Annals of Coloproctology

Volume 23(2); April 2007

Original Articles

The Effect of Dexpanthenol in Postoperative Patients.: Hwang, Mi Ri , Kim, Hungdai , Cho, Dong Ho , Han, Won Kon; J Korean Soc Coloproctol. 2007;23(2):71-74.; DOI: https://doi.org/10.3393/jksc.2007.23.2.71

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Abstract PDF: PURPOSE
The purpose of this study was to compare the efficacy of dexpanthenol in postoperative patients. Dexpanthenol, the alcohol derivative of pantothenic acid, is believed to be a precursor of acetylcholine through its incorporation into coenzyme-A.
METHODS
From June 2005 to December 2005, 130 curative abdominal surgery, which were divided into a dexpanthenol group with 65 patients and a control group with 65 patients, were prospectively and randomly studied for recovery of bowel motility.
RESULTS
No significant difference was found between the two groups as to incidence of postoperative ileus (16.9% vs. 15.4%, P=0.081), the time to flatus (77.2+/-38.4 vs. 77.9+/-31.9 hours, P=0.90), the time to defecation (5.3+/-2.7 vs. 5.1+/-2.6 days, P=0.77), the time to resumption of meals (7.9+/-4.0 vs. 8.9+/-4.2 days, P=0.17), and the duration of hospital stay (16.4+/-7.8 vs. 17.9+/-11.5 days, P=0.39). CONSLUSIONS: Since no differences in the postoperative bowel motility were observed between the two groups, dexpanthenol is not recommended for general surgical use.

The Role of Rectoanal Inhibitory Reflex in the Anal Continence Function.: Seong, Moo Kyung , Yoon, Sang Nam , Park, Ung Chae , Hwang, Jae Kwan; J Korean Soc Coloproctol. 2007;23(2):75-79.; DOI: https://doi.org/10.3393/jksc.2007.23.2.75

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Abstract PDF: PURPOSE
The rectoanal inhibitory reflex (RAIR) aids the anal continence function by a sampling process. On the other hand, it might impair the anal continence function because the internal anal sphincter is relaxed during the reflex. We assessed the parameters of RAIR in incontinent patients with or without a sphincter defect and compared them with healthy control subjects to clarify the exact role of that reflex in the anal continence function.
METHODS
The recovery time, slope, amplitude, and area under the reflex curve of the RAIR were measured for 31 normal controls without any history of anorectal surgery (group A), 32 incontinent patients with a sphincter defect (group B), and 49 incontinent patients without a sphincter defect (group C). Incontinence was defined as bowel accidents of more than 3 by the Cleveland Clinic Florida score. A sphincteric defect was defined endoanal sonographically. The mean ages of group A, B, and C were 57.9+/-14.3, 54.5+/-13.6, and 61.8+/-15.4 years, respectively.
RESULTS
When group A and group B+C were compared, the recovery times (seconds) were 17.5+/-3.5 and 14.8+/-5.5 (P=.003), the slopes (mmHg/second) were 0.67+/-3.04 and 3.27+/-2.44 (P<.001), the amplitudes (%) were 7.0+/-16.5 and 53.3+/-19.4 (P=.352), and the area under the reflex curve (mmHg*seconds) were 230.2+/-102.15 and 173.0+/-140.8 (P=.020). When group B and group C were compared, the recovery times were 15.0+/-5.8 and 14.7+/-5.3 (P=.828), the slopes were 3.6+/-2.8 and 3.1+/-2.2 (P= .388), the amplitudes were 54.2+/-22.4 and 52.7+/-17.4 (P=.737), and the area under the reflex curve were 188.0+/-151.1 and 163.2+/-134.3 (P=.443). All parameters of the RAIR, except the amplitude were significantly diminished in incontinent patients whether they had a sphincter defect or not. CONSLUSIONS: Although the RAIR functions against continence in normal conditions by inhibiting sphincteric tone, it behaves suitably for keeping continence in the presence of incontinence, whatever the cause is, by attenuating the degree of inhibition.

Critical Pathway for Colorectal and Gastric Cancer.: Lee, In Kyu , Lee, Sang Myong , Kim, Sin Sun , Lee, Yoon Suk , Koh, Woo Lee , Kim, Hyun Kyung , Oh, Seong Taek , Jeon, Hae Myung , Chang, Suck Kyun; J Korean Soc Coloproctol. 2007;23(2):80-86.; DOI: https://doi.org/10.3393/jksc.2007.23.2.80

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Abstract PDF

PURPOSE
The critical pathway (CP) is to standardize the clinical practice of specialists working to optimize care. The objective of this study was to develop a critical pathway for the surgical treatment of patients with colorectal or gastric cancer and to evaluate the results of the CP.
METHODS
Twenty-one patients with colorectal cancer, who were managed according to the CP between August 2005 and November 2005, were compared with 18 patients for whom this pathway had not been used between June 2004 and September 2004. Forty-eight patients with gastic cancer, who were managed according to the CP between June 2005 and September 2005, were compared with 49 patients for whom this pathway had not been used daring the same period in 2004. The length of stay and the cost per patients were compared between the CP group and the non-CP group.
RESULTS
For patients with colorectal cancer, the postoperative hospital length of stay in the CP group was significantly shorter (9.0 vs. 12.3 days, P<0.001), but for patients with gastric caner, there was no difference (10.6 vs. 11.4, P=0.134). The mean hospital charges were won5,037,816 and won5,263,508 for colorectal cancer and for gastric cancer, respectively, and won4,808,602 and won4,674,329, for the CP and the non-CP groups, respectively, but these differences were not significant. CONSLUSIONS: The critical pathway in colorectal and stomach surgery decreased the length of stay and might regulate hospital charges. Such a pathway could be easily designed and implemented at hospitals and could standardize clinical practice.

Citations

Citations to this article as recorded by

The Development of a Critical Pathway for Facial Bone Fractures and the Effect of its Clinical Implementation
Woo Young Choi, Cheol Woo Park, Kyung Min Son, Ji Seon Cheon
Archives of Craniofacial Surgery.2013; 14(2): 89. CrossRef
Fast-Track Colorectal Surgery
In Kyu Lee
Journal of the Korean Society of Coloproctology.2010; 26(2): 87. CrossRef

Local Control of Local Excision for T1/T2 Rectal Cancer .: Park, Ki Jae , Choi, Hong Jo , Roh, Young Hoon , Shin, Jong Sok , Lee, Hyung Sik; J Korean Soc Coloproctol. 2007;23(2):87-92.; DOI: https://doi.org/10.3393/jksc.2007.23.2.87

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Abstract PDF

PURPOSE
The aim of this study was to review the outcome of local control after the local excision for T1/T2 rectal cancers and, thus, to assess its effectiveness as an alternative to a more radical resection.
METHODS
This retrospective study analyzed 23 patients with T1/T2 rectal cancer treated by local excision (LE), and their results were compared with the results for 22 patients with rectal cancer of the same stage treated by a radical resection (RR). All patients with pT2 lesions in the LE group received postoperative adjuvant chemoradiation. The outcomes were defined as 5-year local-recurrence-free survival (LRFS). The median follow-up was 72 (range, 40~92) months.
RESULTS
Recurrence occurred in 4 patients (pT1, 1; pT2, 3) in the LE group and in 3 patients (all pT2) in the the RR group. One patient with vascular invasion (T2N1M0) in the RR group showed multiple liver metastases at 23 months postoperatively. The difference in 5-year LRFS was not statistically significant between the two groups. In the LE group, the 5-year LRFS for pT2 lesions was significantly less favorable than that for pT1 lesions (40% vs. 94%; P= 0.005). The 5-year LRFS for pT2 in the RR group was more favorable than that in the LE group, although the difference was not statistically significant (76.9% vs. 40%, P=0.138). CONSLUSIONS: Local excision provides a favorable local control for pT1 rectal cancers. A more radical resection, however, remains an effective surgical option for pT2 lesions because local excision, even combined with adjuvant chemoradiation, showed substantial local recurrences.

Citations

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Recurrences after Local Excision for Early Rectal Adenocarcinoma
Jung Wook Huh, Yoon Ah Park, Kang Young Lee, Seong Ah Kim, Seung-Kook Sohn
Yonsei Medical Journal.2009; 50(5): 704. CrossRef

Comparison of Laparoscopic with Open Resections in Colorectal Cancer: Analysis of Short-term Results.: Kang, Yong Won , Yoon, Seo Gu , Kim, Eu Gene , Lee, Chang Mok , Kim, Kwang Yeon; J Korean Soc Coloproctol. 2007;23(2):93-100.; DOI: https://doi.org/10.3393/jksc.2007.23.2.93

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Abstract PDF

PURPOSE
This study aimed to compare the results of laparoscopic resection with those of open resection for consecutive colorectal cancer patients who underwent surgery at a single center.
METHODS
During the thirty-month period between January 2003 and August 2005, patients with a colorectal adenocarcinoma admitted to our hospital were assessed. Cancers related with FAP or HNPCC, cancers treated with endoscopy or local excision, and recurrent cancers were excluded from the study. Three hundred two laparoscopic resection patients were matched to 302 open resection patients.
RESULTS
The mean age of the laparoscopic resection group was 59.5 years while that of the open resection group was 59.4 years. Patients in two groups were similar in terms of gender distribution, level of CEA and ASA, and location and size of tumor. The modified Dukes' stages showed 51 patients in stage A, 33 in stage B1, 62 in stage B2, 17 in stage C1, and 139 in stage C2 for the laparoscopic resection group and 33 in stage A, 52 in stage B1, 82 in stage B2, 18 in stage C1, and 117 in stage C2 for the open resection group (P=0.024). The operative time averaged 9.6 minutes longer in the laparoscopic group (188.9 vs. 179.3 min, P<0.0001). The rate of stoma formation for protection of anastomosis in the laparoscopic group was 4.9% (5.8% in open group). There were significant differences in blood loss (556.2 vs. 952.8 ml, P<0.0001), the amount of intraoperative blood transfusion (1.6 vs. 2.3 unit, P=0.004), the number of harvested lymph nodes (21.1 vs. 16.9, P<0.0001), and the rate of high ligation of IMA (91.7 vs. 75.5%, P<0.0001). The length of the distal resection margins from cancer was longer in the open group (2.9 vs. 3.5 cm, P=0.037). Patients in the laparoscopic group had a faster recovery of bowel function (P<0.0001) and a significant reduction in the mean length of hospital stay (11.5 vs. 16.8 days, P<0.0001). There was no mortality in either group. Early and late complications were comparable. The conversion rate was 1.6 percent. CONSLUSIONS: The benefits of a laparoscopic resection for colorectal cancers are less blood loss and transfusion, faster postoperative bowel motion, a shorter hospital stay, low morbidity, and a large number of harvested lymph nodes. In conclusion, a laparoscopic resection for colorectal cancers can be done safely and effectively and is an acceptable alternative to a conventional open resection.

Citations

Citations to this article as recorded by

Effects of Postoperative Oral Care Using Cold Therapy on Nausea, Vomiting and Oral Discomfort in Patients with Laparoscopic Myomectomy
Mi-Young Jung, Hyo-Sun Choi, Kyung-Yeon Park
Journal of Korean Academy of Fundamentals of Nursing.2012; 19(3): 292. CrossRef
The Effects of Pneumoperitoneum on Heart Rate, Mean Arterial Blood Pressure and Cardiac Output of Hypertensive Patients during Laparoscopic Colectomy
Eun Ju Kim, Haesang Yoon
Journal of Korean Academy of Nursing.2010; 40(3): 433. CrossRef
Postanal Retrieval and Anastomosis in Laparoscopic Rectal Surgery : Report of 3 Cases
Il Yong Shin, Kwan Ju Lee, Hyung Rae Kim, Se Jun Kim, Jung Koo Kim, Hyung Jin Kim, Dong Ho Lee, Yoon Suk Lee, In Kyu Lee, Won Kyung Kang, Chang Hyeok Ahn, Seong Taek Oh, Jun Ki Kim, Chang Joon Ahn, Sang Chul Lee
Journal of the Korean Society of Coloproctology.2008; 24(6): 487. CrossRef

Risk Factors for Anastomotic Leakage after Laparoscopic Rectal Resection in Rectal Cancer: Does Laparoscopic Rectal Resection Increase Anastomotic Leakage Rate?.: Lee, Ho Suk , Kim, Min Ghwon , Park, Chang Kyun , Cho, Yoo Jin , Hwang, Duk Won , Noh, Sang Ik; J Korean Soc Coloproctol. 2007;23(2):101-109.; DOI: https://doi.org/10.3393/jksc.2007.23.2.101

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Abstract PDF: PURPOSE
The purpose of this study is to evaluate the risk factors for clinical anastomotic leakage after laparoscopic resection for rectal cancer.
METHODS
From March 2001 and February 2006 in Seoul Veterans' Hospital, the prospective laparoscopic colorectal resection database identified 101 patients who a had laparoscopic rectal resection with colorectal or coloanal anastomosis. The associations between clinical anastomotic leakage and patient-, tumor-, surgery- and laparoscopic-related variables were studied.
RESULTS
The rate of clinical anastomotic leakage was 4 percent (4 of 101). The patient-related variable significantly associated with clinical anastomotic leakage was preoperative radiotherapy. The surgery-related factor that turned out to be significant was anastomosis situated less than 5 cm from the anal verge. No tumor- or laparoscopic-related variables were significantly associated with clinical anastomotic leakage. CONSLUSIONS: A protective ileostomy should be considered after a laparoscopic rectal resection for an rectal cancer for anastomosis situated less than 5 cm from the anal verge, particularly when preoperative radiotherapy is being used.

Recurrence Pattern after Laparoscopic Resection for Colorectal Cancer: Analysis according to Timing of Recurrence and Location of Primary Tumor.: Park, In Ja , Kim, Seon Hahn , Joh, Yong Geul , Hahn, Koo Yong; J Korean Soc Coloproctol. 2007;23(2):110-115.; DOI: https://doi.org/10.3393/jksc.2007.23.2.110

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Abstract PDF

PURPOSE
The aim of this study was to assess the recurrence pattern after a curative laparoscopic resection for colorectal cancer according to timing of recurrence and the location of the primary tumor.
METHODS
Between July 1999 and December 2003, we included 318 patients who underwent a laparoscopic resection for stage I-III colorectal cancer and in whom recurrence had been detected within two postoperative years and who had been followed up for more than two years. The mean age was 57 (23~88) years. The median follow-up time was 36 (7~71) months.
RESULTS
The number of rectal cancer patients was 214, and that of colon cancer patients was 104. The total recurrence rate was 15.4%, 7.7% among colon cancer patients and 19.2% among rectal cancer patients. Recurrence according to stage was as follows: stage I: 1.6%, stage II: 5.4%, stage III: 32.5%. Of the total recurrence, 79.6% occurred within two postoperative years. In patients with rectal cancer, local recurrence was more common than in patients with colon cancer. Other types of recurrence were not influenced by the location of the primary tumor. According to timing of recurrence, metastasis to distant lymph nodes developed proportionally after two postoperative years. CONSLUSIONS: Most of the recurrencs developed within two years after a laparoscopic resection for colorectal cancer. The recurrence pattern varied with the location of primary tumor and the timing of recurrence. The recurrence pattern after a laparoscopic resection for colorectal cancer was similar to that after open surgery for colorectal cancer.

Citations

Citations to this article as recorded by

A meta-analysis of short-term outcome of laparoscopic surgery versus conventional open surgery on colorectal carcinoma
Guojun Tong, Guiyang Zhang, Jian Liu, Zhengzhao Zheng, Yan Chen, Enhai Cui
Medicine.2017; 96(48): e8957. CrossRef
Comparison of the clinical outcomes of laparoscopic-assisted versus open surgery for colorectal cancer
KAI CHEN, ZHUQING ZHANG, YUNFEI ZUO, SHUANGYI REN
Oncology Letters.2014; 7(4): 1213. CrossRef
Laparoscopic-Assisted Versus Open Surgery for Colorectal Cancer: Short- and Long-Term Outcomes Comparison
Antonio Biondi, Giuseppe Grosso, Antonio Mistretta, Stefano Marventano, Chiara Toscano, Salvatore Gruttadauria, Francesco Basile
Journal of Laparoendoscopic & Advanced Surgical Techniques.2013; 23(1): 1. CrossRef
Long-term Outcomes of Laparoscopic Surgery for Colorectal Cancer
Jeong-Eun Lee, Yong-Geul Joh, Sang-hwa Yoo, Geu-Young Jeong, Sung-Han Kim, Choon-Sik Chung, Dong-Gun Lee, Seon Hahn Kim
Journal of the Korean Society of Coloproctology.2011; 27(2): 64. CrossRef

Differential Expressions of Genes in Colorectal Cancer with Liver Metastasis by using a cDNA Microarray Chip: A Pilot Study.: Kim, Jae O , Choi, Gyu Seog , Kim, Sang Geol , Chang, Eun Jung , Kim, Woo Ri , Lee, In Taek , Jun, Soo Han , Kim, Mun Kyu , Kim, Jeong Chul; J Korean Soc Coloproctol. 2007;23(2):116-128.; DOI: https://doi.org/10.3393/jksc.2007.23.2.116

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Abstract PDF: PURPOSE
Liver metastasis is the most common type of failure in the treatment of colorectal cancer. The identification of differential expressions of genes in colorectal cancer and liver metastasis is important to differentiate the genetic mechanism of carcinogenesis and liver metastasis from that of a normal mucosa. The aim of this study is to find candidate genes playing roles in liver metastasis of colorectal cancer by using cDNA microarray.
METHODS
We screened a group of genes differentially expressed in a normal mucosa and in cancer and liver metastasis by using a 4.7 K cDNA microarray chip in 8 patients with far advanced colorectal cancer from Jan 2003 to May 2004 at Kyungpook National University Hospital.
RESULTS
A comparison of mRNA expressions of genes in normal mucosa vs. cancer, normal mucosa vs. liver metastasis, and cancer vs. liver metastasis, 76 and 27 known and unknown genes were significantly over-expressed in cancer and liver metastasis, respectively. Also 62 and 26 genes were down- regulated in cancer and liver metastasis. Among those genes, TIMP-1, SRY-box9, Rattus norvegicus fibronectin 1, mitotic check point regulator, etc. were constantly up- regulated in cancer or metastasis, and hsgk, etc. were down-regulated in cancer or liver metastasis. CONSLUSIONS: The cDNA microarray chip technique could be a useful for robust screening of candidate genes involved in carcinogenesis or metastasis of colorectal cancer.

Case Reports

A Case of a Rectal Teratoma.: Oh, Seung Yeop , Song, Sun Choon , Lee, Kwang Jae , Kim, Yong Bae , Suh, Kwang Wook; J Korean Soc Coloproctol. 2007;23(2):129-131.; DOI: https://doi.org/10.3393/jksc.2007.23.2.129

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Abstract PDF

We report the case of a rectal teratoma. A 62-year-old woman was referred to our department for evaluation of a rectal mass. She had a 3-month history of rectal bleeding and constipation. No palpable mass was detected using digital rectal examination. Colonoscopic examination demonstrated a protruding mass with a broad stalk in the posterior wall about 12 cm from the anal verge. A computed tomography scan showed a mass, which contained calcifications and fatty components, protruding into the rectal lumen. On operation, the mass was located in the upper rectum, and the right lateral portion of the upper rectum was adhesed to the right ovary. Thus, she had undergone a low anterior resection and right oophorectomy. The pathologic results confirmed a teratoma arising in the muscularis mucosa and the submucosa of the rectal wall.

Citations

Citations to this article as recorded by

A Case of Primary Mature Teratoma of the Rectum
Hyun Sung Park, Seung Goun Hong, Se Young Jung, Shin Myung Kang, Kyoungyong Lee, Dong Wook Yu
Soonchunhyang Medical Science.2014; 20(1): 27. CrossRef

Large Cell Neuroendocrine Carcinoma of Anal Canal: Report of a Case.: Yun, Min Young , Choi, Sun Keun , Choi, Suk Jin , Hur, Yun Suk , Lee, Kun Young , Kim, Sei Joong , Cho, Young Up , Ahn, Seung Ick , Hong, Kee Chun , Shin, Suk Hwan , Kim, Kyung Rae , Woo, Ze Hong; J Korean Soc Coloproctol. 2007;23(2):132-135.; DOI: https://doi.org/10.3393/jksc.2007.23.2.132

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Abstract PDF: A neuroendocrine carcinoma of the anal canal is a very rare entity; however, this type of tumor is known for its aggressive progression and poor prognosis. We describe the case of a 58-year-old female with a neuroendocrine carcinoma arising in the anal canal. The tumor was found in the anal canal with multiple liver metastases. The patient died due to massive liver metastases 11months after diagnosis and operation. For its rarity and clinical significance, we report the case with a review of the literature.

Review

Present and Future in the Treatment of Fecal Incontinence.: Park, Duk Hoon; J Korean Soc Coloproctol. 2007;23(2):136-143.; DOI: https://doi.org/10.3393/jksc.2007.23.2.136

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Abstract PDF: Treatment of fecal incontinence still remains a challenge to modern medicine due to many specific sides of this problem. The diversity of causes of fecal incontinence and different modes of action of the various treatment modalities mandate a tailored, individualized approach in each case. Surgery is the last treatment modality for patients suffering from severe fecal incontinence. Recent studies have shown poor late results after primary sphincter repair and low predictive value for most preoperative diagnostic tests. New surgical options such as artificial devices and electrically stimulated muscle transpositions are reported by acceptable success rates and unacceptably frequent complications. That is why current attention has focused on non- or minimally invasive therapies such as sacral nerve stimulation and temperature-controlled radio-frequency energy delivery to the anal canal. However, all these innovative techniques remain experimental untill enough high- evidence data are gathered for their objective evaluation.

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