Annals of Coloproctology

Volume 24(5); October 2008

Original Articles

Prognostic Factors Associated with Poor Outcome of Biofeedback Therapy for Constipated Patients with Pelvic Outlet Obstruction.: Kim, Sung Jin , Hwang, Yong Hee , Jung, Yong Hwan; J Korean Soc Coloproctol. 2008;24(5):313-321.; DOI: https://doi.org/10.3393/jksc.2008.24.5.313

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Abstract PDF: PURPOSE
The aim of this study was to identify the prognostic factors associated with poor outcome of biofeedback therapy.
METHODS
One hundred thirty-seven (137) constipated patients with pelvic outlet obstruction (median age 49 years) had more than one biofeedback session after defecography. Follow-up data (mean follow-up: 14 months; range: 2~37 months) were obtained in 114 patients. Any differences in demographics, clinical symptoms, and parameters of an anorectal physiological study were evaluated between the success group and the failure group.
RESULTS
At follow-up, 80 (70 percent) patients felt improvement in symptoms, but 34 (30 percent) patients did not. Pre-biofeedback presence of symptoms of difficult defecation predict poor outcome (88 vs. 69 percent for failure vs. success, P<0.05). The positive and the negative predictive values of difficult defecation for poor outcome were 35 percent and 86 percent, respectively. A negative mean pressure change on pre-biofeedback anal manometry was related to a poor outcome (65 vs. 26 percent for failure vs. success, P<0.001). The positive and the negative predictive values of negative mean pressure change for poor outcome were 51 percent and 83 percent, respectively. A negative electrical current change on pre-biofeedback anal electromyography was related to a poor outcome (23 vs. 9 percent for failure vs. success, P<0.05). The positive and the negative predictive values of negative electrical-current change for poor outcome were 53 percent and 74 percent, respectively.
CONCLUSIONS
Difficult defecation, negative mean pressure change in pre-biofeedback anal manometry, and negative electrical current change in pre-biofeedback anal electromyography were predictors associated with poor outcome of biofeedback therapy for constipated patients with pelvic outlet obstruction.

Treatment of Colon Perforation Associated with Colonoscopy.: Park, Hae Ran , Baek, Seong Kyu , Bae, Ok Suk , Park, Sung Dae; J Korean Soc Coloproctol. 2008;24(5):322-328.; DOI: https://doi.org/10.3393/jksc.2008.24.5.322

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PURPOSE
Recently, non-operative conservative management or laparoscopic repair has been reported for the management of colonic perforation during colonoscopy. However, the preferred management strategy remains controversial. The purpose of the present study is to identify an appropriate strategy for the treatment of colon perforation during colonoscopy.
METHODS
The medical records of patients who developed colon perforation during colonoscopy between May 2003 and November 2007 were retrospectively reviewed. The mechanism and site of perforation, the treatment administered, complications, and clinical outcomes were analyzed.
RESULTS
In total, 16 perforations were evaluated. Of these, 11 developed during diagnostic colonoscopy and 5 during therapeutic colonoscopy. The most frequent perforation site was the sigmoid colon (12), followed by the transverse colon (2), the rectum (1), and unknown site (1). Six patients underwent surgery due to signs of diffuse peritonitis 10 were initially treated conservatively. Among the patients who underwent surgery, four underwent laparoscopic repair and two underwent open repair. Among the patients initially treated conservatively two patients required surgery due to clinical deterioration of peritonitis and rectovaginal fistula. These 2 patients underwent repair with proximal diverting stomas.
CONCLUSIONS
Colon perforation associated with colonoscopy is a rare event, but raises serious complications. Selected patients with colonoscopic perforation may be treated conservatively, but if these patients fail to respond to such treatments, extensive surgical procedures may be warranted.

Citations

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Management Outcomes of Colonoscopic Perforations Are Affected by the General Condition of the Patients
Jae Ho Park, Kyung Jong Kim
Annals of Coloproctology.2018; 34(1): 16. CrossRef
Comparison of the surgical outcomes of laparoscopic versus open surgery for colon perforation during colonoscopy
Jeongsoo Kim, Gil Jae Lee, Jeong-Heum Baek, Won-Suk Lee
Annals of Surgical Treatment and Research.2014; 87(3): 139. CrossRef
A Case of Successful Percutaneous Drainage of a Pelvic Abscess Complicating Colonoscopy
Youn Si, Shin Young Kim, Seung Bong Choi, Hyung Jin Kim, Yoon Suk Lee, Hyun Min Cho, Jun Gi Kim, Seung Tack Oh, In Kyu Lee
Journal of the Korean Society of Coloproctology.2009; 25(5): 347. CrossRef

Polymorphism of the 5,10-Methylenetetrahydrofolate Reductase (MTHFR) Gene and Microsatellite Instability (MSI) in Mucinous Colorectal Cancer.: Kim, Hae Sol , Kang, Bong Su , Kim, Jong Woo , Ahn, Dae Ho , Bae, Su Jin , Kim, Nam Gun; J Korean Soc Coloproctol. 2008;24(5):329-336.; DOI: https://doi.org/10.3393/jksc.2008.24.5.329

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Abstract PDF

PURPOSE
Generally, a mucinous carcinoma (Muc) of the colon show higher rates of microsatellite instability (MSI) than a non-mucinous carcinoma (non-Muc). Mutated methylenetetrahydrofolate reductase (MTHFR) brings about low enzyme activity, which may reduce genomic DNA methylation. These processes may be critical for the oncogenic transformation of human cells. We compared the relationship of MSI and MTHFR polymorphism in Muc to that in non-Muc.
METHODS
From March 2003 to August 2007, genomic DNA was isolated from whole blood and tissue specimens of 285 colorectal cancer patients (Muc: 31 cases, non-Muc: 254 cases) and 448 normal control patients. These were subjected to MSI analysis and MTHFR genotyping by using PCR-based restriction fragment length polymorphism analyses.
RESULTS
MSI was significantly more frequent in the Muc group (40.7%) than in the non- Muc group (14.8%). The frequencies of polymorphism of MTHFR 677C>T were CC (31.5%), CT (57%), and TT (11.5%) in the patient group and 32.4%, 53.1%, and 14.5% in the control group. In the Muc group, the frequencies of polymorphism of MTHFR 677C>T were CC (36%), CT (56%), TT (8%), and in the non-Muc group, they were 31.1%, 57%, and 11.9%. The frequencies of polymorphism of MTHFR 1298A>C were AA (73%), AC (21.3%), and CC (5.7%) in the patient group and 69.6%, 28.6%, and 1.8% in the control group. In the Muc group, the frequencies of polymorphism of MTHFR 1298A>C were AA (50%), AC (30%), and CC (20%), and in the non-Muc group, they were 76%, 20.3%, and 3.7%. The Muc group showed higher frequencies of the CC variant than the non-Muc group (P-value=0.018). No relation between MSI and MTHFR polymorphisms were seen in any comparison of the Muc and the non-Muc groups.
CONCLUSIONS
The Muc group showed higher rates of MSI than the non-Muc group, but no definite difference between the Muc and the non-Muc groups was noted in the case of polymorphism of MTHFR 677C>T. However, the TT-type variant showed slightly lower frequencies in the Muc group than in the non-Muc group. On the contrary, the Muc group showed a higher rate of the CC variant in polymorphism of MTHFR 1298A>C. These inconsistent results seem to be due to the small size of the Muc group, so further study is needed.

Citations

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Relationship between Metabolic Syndrome and MTHFR Polymorphism in Colorectal Cancer
Bong Su Kang, Dae Ho Ahn, Nam Keun Kim, Jong Woo Kim
Journal of the Korean Society of Coloproctology.2011; 27(2): 78. CrossRef

Expression of Hypoxia-inducible Factor-1alpha and Vascular Endothelial Growth Factor in Colon Cancer: Relationship to the Prognosis and Tumor Markers.: Choi, Yoon Young , Cho, Hyun Deuk , Park, Dong Guk , Kim, Sung Young , Lee, Moon Soo , Kim, Chang Ho , Cho, Moo Sik , Baek, Moo Jun; J Korean Soc Coloproctol. 2008;24(5):337-344.; DOI: https://doi.org/10.3393/jksc.2008.24.5.337

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PURPOSE
Angiogenesis is one of the key steps in solid tumor growth and metastasis. We investigated the prognostic significance of vascular endothelial growth factor (VEGF) and hypoxia-inducible factor 1alpha (HIF-1alpha) expressions as markers of angiogenesis in colon cancer.
METHODS
We retrospectively reviewed the medical records of 78 patients with colon or rectal cancer who underwent a surgical resection at Soonchunhyang University Hospital from January 2000 to December 2001, and we evaluated the expression of VEGF and HIF-1alpha in archival tumor tissues by using immunohistochemistry. We recorded the clinical and the pathological characteristics of the patients and analyzed their survival outcomes.
RESULTS
Thirty-four (34) patients were male, and the mean age of all the patients was 66.7 years. HIF-1alpha and VEGF were positive in 56% (44 patients) and 53% (42 patients) of the tumors, respectively. HIF-1alpha expression was significantly associated with several pathological parameters, such as TNM stage (P=0.001), lymph node metastasis (P=0.001). HIF-1alpha expression was also associated with VEGF expression (P=0.032). The survival of patients with HIF-1alpha expression was worse than that of patients with no HIF-1alpha expression (P=0.036). However, VEGF expression was not associated with other pathological characteristics.
CONCLUSIONS
We suggest that, in cases of colorectal cancer, HIF-1alpha expression may be associated with expression of VEGF, progression of tumors, and poor prognosis.

Citations

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Expression of LDH-5 in Colorectal Carcinomas: Correlation with Prognosis and Tumor Angiogenesis
Tae Sung Ahn, Chang Jin Kim, Dong Jun Jung, Dong Guk Park, Sung Woo Cho, Sung Young Kim, Moon Soo Lee, Chang Ho Kim, Moo Sik Cho, Moo Jun Baek
Journal of the Korean Society of Coloproctology.2010; 26(1): 62. CrossRef

Retrospective Analysis of Patients Treated with Cetuximab plus FOLFIRI for Previous Irinotecan-combined Chemotherapy in Metastatic Colorectal Cancer.: Park, Jae Woo , Moon, Sun Mi , Hwang, Dae Yong; J Korean Soc Coloproctol. 2008;24(5):345-350.; DOI: https://doi.org/10.3393/jksc.2008.24.5.345

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Abstract PDF: PURPOSE
Many reports about efficacy of cetuximab in the prolongation of survival have been published. Especially, the combination of cetuximab and FOLFIRI has a high activity even in prior irinotecan refractory metastatic colorectal cancer (mCRC). Beside small number of patients, we are trying to evaluate the efficacy and safety of cetuximab combined with FOLFIRI for patients who prior irinotecan chemotherapy had failed.
METHODS
A retrospective analysis of 26 patients treated with cetuximab with FOLFIRI from July 2006 to August 2007 was done. All patients had already been treated with FOLFIRI chemotherapy in 1st line or 2nd line regimens for mCRC. The initial dose of cetuximab was 400 mg/m2 at the 1st week, after which the dose was 250 mg/m2 weekly plus FOLFIRI biweekly. We defined 1 cycle as 8 weeks, and the responses were evaluated at week 8.
RESULTS
The median follow-up period was 6.2 (1.1~13.9) months. After 8 weeks, 50% of the patients had a partial response, and the disease control rate was 57.5%. The median time to progression was 3 months. EGFR expression and tumor response had no correlation (P=0.07). Skin reaction and tumor response (median time to progression) had a significant correlation (P= 0.022). Cetuximab did not increase the toxicity associated with FOLFIRI, except for an acneiform rash. CONCLUSIONS: Cetuximab combined with FOLFIRI chemotherapy was effective in treating mCRC patients after FOLFIRI regimen chemotherapy.

Clinical Trial

Prognostic Value of Erythrocyte Sedimentation Rate in Patients with Colorectal Cancer.: Kim, Young Ki , Hong, Seong Woo , Chun, Jung Woo , Chang, Yeo Goo , Paik, In Wook , Lee, Hyucksang; J Korean Soc Coloproctol. 2008;24(5):351-356.; DOI: https://doi.org/10.3393/jksc.2008.24.5.351

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Abstract PDF: PURPOSE
Prognostic indicators are used increasingly in clinical trials and to guide surveillance for patients with colorectal cancer (CRC). The significance of a preoperative, elevated erythrocyte sedimentation rate (ESR) as a predictive indicator for malignancy and for prognosis in colorectal cancer has not been elucidated. Hence, the current study was conducted to evaluate the ESR as a prognostic indicator in patients with CRC.
METHODS
This study enrolled 232 patients who underwent surgery in our hospital between 1997 and 2004. ESR with clinicopathologic features and overall survival were evaluated retrospectively.
RESULTS
The ESRs of 139 patients were elevated, and those of 93 patients were normal. Elevated ESR was associated with the male gender, decreased hemoglobin, increased platelet count, high preoperative CEA, high preoperative CA19-9, tumor size (> or =5 cm), T stage, and TNM stage. Patients with elevated ESR had poorer survival (P=0.001), but a multivariate analysis did not reveal an elevated ESR as an independent factor for prognosis.
CONCLUSIONS
Preoperative elevation of ESR in patients with CRC suggests the presence of a tumor with aggressive behavior and a poor outcome.

Original Articles

Cost of Colorectal Cancer Care in Korea: A Prospective Group Study with a 2-year Follow-up.: Choi, Kui Son , Park, Eun Cheol , Lim, Min Kyung , Lim, Jin Hwa , Kim, Sung Gyeong , Park, Jae Hyun , Jeong, Seung Yong , Park, Ji Won , Lim, Seok Byung , Choi, Hyo Seong , Jung, Kyung Hae , Kim, Dae Yong , Park, Jae Gahb; J Korean Soc Coloproctol. 2008;24(5):357-366.; DOI: https://doi.org/10.3393/jksc.2008.24.5.357

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Abstract PDF

PURPOSE
The incidence of cancer incidence and the rate of mortality are increasing in Korea. Specifically, colorectal cancer in men is one of the most sharply increasing malignancies. The objective of this study was to assess the direct costs for colorectal cancer patients and to identify the factors that influence cancer costs.
METHODS
The direct costs of colorectal cancer were examined with a prospective group study at a hospital. The direct costs were assessed every 3 months over a 24-month period through patient interviews, medical records, and claims data. We identified the major factors associated with the cost of colorectal cancer by using a general linear model for the log-transformed data.
RESULTS
The group was comprised of 100 patients with colon cancer and 120 patients with rectal cancer. The average costs per patient during the first and the second years after diagnosis were 16,280,000 won and 5,786,000 won respectively. Medical costs accounted for about 68% (11,090,000 won) of the first year's total cost and about 62% (3,602,000 won) of the second year's total cost. National Health Insurance (NHI) paid approximately 50% of the total medical cost. The total cost of colorectal cancer was clearly associated with the stage of the disease at first diagnosis, the cancer site, therapeutic modalities, and recurrence.
CONCLUSIONS
These results indicate that colorectal cancer has a heavy financial impact on cancer patients. The total cost of colorectal cancer is clearly associated with the stage of the disease at first diagnosis. Increased efforts in terms of prevention and early detection may assist in reducing the costs.

Citations

Citations to this article as recorded by

Financial burden of colorectal cancer treatment among patients and their families in a middle-income country
Meram Azzani, April Camilla Roslani, Tin Tin Su
Supportive Care in Cancer.2016; 24(10): 4423. CrossRef
Palliative treatment of colorectal cancer in Germany: cost of care and quality of life
Martin Emmert, Katharina Pohl-Dernick, Axel Wein, Frank Dörje, Susanne Merkel, Frank Boxberger, Gudrun Männlein, Robert Joost, Hans-Detlev Harich, Roland Thiemann, Christof Lamberti, Markus F. Neurath, Werner Hohenberger, Oliver Schöffski
The European Journal of Health Economics.2013; 14(4): 629. CrossRef
Costs of Initial Cancer Care and its Affecting Factors
So Young Kim, Sung Gyeong Kim, Jong Hyock Park, Eun Cheol Park
Journal of Preventive Medicine and Public Health.2009; 42(4): 243. CrossRef

Clinical Characteristics of Ovarian Metastasis from Colorectal Cancer.: Yun, Chol Hee , Park, Jae Woo , Moon, Sun Mi , Hwang, Dae Young; J Korean Soc Coloproctol. 2008;24(5):367-372.; DOI: https://doi.org/10.3393/jksc.2008.24.5.367

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PURPOSE
Treatment of ovarian metastasis from colorectal cancer has been controversial, and only limited data on ovarian metastasis have been reported. We reviewed the clinical features of patients with ovarian metastasis from a colorectal carcinoma.
METHODS
From 1993 to 2002, 568 women were treated for colorectal cancer. Of those, 17 cases were diagnosed as ovarian metastasis. We reviewed the 17 cases retrospectively.
RESULTS
The incidence of ovarian metastasis was 3.0% (17/568). The number of cases involving synchronous ovarian metastasis was 7 (1.2%). Those 7 patients also had another metastasis including ovarian metastasis. Ten cases (1.8%) involved metachronous ovarian metastasis. Of those 10 patients, 8 had ovarian metastasis in combination with other organ metastasis. The median disease-free interval from the diagnosis of the primary colorectal cancer to the diagnosis of ovarian metastasis was 9.8 months, and the median survival after the diagnosis of ovarian metastasis was 17.2 months. The median survival after the diagnosis of ovarian metastasis was 23.4 months in the ovarian- metastasis-only group, compared with 10.1 months in the group with ovarian and other metastasis. The difference in survival between the two groups was statistically significant.
CONCLUSIONS
The incidence of ovarian metastasis from colorectal cancer was low. When such an event occurred, it was frequently associated with widespread disease and resulted in a poor prognosis. However, patients having only ovarian metastasis had a higher survival rate.

Citations

Citations to this article as recorded by

Clinicopathological Characteristics of Ovarian Metastasis from Colorectal Cancer
Youn Si, Jae-Im Lee, Soo-Hong Kim, Ji-Hoon Kim, Hyung Jin Kim, Yoon Suk Lee, Hyun Min Cho, Jun Gi Kim, Seung Tack Oh, In Kyu Lee
Journal of the Korean Surgical Society.2010; 79(4): 287. CrossRef

Mid-term Results of Laparoscopic Surgery and Open Surgery for Radical Treatment of Colorectal Cancer.: Lee, Gil Jae , Lee, Jung Nam , Oh, Jae Hwan , Baek, Jeong Heum; J Korean Soc Coloproctol. 2008;24(5):373-379.; DOI: https://doi.org/10.3393/jksc.2008.24.5.373

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Abstract PDF

PURPOSE
The aims of this study were to assess the oncologic safety of laparoscopic colorectal surgery compared to that of conventional open surgery and to compare the disease-free survival (DFS) rates between laparoscopic and open colorectal surgery for radical treatment of colorectal cancer.
METHODS
From January 2001 to December 2005, 583 patients underwent laparoscopic or conventional open surgery. To address only radical treatment of colorectal cancer, we excluded subjects who had undergone emergency or palliative operation. Four hundred ninety patients were identified for this study. The laparoscopic (LG) and open group (OG) had 74 and 166 patients, respectively, for colon cancer, and 92 and 158 patients, respectively, for the rectal cancer.
RESULTS
No difference was noted in the lengths of the distal margins of the resected bowels between the LG and the OG for rectal cancer (P>0.05). In addition, no significant difference was found in DFS rates between the LG and the OG for both colon and rectal cancer (P>0.05).
CONCLUSIONS
The laparoscopic technique does not seem to present any disadvantages and is safe and feasible for the treatment of colorectal cancer. No difference was found between laparoscopic and open surgery in terms of DFS for colorectal cancer.

Citations

Citations to this article as recorded by

Effects of Heated-Humidified Anesthetic Gas in the Elderly Patients with Colorectal Cancer during Laparoscopic Surgery: Randomized Controlled Trial
Hyo-Sun Park, Younhee Kang
Korean Journal of Adult Nursing.2018; 30(2): 206. CrossRef
Comparison of long-term oncologic outcomes of stage III colorectal cancer following laparoscopic versus open surgery
Jeong-Heum Baek, Gil-Jae Lee, Won-Suk Lee
Annals of Surgical Treatment and Research.2015; 88(1): 8. CrossRef
Experience of Colorectal Cancer Survival Journeys: Born Again after Going Through an Altered Self Image
Jung-Ae Park, Kyung Sook Choi
Asian Oncology Nursing.2013; 13(3): 163. CrossRef
Robotic and laparoscopic total mesorectal excision for rectal cancer: a case-matched study
Jeong-Heum Baek, Carlos Pastor, Alessio Pigazzi
Surgical Endoscopy.2011; 25(2): 521. 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
Oncologic Outcomes of Robotic-Assisted Total Mesorectal Excision for the Treatment of Rectal Cancer
Jeong-Heum Baek, Shaun McKenzie, Julio Garcia-Aguilar, Alessio Pigazzi
Annals of Surgery.2010; 251(5): 882. CrossRef
Complications of Robotic Total Mesorectal Excision
Jeong-Heum Baek, Shaun McKenzie, Alessio Pigazzi
Seminars in Colon and Rectal Surgery.2009; 20(4): 190. CrossRef

IMA-origin Lymph Node Metastasis in Left Colon Cancer.: Lee, Jae Hoon , Jung, Sang Hun , Kim, Hyun Jin , Hwang, Jong Sung , Kim, Jae Hwang , Shim, Min Chul; J Korean Soc Coloproctol. 2008;24(5):380-385.; DOI: https://doi.org/10.3393/jksc.2008.24.5.380

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Abstract PDF: PURPOSE
Although an extended colon resection with high ligation of the inferior mesenteric artery (IMA) generally has been recommended as curative surgery for advanced left colon cancer (LCC), it shows little or no survival advantage over segmental resection with low ligation of IMA. The present study is to determine the risk factors associated with IMA-origin lymph-node (LN) metastasis and to clarify the implication of IMA-origin LN metastasis.
METHODS
We examined the clinicopathological results of 200 cases of LCC. LN dissection was performed as follows: D2 en-bloc resection of the primary tumor, IMA-origin LN dissection, and paraaortic LN dissection.
RESULTS
The incidence of IMA-origin LN metastasis of LCC was 4.5% (9 cases), and all cases involved sigmoid colon cancer. The independent risk factors of IMA-origin LN metastasis were four or more regional LN metastases (hazard ratio: 16.51, 95% confidence interval: 1.60~164.12) and a preoperative CEA level of greater than 6 ng/ml of (hazards ratio: 6.63, 95% confidence interval: 1.06~41.32). The incidence of IMA-origin LN metastasis among stage IIIC patients was 26.7%. Five of the 9 (55.6%) cases of IMA-origin LN metastasis had a concomitant paraaortic LN metastasis.
CONCLUSIONS
The incidence of IMA-origin LN metastasis among patients with LCC was low; however, IMA-origin LN metastasis should be considered as a systemic metastasis.

Case Reports

Primary Repair of a Huge Incisional Hernia by Using an External Oblique Myofascial Releasing Technique without Mesh: A Case Report.: Park, Ki Jae , Woo, Jin Hee , Lee, Hak Youn , Lee, Se Yong , Shin, Jong Sok , Roh, Young Hoon , Kim, Sung Heun , Choi, Hong Jo; J Korean Soc Coloproctol. 2008;24(5):386-389.; DOI: https://doi.org/10.3393/jksc.2008.24.5.386

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Abstract PDF: Incisional hernias are one of the most common complications after abdominal surgery and are an important cause of postoperative morbidity. Various methods are available for repairing incisional hernias, such as primary suture repair, an open mesh technique, and a laparoscopic mesh technique. The surgical management of a large incisional hernia by using a prosthetic mesh in a contaminated operative field (i.e., opened bowel from previous stoma or bowel resection) remains a difficult challenge because the non-absorbable mesh used is accompanied by a potential risk of infection and its related morbidity. We present a case of a large abdominal-wall defect, which was corrected by utilizing an external oblique myofascial releasing technique without the use of mesh, in a patient with an incisional hernia coexistent with Hartmann's colostomy.

Laparoscopic Management of Sigmoid Volvulus for Which Endoscopic Reduction had Failed.: Choi, Sung Il , Lee, Suk Hwan; J Korean Soc Coloproctol. 2008;24(5):390-393.; DOI: https://doi.org/10.3393/jksc.2008.24.5.390

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The laparoscopic approach to the treatment of sigmoid volvulus has been challenging because of the different anatomy of the colon and the mesentery. We report a case of a laparoscopic sigmoidectomy and anastomosis for a patient with sigmoid volvulus for whom endoscopic reduction had failed. A 68-year-old man with sigmoid colon volvulus underwent laparoscopic surgery. The laparoscopic surgery was difficult because of the tortuous and dilated bowel and the many fibrous bands. We performed an intraoperative decompression by using a rectal tube through the anus and a primary anastomosis without on- table preparation. The patient was discharged six days later without complications. We assumed that laparoscopic resection and anastomosis is a safe, effective procedure for the management of sigmoid volvulus.

Citations

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Single-port laparoscopic surgery for sigmoid volvulus
Byung Jo Choi
World Journal of Gastroenterology.2015; 21(8): 2381. CrossRef

Review

Rectal Cancer: Function-preserving Surgery.: Kim, Nam Kyu; J Korean Soc Coloproctol. 2008;24(5):394-405.; DOI: https://doi.org/10.3393/jksc.2008.24.5.394

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Abstract PDF: The main goals in the surgical treatment of rectal cancer are to remove the cancer completely and to preserve the anorectal function. Rectal cancer is one of the leading health issues in Korea because of its increasing incidence with changing lifestyles and diets. The optimal treatment of rectal cancer is based on a multimodality approach. Among the modalities, proper surgery is the key for a curative treatment. In the early 20th century, local recurrence was reported to be as high as 30~40%. However, after the introduction of total mesorectal excision (TME), local recurrence decreased dramatically (to less than 10%). TME includes on sharp pelvic mesorectal dissection and complete clearing of the rectal cancer and the mesorectum along the rectal proper fascia. TME is now considered as a standard procedure for surgical treatment of rectal cancer. These days, sphincter-saving surgical techniques, such as transanal excision, ultralow anterior resection with coloanal anastomosis, and intersphincteric resection, have become popular for the treatment of low rectal cancer. Many researchers reported that oncologic outcomes were not compromised by the increased sphincter preservation rate. In clinical settings, the quality of life should be considered important because of the improved oncologic results in recent years. Surgeon should be aware of changes in the anorectal function after surgery. Reservoir and fecal continence, as well as sexual and voiding functions, should be closely evaluated during follow-up period. Impaired anorectal function may have multiple contributing factors: for example, a reduced reservoir volume, an unnoticed complex injury of the anal sphincter, or a traction injury (anal dilation). In terms of poor sexual and voiding functions, identification of the autonomic nerve plexus in the operative field is not enough for preserving the sexual and voiding functions. During pelvic dissection, traction injury caused by blunt dissection and electrothermal or vasa nervosum injury during sharp perimesorectal dissection should be avoided for better functional results. Preoperative or postoperative radiation may also be a reason for sexual and voiding dysfunction. If the ultimate goal of rectal cancer surgery is to be achieved, precise surgical technique and proper patient selection are mandatory. This issue contains recent advances in sphincter-saving surgery and nerve preservation for rectal cancer, which will be a useful reference for colorectal surgeons.

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