chemoradiation was performed in 10 cases: one Tis with positive resection margin, 6 deep T1, and 3 T2 tumors. Five tumors was salvaged by immediate surgery: one T1 with positive resection margin, 3 T2 with positive resection margin, and 1 T3. During the follow up period, one local recurrence was developed after 25 months of surgery and salvaged by low anterior resection.
CONCLUSION
Local excision for rectal cancer can be performed safely in strictly selected patients and meticulous surgical technique according to tumor location is mandatory to reduce postoperative complications.

Correlation of beta-catenin and p53 Protein Expression with Clinico-pathologic Characteristics of Colorectal Cancer.: Moon, Kil Min , Park, Young Jin , Kim, Han Seung , Park, Seung Hae , Kim, Ji Il , Kim, Ki Hong , Song, Byung Joo , Lee, Meung Soo , Kim, Chul Nam , Chang, Seok Hyo; J Korean Soc Coloproctol. 2002;18(5):311-316.

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Abstract PDF: PURPOSE
Both the beta-catenin and p53 play a crucial role in the process of colon carcinogenesis. The expression of beta-catenin and/or p53 has been reported to be associated with pathologic features of tumor and prognosis of patients. In addition, several recent studies have suggested a close biological association between p53 expression and nuclear beta-catenin level. We analyzed the pathologic variables and p53 expression according to the intra-nuclear beta-catenin expression in colon cancer to make such assumptions more clear since they are still controversial issues.
METHODS
The expressions of beta-catenin, p53 and Ki-67 protein in colon cancer were determined by immunohistochemical staining. The relationship between these protein expressions and tumor characteristics was statistically analyzed.
RESULTS
The intra-nuclear beta-catenin accumulation was not associated with any of the pathological variables including lymph node metastasis and tumor differentiation, but it was correlated with higher level of Ki-67 proliferation index (P=0.006) and negative staining of p53 (P=0.015). Positive p53 staining was significantly associated with lymph node metastasis (P=0.006), lymphatic invasion (P=0.03) and venous invasion (P=0.02).
CONCLUSION
These results support the suggestion that intra-nuclear accumulation of beta-catenin may regulate the p53 activity in colorectal cancer. In addition, positive staining of p53 may be used as a valuable prognostic indicator since it was strongly associated with lymph node metastasis, lymphatic and venous invasion.

The Prognostic Significance of Immunohistochemically Detected Isolated Tumor Cells in Lymph Node in Colorectal Cancer.: Lee, Jin Seok , Lim, Jung Woo , Choi, Sang Kyung , Chung, Eun Jung , Lee, Young Joon , Hong, Soon Chan , Kwon, Soo In , Park, Soon Tae , Ha, Woo Song; J Korean Soc Coloproctol. 2002;18(5):317-323.

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Abstract PDF: PURPOSE
Metastasis of a colorectal carcinoma to regional lymph nodes indicates poor prognosis. The detection of lymph node metastasis is routinely performed by his topathological analysis of hematoxylin-eosin (H&E) stained sections. However the routine histological technique may fail to detect isolated tumor cells in lymph nodes. The aims of this study are to elucidate the prognostic significance of the presence of isolated tumor cells in the regional lymph nodes in colorectal cancer, and to elucidate the correlation between the presence of isolated tumor cells and p53 protein expression in the primary colorectal cancer tissue.
METHODS
We used immunohistochemical staining with anti-cytokeratin antibody to examine 452 lymph nodes in 24 patients (11 recurrent and 13 nonrecurrent) who were histologically determined Astler-Coller B. And we used immunohistochemical staining with p53 protein to examine primary colorectal cancer tissues of the patients.
RESULTS
Immunohistochemical staining of cytokeratin revealed the presence of isolated tumor cells in 5/13 patients (38.5%), 5/214 lymph nodes (2.34%) in the nonrecurrent group and 6/11 patients (54.6%), 11/244 lymph nodes (4.51%) in the recurrent group, respectively. The detection rate of isolated tumor cells in the recurrent group was slightly higher than nonrecurrent group, but the difference was not significant statistically. The expression rate of p53 protein was 23.1% (3/13) in the nonrecurrent group and 36.4% (4/11) in the recurrent group, respectively. The expression rate of the p53 protein was not significantly correlated with the presence of isolated tumor cells in regional lymph nodes and the rate of tumor recurrence.
CONCLUSIONS
The presence of isolated tumor cells in regional lymph nodes was not a prognostic indicator in predicting recurrence in histologically determined Astler- Collar B colorectal cancer patients.

Clinical Significance of Preoperative High Serum CEA Value in Patients with Colorectal Cancer.: Kim, Keon Kug , Yu, Chang Sik , Cho, Young Kyu , Namgung, Hwan , Kim, Hee Cheol , Kim, Jin Cheon; J Korean Soc Coloproctol. 2002;18(5):324-329.

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Abstract PDF: PURPOSE
The preoperative s-CEA level are correlated to the extent of the tumor and distant metastasis in patients with colorectal cancer. This study was performed to analyze patterns of distant metastasis and survival rate according to the levels of preoperative s-CEA and evaluate the significance of chest CT and bone scan as methods of preoperative staging work-up in patients with high s-CEA level (>or=20 ng/ml).
METHODS
A retrospective study was performed on 1,136 colorectal cancer patients who underwent surgery in Asan medical center between 1989 and 1995. These patients were classified into 3 groups according to preoperative s-CEA level (group A: <6; group B: >or=6,<20; group C: >or=20). We scrutinized the patterns of metastasis and compared the survival rates between the groups. Another study was, then, conducted prospectively on the basis of the above results. One hundred and sixty nine patients with s-CEA level (>or=20 ng/ml) were routinely examined by chest CT and bone scan for preoperative metastatic work-up in addition to the conventional work-up. Statistical analysis was performed by chi-squared test, Kaplan-Meier and log-rank test.
RESULTS
The preoperative s-CEA level and the tumor stages were significantly correlated (P=0.009). The distant metastasis rates in group A, B, and C were 22.7% (163/719), 49.1% (115/234), 76.5% (140/183), respectively (P=0.000). Five year survival rate of each group were significantly different in far advanced stage, stage III (0.71 vs. 0.61 vs. 0.51 : P=0.002) and stage IV (0.21 vs. 0.10 vs. 0.05 : P=0.004). In stage I and II, however, we couldn't find statistical differences. Among 169 patients with s-CEA level above 20ng/ml, 52 (30.7%) had liver metastasis. Twenty three patients (13.6%) had lung metastasis. Twenty (11.8%) cases of pulmonary metastasis were found on chest CT scan and 3 cases on chest X-ray or abdominal CT scan. Only 4 (2.4%) cases, however, had bone metastasis on bone scan.
CONCLUSIONS
These results suggest that the high preoperative s-CEA level seemed to be closely correlated with distant metastasis and prognosis. A meticulous preoperative staging work-up including chest CT scan is recommended in patients with high preoperative s-CEA level.

The Clinical Significance of Carcinoembryonic Antigen and CA72-4 Assays of Peritoneal Fluid in Colorectal Carcinomas.: Park, Jong Dae , Kim, Hee Cheol , Cho, Young Kyu , Yu, Chang Sik , Kim, Jin Cheon; J Korean Soc Coloproctol. 2002;18(5):330-336.

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Abstract PDF: PURPOSE
CEA and CA72-4 assays in peritoneal fluid offers the greatest advantage in increasing the sensitivity of cytologic diagnosis of carcinomas of the G-I tract. Actually, little investigations have been taken for the relations between CEA and CA72-4 levels in peritoneal fluid and the clinicopathologic characteristics of colorectal carcinomas. The intent of this study was to verify the usefulness of CEA and CA72-4 levels in peritoneal fluid for the treatment of colorectal carcinoma.
METHODS
Seventy-three colorectal cancer patients who were hospitalized in our colorectal division were prospectively investigated. Thirty-five out of 73 patients had ascites. Preoperatively, the levels of serum CEA and CA72-4 were measured. At the time of laparotomy, ascites or peritoneal washings were collected from all patients and the levels of carcinoembryonic antigen and CA72-4 were measured and submitted for the analysis to the cytology laboratory. We analyzed the results with the levels of serum CEA and CA72-4, histologic differentiation, location, stage of the tumor, and obstruction due to tumor.
RESULTS
The levels of serum CEA and CA72-4 were significantly correlated with those of peritoneal fluid. The elevated levels of CEA and CA72-4 of peritoneal fluid were also significantly correlated with advanced stages of colorectal carcinomas, respectively. But according to histologic differentiation, only CA72-4 levels of peritoneal fluid were elevated in poorly differentiated or mucinous carcinoma. No difference between the levels of CEA and CA72-4 of peritoneal fluid was present in accordance with the location of tumors.
CONCLUSIONS
The measurement of CEA and CA72-4 of peritoneal fluid may be valuable method in discriminating between the early-stage versus the late-stage colorectal carcinoma.

Malignant Tumors of the Anus: Spectrum of Disease, Treatment and Outcomes.: Huh, Kyu Ha , Lee, Kang Young , Ha, Hyun Soo , Park, Jae Kun , Kim, Nam Kyu , Sohn, Seung Kook , Min, Jin Sik; J Korean Soc Coloproctol. 2002;18(5):337-342.

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Abstract PDF: PURPOSE
This retrospective study was performed to evaluate clinicopathologic findings, outcomes according to the treatment modality, and prognostic factors in anal cancer.
METHODS
Among the 64 patients who were diagnosed as anal cancer at our department from September 1986 to December 1999, 55 patients were analysed retrospectively. Nine patients who refused the treatment or whose medical record could not be retrieved were excluded. Concurrent chemoradiotherapy was performed for twenty-seven patients with squamous cell carcinoma. The chemotherapy with 5-FU and cisplatin and the radiotherapy were started at the same time. 750 mg/m2/day of 5-FU was infused intravenously for 5 days and 100 mg/m2 of cisplatin was started on the second day of therapy. The second cycle chemotherapy was given for 5 days before the radiotherapy was completed. A dose of 5,400cGy was given to the primary lesion and whole pelvis including inguinal area. Eight patients with squamous cell carcinoma were treated by surgery including abdominoperineal resection, local excision, or wide excision. Abdominoperineal resection was the primary treatment modality for melanoma of anus.
RESULTS
Among 55 patients with anal cancer, the dominant histologic type was squamous carcinoma (n=35), followed by cloacogenic carcinoma (n=6) and melanoma (n=6). The clinical stages by AJCC were classified as stage I: 4 cases, stage II: 15 cases, stage III: 29 cases, stage IV: 7 cases. The overall 5-year survival rate of anal cancer was 60%. The 5-year survival rate in squamous carcinoma was 79.9% for the concurrent chemoradiotherapy group (n=27) and 54.7% for the surgical resection group (n=8), which was statistically insignificant. Variables affecting the survival rate with statistical significance were age, the initial tumor size, and the state of lymph node and distant metastasis.
CONCLUSIONS
The concurrent chemoradiotherapy for patients with squamous cell carcinoma of the anus offered the same outcomes equivalent to surgical modality and preserved anal sphincter function. Melanoma of the anus exhibited poor prognosis and more systemic recurrence regardless of treatment modality. On univariate analysis for risk factors, age, tumor size, and lymph node and distant metastasis had statistical significance.

Clinicopathological Characteristics of Multiple Primary Colorectal Cancer.: Kim, Yong Jin , Kim, Nam Kyu , Lee, Kang Young , Sohn, Seung Kook , Min, Jin Sik; J Korean Soc Coloproctol. 2002;18(5):343-348.

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Abstract PDF: PURPOSE
Through studying the clinical manifestation and prognosis of multiple colorectal cancer in comparison to those of solitary primary colorectal cancer, we expect this study to help establish a strategy for the diagnosis and treatment of it.
METHODS
2,302 patients with colorectal cancer, operated at the department of surgery, Yonsei university college of medicine, between Jan. 1989 and Dec. 1999 were evaluated for multiple colorectal cancer. Synchronous cancer was defined as distinct lesions separated by a distance of greater than 4 cm with the invasion of the tumor below the muscularis mucosa at the time of diagnosis. Metachronous cancer was defined as the development of colon cancer more than 6 months after the initial treatment without evidence of recurrence or metastasis from the primary tumor.
RESULTS
The incidence of multiple cancer was 2.1% (49 patients). Among them, 1.8% were synchronous and 0.3% were metachronous. The average age was 59.7 years old, similar to the solitary colorectal cancer group whose mean age was 57.1 years old. The median follow up period was 44 months and average follow up period was 53 months. The frequency of cancer increased as it got closer to the rectum. The most frequent location was the rectum (43%) and the sigmoid colon (24%). The average time interval until the development of metachronous cancer was 46 months after initial operation. Adenomatous polyps were identified in 11 patients (43%) out of 49 patients with multiple colorectal cancer, whereas 538 patients (24%) out of 2,253 patients with solitary colorectal cancer were discovered with ademomatous polyps. The survival rate of multiple colorectal cancer was 59%, lower than that of solitary colorectal cancer (64%). But the difference was not statistically significant (P>0.05).
CONCLUSIONS
The diagnosis of multiple colorectal cancer is very important in view of curative radical surgery and prognosis. This emphasizes the need for detection of early stage cancer by developing genetic markers and using advanced radiological diagnostic tools.

Case Report

A Case Report of Surgical Treatment of Anal Condyloma Acuminata in HIV-Infected Patient.: Hyun, Seok Woo , Jung, Hun , Park, Jong Kyung , Oh, Seung Taek , Chang, Suk Kyun; J Korean Soc Coloproctol. 2002;18(5):349-352.

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Abstract PDF: Acquired immunodeficiency syndrome (AIDS) was reported for the first time in the U.S, 1981 and eversince, the number of patients have increased substantially. Similar situation is encountered in Korea, with concordant increase in number of HIV-infected patients requiring surgical management, a high proportion being anal condyloma acuminata, which needs proper evaluation and management due to its malignant potential. Since, we have had a recent case with surgical intervention, we review the pathogenesis and treatment modality of the disease in this paper.

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