Annals of Coloproctology

Volume 24(6); December 2008

Original Articles

Long-term Result of Surgical Treatment for Crohn's Enteritis.: Choi, Sang Ji , Choe, Eun Kyung , Park, Sung Chan , Park, Kyu Joo; J Korean Soc Coloproctol. 2008;24(6):409-416.; DOI: https://doi.org/10.3393/jksc.2008.24.6.409

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We sought to determine the long-term outcome of surgical management for gastrointestinal Crohns's disease (CD) and to find out whether there is any improvement over the time period.
METHODS
We analyzed the records of the 102 patients who underwent surgery for gastrointestinal CD excluding perianal CDbetween 1978 and 2007. A cumulative surgical recurrence rate was analyzed by Kaplan-Meier plots and log-rank tests.
RESULTS
The main sites of CD were ileocecal area in 54.5%, followed by small bowel (29.7%) and large bowel (7.9%). Common indications for operation were obstruction (25.7%), diagnostic purpose (20.8%), and failure of medical treatment (12.9%). The operation performed were ileocolectomy including right hemicolectomy in 53 cases (45.3%), small bowel resection in 38 cases (31.7%), and strictureplasty 12 cases (10.0%, including 11 cases combined with bowel resection). The average follow-up period after operation was 6.4years (range: 0.5~29 yr, median: 5.3 yr). Among all patients, 22 (21.6%) underwent operations for recurrence. The re-operation rate was higher in the younger patients group (age at diagnosis less than 25 years) (34.1% vs. 12.1%, P<0.05), and in case of the patients whose length of initial intestinal resection was less than 40 cm (27.9% vs. 7.7%, P<0.05). The overall cumulative re-operation rates at 5years, 10years and 15years were 15%, 25%, and 60%, respectively.
CONCLUSIONS
Despite recent advances in medical therapy, the cumulative re-operation rate of patients operated for gastrointestinal CD remains similar to our previous report in 1997.

Abdominal Computed Tomography in Patients with Right Lower Quadrant Pain.: Won, Chang Sik , Roh, Hye Rin , Park, Seung Bae , Kim, Yang Hei , Chae, Gi Bong; J Korean Soc Coloproctol. 2008;24(6):417-421.; DOI: https://doi.org/10.3393/jksc.2008.24.6.417

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Abstract PDF: PURPOSE
This study was performed to evaluate the usefulness of abdominal computed tomography (CT) for patients with right lower quadrant (RLQ) pain.
METHODS
Between January 2006 and July 2008, 191 consecutive patients with RLQ pain underwent abdominal CT (CT group). Forty-two patients who had undergone abdominal ultrasound (US group) and 52 patients without abdominal CT or abdominal ultrasound for RLQ pain (clinical Dx group) underwent emergent operations. Using the Alvarado scoring system, we scored all patients. The abdominal CT was performed in the abdominal and pelvic area with contrast.
RESULTS
One hundred twenty-one (63.4%) of the 191 patients in the CT group were preoperatively diagnosed as having acute appendicitis and underwent surgery. There were three cases of negative appendectomy (1.6%). In the US group and the clinical Dx group, the negative appendectomy rates were 4.8% and 3.8%, respectively. The sensitivity of the abdominal CT was 96.7%. In the CT group, in addition to acute appendicitis, colitis, nonspecific enteritis, diverticulitis, urinary stone, ovary, uterine, and diseases were indentified.
CONCLUSIONS
In this study, abdominal CT scans in patients with RLQ pain were useful for the diagnosis acute appendicitis and for the differential diagnosis of other diseases presenting with RLQ pain. The false positive rate was significantly lower in the CT group than in the other groups.

Oncologic Result as According to Tumor Regression Grade after Neoadjuvant Chemoradiation Therapy in Locally Advanced Rectal Cancer.: Park, Jong Hyun , Song, Min Sang , Min, Hyo Suk , Kim, Ji Yeon; J Korean Soc Coloproctol. 2008;24(6):422-432.; DOI: https://doi.org/10.3393/jksc.2008.24.6.422

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PURPOSE
The effects of neoadjuvant chemoradiation therapy (NCRT) in cases of locally advanced rectal cancer include tumor downstaging with respect to a curative resection and a decreasing incidence of local recurrence. The aim of this study is to evaluate the oncologic results according to the tumor regression grade (TRG) after NCRT and radical surgical resection in cases of locally advanced rectal cancer.
METHODS
From 1999 to 2003, 140 consecutive patients, who suffered from locally advanced rectal cancer (T3 or T4, or lymph node positive) were enrolled in this study. They all received neoadjuvant chemoradiation therapy and a radical resection. Chemotherapy was based on 5-fluorouracil (5-FU), and the total radiation dose was 5,040 cGy over 6 weeks. A radical surgical resection, including a total mesorectal excision, was done 6 to 8 weeks after the completion of NCRT. We classified patients into subgroups by using the TRG; then, we investigated the overall and the disease-free survival rates and the local recurrence and the distant metastasis rates.
RESULTS
One hundred twenty-six (126, 90%) patients responded to radiation therapy. According to the TRG, the numbers of non- responders (Grade I, NR), partial responders (Grade II, PR), and patients who went into complete remission (Grade III, CR) were 14 (10%), 98 (70%), and 28 (20%), respectively. The overall survival (OS) and the disease-free survival (DFS) rates for 3 years (n=140) were 91.43% and 74.29%, and the rates for 5 years (n=117) were 81.20% and 67.52%, respectively. While there was no significant difference in the 3-year OS or DFS between the three groups stratified by TRG (P=0.1136, P=0.1215), the 5-year OS and DFS showed a statistical difference (P=0.0485, P=0.0458). Furthermore, the 3-year OS and DFS rates (P=0.0451, P=0.0458), as well as the 5-year OS and DFS rates (P=0.0139, P=0.0131) were significantly better for patients in the CR group than for the other patients. Still, no statistical significance differences existed between the CR group and the non-CR groups or between the TRG groups in terms of the local recurrence and the distant metastasis rates (P=0.447, P=0.271).
CONCLUSIONS
Any tumor response group that shows complete Rremission after NCRT and radical surgical resection has an oncologic benefit in overall survival and disease- free survival in our study.

Citations

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A Phase II Study of Additional Four-Week Chemotherapy With Capecitabine During the Resting Periods After Six-Week Neoadjuvant Chemoradiotherapy in Patients With Locally Advanced Rectal Cancer
Kyung Ha Lee, Min Sang Song, Jun Boem Park, Jin Soo Kim, Dae Young Kang, Ji Yeon Kim
Annals of Coloproctology.2013; 29(5): 192. CrossRef

Expression of Vascular Endothelial Growth Factor in Colorectal Cancer.: Jo, Tai Woong , Lim, Sung Chul , Kim, Sungsoo , Min, Young Don , Kim, Kyung Jong; J Korean Soc Coloproctol. 2008;24(6):433-438.; DOI: https://doi.org/10.3393/jksc.2008.24.6.433

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Abstract PDF: PURPOSE
The neovascularization is an essential factor for the growth of solid organ cancer and especially vascular endothelial growth factor (VEGF) has been known to the very important mediator of neovascularization. Thus, this study was searching that expression of VEGF in colorectal cancer correlate to clinicopathologic factors.
METHODS
We analyzed 93 patients with sporadic colorectal cancer who underwent colectomy and their specimens were studied immunohistochemistry at Chosun University hospital from March, 2002 to November, 2005.
RESULTS
The expression rate of VEGF was 61 cases of all (65.6%). There were no significant relation VEGF expression to age, sex and lymph node metastasis. But, VEGF expression in colon cancer was 80.5% rather than 53.8% in rectal cancer (P=0.010). Correlation with T staging, expression of VEGF was 10.0% in pT0, 62.5% in pT1, pT2 and 77.2% in pT3, pT4 (P<0.0001), and correlation with TNM staging, expression of VEGF was 10.0% in stage 0, 63.2% in stage I, 72.0% in stage II, 73.3% in stage III and 100.0% in stage IV (P=0.001).
CONCLUSIONS
Expression of VEGF in colorectal cancer closely correlates with cancer progression and VEGF was more expressed in colon cancer than rectum.

Clinical Trial

Clinical Significance of Serum Carcinoembryonic Antigen (CEA) Level at Diagnosis of Liver Metastases in Patients with Colorectal Cancer.: Nam, Jung Su , Shin, Jin Yong , Kim, Kyoung Ha , Park, Jeong Ik , Kim, Woon Won , Choi, Chang Soo , Choi, Young Gil , Hong, Kwan Hee; J Korean Soc Coloproctol. 2008;24(6):439-446.; DOI: https://doi.org/10.3393/jksc.2008.24.6.439

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Abstract PDF

PURPOSE
In numerous clinical trials to stratify prognosis of patients with liver metastases (LM) from colorectal cancer (CRC), the clinical value of serum carcinoembryonic antigen (CEA) levels at diagnosis of LM has not been fully investigated in these group. The aim of this study is to explore the relation of CEA to characteristics of LM and to analyze prognostic value of this widely used tool.
METHODS
We retrospectively analyzed clinical data of 143 LM patients who were performed surgical intervention or non-surgical intervention. The cohort was divided into two groups; normal CEA group (NCEAG, <5 ng/ml, n=41) and elevated CEA group (ECEAG, > or =5 ng/ml, n=102). We examined correlation between serum CEA at diagnosis of LM and other clinicopathologic factors and performed univariate and multivariate analyses to determine the clinical impact of this marker on survival.
RESULTS
Compared to ECEAG, the characteristics of LM of NCEAG was associated with unilobar distribution of LM (P=0.003), less metastases (P<0.001), less rate of synchronocity (P=0.008) and more surgical intervention of hepatic deposits (P<0.001). The 5-year survival rate for NCEAG was better than ECEAG (P=0.031). Multivariate analysis revealed that the presence of lymphatic duct invasion, no performance of chemotherapy, bilobar distribution of LM, and treatment of non-surgical intervention had a significant effect on survival. CEA elevation was identified as independently associated with bilobar distribution and non-surgical intervention of LM.
CONCLUSIONS
Although CEA level is not a independent prognostic factor in this study, the clinical characteristics identified in this study and correlation to non surgical intervention of LM may help better patient selection in the management of CRC LM patients.

Citations

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Prognostic value of increased postoperative carcinoembryonic antigen in patients with early intestinal anastomosis leakage who underwent right hemicolectomy surgery
Seifollah Rezaei, Naser Masoudi, Mohammad Yasin Karami, Ehsan Sobhanian, Morteza Amestejani, Ali Jafari
Polish Journal of Surgery.2022; 95(1): 24. CrossRef
Preoperative carcinoembryonic antigen level as an independent prognostic factor in potentially curative colon cancer
Jung Wook Huh, Byung Ryul Oh, Hyeong Rok Kim, Young Jin Kim
Journal of Surgical Oncology.2010; 101(5): 396. CrossRef

Original Articles

Correlation between MBD2 Expressions in Colorectal Cancer Tissue and Blood.: Park, Hyun Koun , Lee, Jeong Eun , Lee, Ryung Ah , Kim, Kwang Ho; J Korean Soc Coloproctol. 2008;24(6):447-452.; DOI: https://doi.org/10.3393/jksc.2008.24.6.447

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Abstract PDF: PURPOSE
DNA methylation is a major epigenetic mechanism for modification of genetic expression without a change in the DNA sequence. MBD2 (methyl-CpG-binding domain 2 protein) belongs to a family of enzymes concerning of DNA demethylation and suppresses the hypermethylation of the CpG island and DNA transcription. In this study, we investigated the change of MBD2 expression in the blood and tissue of colorectal cancer patients and compared the two expression levels.
METHODS
The 68 patients included in this study were patients with colorectal cancer who had undergone surgery at our hospital, and 50 other patients with no malignant disease were recruited from normal populations. Total RNA samples were isolated from whole blood samples and cancer tissues of specimens using a TRI REAGENT BD kit. MBD 2 expression was measured by real-time quantitative reverse transcription-polymerase chain reaction assays.
RESULTS
The mean age was older in the case group than in the control group. The mean expression level of MBD2 in blood was not different between the two groups. In the case group, the tissue MBD2 expression was lower than the blood MBD2 expression under all conditions, and that difference was statistically significant (P<0.01). The expression of MBD2 in cancer tissue showed a negative correlation with that in the blood of cancer patients, correlation coefficient of R=0.073, but that result was not statistically significant (P=0.611).
CONCLUSIONS
The blood MBD2 expression was statistically the same in the cancer and the control groups. In the cancer group, blood MBD2 expression was significantly higher than tissue MBD2 expression. The reverse correlation between blood MBD2 expression and tissue MBD2 expression in cancer patients suggests that MBD2 may affect the mechanism of carcinogenesis.

The Prognostic Significance of ErbB1 (EGFR) Expressions in Patients with Curative Resection for Colorectal Cancers.: Kang, Sang Hee , Kim, Sung Soo , Min, Byung Wook , Lee, Joo Han , Um, Jun Won; J Korean Soc Coloproctol. 2008;24(6):453-459.; DOI: https://doi.org/10.3393/jksc.2008.24.6.453

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Abstract PDF: PURPOSE
The ErbB family is associated with cell growth, differentiation, cell survival, apoptosis, cell cycle progression, angiogenesis. In this study, the expressions of ErbB family of colorectal cancer specimen were investigated to determined correlations between the clinicopathologic characteristics and the expression of ErbB family in the curative resection for colorectal cancers, including cancer specific survival.
METHODS
Patients who underwent the curative surgery for colorectal cancers from January 1997 to December 2000 at Ansan Medical Center, Korea University College of Medicine were enrolled in this study, and one hundred ninety six of colorectal cancer. The clinical relationship between the expression of ErbB family for colon adenocarcinoma and clinicopathologic characteristic factors including survival were analyzed.
RESULTS
There was no clinical relationship of the expression of ErbB family with clinicopatholologic characteristics. However, survival analysis demonstrated that 5 year survival rates (5YSR) of patients with the positive expression of ErbB1 (EGFR) was lower than those of the negative expression of ErbB1 (P<0.05) in colorectal cancer patients. Moreover 5YSR of the positive expression of ErbB1 was lower than that of negative expression of ErbB1 in well differentiation subgroup, node negative subgroup, node positive subgroup, and also stage T3 subgroup (P<0.05).
CONCLUSIONS
The positive ErbB1 expression of colorectal cancer was one of poor prognostic factors in patients with colorectal cancer in this study. We need the further study to prove the real relation between target therapy for the positive expression of ErbB1 (EGFR) in colorectal cancer and the improvement of survival rate.

Expression of RhoA in Colorectal Cancers and Its Clinicopathological Significance.: Jung, Hae Il , Choi, Yoon Young , Baek, Moo Jun , Bae, Sang Ho , Bae, Sang Byung , Jung, Dong Jun , Kim, Sung Yong , Lee, Moon Soo , Cho, Moo Sik , Kim, Chang Ho; J Korean Soc Coloproctol. 2008;24(6):460-466.; DOI: https://doi.org/10.3393/jksc.2008.24.6.460

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Abstract PDF

PURPOSE
The Rho family of GTPases are involved in actin cytoskeleton organization and are associated with carcinogenesis and progression of human cancers. The clinicopathological significance of RhoA is not yet well known in the case of colorectal cancer. To investigate the expression of RhoA protein in colorectal carcinoma and to evaluate the relationship between RhoA protein expression and invasion and metastasis of colorectal cancer, we examined the expression of RhoA protein by using Western blotting and immunohistochemistry.
METHODS
The protein levels of RhoA in colorectal carcinomas of surgical specimens were analyzed in 71 consecutive patients with colorectal cancers by using immunohistochemistry and Western blotting. The relationships between the protein levels of RhoA in tumor tissues and the clinicopathological features of the patients were also assessed.
RESULTS
RhoA was highly expressed in 48 colorectal carcinomas (67.6%). There was a significant association between RhoA expression and lymph nodal status. The expression of RhoA protein was related to lymph-node metastasis (P=0.032) and advanced TNM tumor staging (P=0.020). RhoA expression had a significant prognostic value for overall survival. Kaplan-Meier plots of survival in patients with high RhoA showed that high RhoA expression was associated with a shorter overall survival. However, no association was found between RhoA and other pathologic or clinical variables, including age, gender, degree of differentiation, and presence of perineural spread.
CONCLUSIONS
The RhoA protein may be related to malignant transformation and development of colorectal caricinomas and may play an important role in the invasion and the metastasis of colorectal carcinomas.

Citations

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Unraveling the Role of Molecular Profiling in Predicting Treatment Response in Stage III Colorectal Cancer Patients: Insights from the IDEA International Study
Ippokratis Messaritakis, Eleni Psaroudaki, Konstantinos Vogiatzoglou, Maria Sfakianaki, Pantelis Topalis, Ioannis Iliopoulos, Dimitrios Mavroudis, John Tsiaoussis, Nikolaos Gouvas, Maria Tzardi, John Souglakos
Cancers.2023; 15(19): 4819. CrossRef

Multiple Primary Cancers Including Colorectal Cancer.: Kim, Soo Hong , Kim, Hyung Jin , Lee, Jae Im , Lee, Yoon Suk , Kang, Won Kyung , Park, Jong Kyung , Oh, Seong Taek; J Korean Soc Coloproctol. 2008;24(6):467-472.; DOI: https://doi.org/10.3393/jksc.2008.24.6.467

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Abstract PDF

PURPOSE
With advance in diagnostic techniques and treatment modalities, it has been increasing that the patients with colorectal cancer experience another primary malignancies. Understanding the characteristics of multiple primary malignancies is important to establish an effective surveillance program for the early detection of second cancer.
METHODS
The database of 2,709 patients diagnosed with colorectal cancer between 1985 and 2007 in Kangnam St. Mary's Hospital was analyzed retrospectively.
RESULTS
Out of 2,709 patients, 102 (3.76%) of them were found to have multiple malignancies. Among them, 37 patients had synchronous cancers and 65 patients had metachronous cancers. The most common site of multiple primary malignancies was the stomach, followed by kidney, thyroid and breast.
CONCLUSIONS
In the patients with colorectal cancer, it should be considered to evaluate multiple primary malignancies, especially stomach, during the routine follow up. And the most frequent multiple primary cancer before colorectal cancer was also stomach cancer. Careful attention should be paid to the colorectal cancer in stomach cancer patients.

Citations

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An Uncommon Presentation of a Metachronous Primary Gastric Tumor in a Patient with a Resected Colorectal Carcinoma: Case Report and Review of the Literature
Michalis Galanopoulos, Elisavet Nikolaidou, Christos Liatsos
Journal of Gastrointestinal Cancer.2015; 46(1): 85. CrossRef
Clinical Characteristics of Colorectal Cancer Patients With a Second Primary Cancer
Jin Woo Lee, Jong Woo Kim, Nam Keun Kim
Annals of Coloproctology.2014; 30(1): 18. CrossRef
Triple Synchronous Primary Cancers of Rectum, Thyroid, and Uterine Cervix Detected during the Workup for Hematochezia
Jun Sik Lee, Won Moon, Seun Ja Park, Moo In Park, Kyu Jong Kim, Lee La Jang, Mi Jung Park, Bong Kwuen Chun
Internal Medicine.2010; 49(16): 1745. CrossRef

Pathologic Complete Remission after Preoperative Chemoradiation for Rectal Cancer: Analysis of Clinicopathologic Characteristics and Oncologic Outcome.: Kim, Dae Dong , Yu, Chang Sik , Shin, Ui Sup , Yoon, Sang Nam , Kim, Jin Cheon; J Korean Soc Coloproctol. 2008;24(6):473-478.; DOI: https://doi.org/10.3393/jksc.2008.24.6.473

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PURPOSE
To assess the clinico-pathologic characteristics associated with pathologic complete remission (pCR) after preoperative chemoradiotherapy (PCRT) for rectal cancer and evaluate predictive factors for pCR and prognostic impact of pCR.
METHODS
We analyzed 325 patients who underwent PCRT and surgical resection between September 1999 and September 2006. We have treated 319 patients with PCRT for locally advanced rectal cancer and 6 patients for sphincter-saving procedure. Chemotherapy consisted of either of bolus 5-FU (325 mg/m2/d) or capecitabine (1,650 mg/m2/d) for the duration of radiation and after surgery. Radiation therapy was delivered and surgery was performed 4~6 weeks following the completion of PCRT. We compared pCR patients with non-pCR patients according to the clinico-pathologic characteristics and followed up with a median of 32 (range, 12~91) months.
RESULTS
The pCR (n=41, 12.6%) and non-pCR (n=284) groups were comparable in age, sex, location of the tumor, chemotherapy regimen, pre-CRT CEA level except pre-CRT clinical stage (12.2% vs. 0.4% in stage I, P= 0.047). There was no significant difference in genetic characteristics between groups. There was no specific predictive factors for pCR except pre-CRT T category (pCR in T2 (5/8, 62.5%) vs. T3 (33/283, 11.7%) or T4 (3/33, 9.1%), P=0.001). The 3-year disease free survival (DFS) was 100% and 83.6% in the pCR and non-pCR group respectively (P=0.012). There were 5 local and 34 systemic recurrences only in non-pCR group.
CONCLUSIONS
Rectal cancer patients with pCR after PCRT have an excellent prognosis and are unlikely to fail locally or systemically because of the effect of stage. However there was no specific predictive factor for pCR except preoperative T category.

Citations

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Monitoring of Residual Pesticides in Grape Seed Oil being Sold in Gyeonggi Province
Mi-Hui Son, Jae-Kwan Kim, You-Jin Lee, Ji-Eun Kim, Eun-Jin Baek, Byeong-Tae Kim, Myoung-Ki Park, Bo-yeon Kwon
Journal of Food Hygiene and Safety.2024; 39(2): 128. CrossRef

The Prognostic Impact of Obstructed Colorectal Cancer.: Jung, Hwa Kyung , Jung, Sang Hun , Kim, Jae Hwang , Shim, Min Chul; J Korean Soc Coloproctol. 2008;24(6):479-486.; DOI: https://doi.org/10.3393/jksc.2008.24.6.479

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An obstructed colorectal cancer (OB) has a poorer survival than a non-obstructed cancer (NOB). This study examined the prognostic impact of bowel obstruction on colorectal cancer.
METHODS
From December 1999 to December 2005, patients undergoing single stage operation for OB were examined prospectively. OB (n= 193) was compared with a NOB (n=444) used in a primary tumor resection during the same period. 637 colorectal cancers were examined in this study.
RESULTS
The overall operative mortality was 21 (3.3%) and the postoperative mortality was significantly higher in the OB (OB: 16, 8.3%) group than in the NOB (NOB: 5, 1.1%) group. The proportion of OB was higher in the left-colon (52.8%) than in the right colon (16.0%) and rectum (31.1%, P<0.001). However, OB was associated with an older age (P=0.013). The proportion of advanced tumor stage was higher in OB (II: 35.8%, III: 39.5%, IV: 24.7%) than in NOB (II: 53.2%, III: 35.8%, IV: 11.0%, P<0.001). The 5-year cancer-related survival for OB was worse than NOB (OB: 77.3%, NOB: 57.8%, P<0.05). However, in the cases of a colorectal cancer performed curative resection (stage II and III), the survival for OB was not worse than NOB: stage II (OB: 82.8%, NOB: 92.2%, P=0.24), stage III (OB: 65.2%, NOB: 56.9%, P=0.43).
CONCLUSIONS
OB has older and more advanced disease characteristics. However, if an oncologically curative resection is performed, the survival for OB is similar to that of a NOB.

Case Reports

Postanal Retrieval and Anastomosis in Laparoscopic Rectal Surgery: Report of 3 Cases.: Shin, Il Yong , Lee, Kwan Ju , Kim, Hyung Rae , Kim, Se Jun , Kim, Jung Koo , Kim, Hyung Jin , Lee, Dong Ho , Lee, Yoon Suk , Lee, In Kyu , Kang, Won Kyung , Ahn, Chang Hyeok , Oh, Seong Taek , Kim, Jun Ki , Ahn, Chang Joon , Lee, Sang Chul; J Korean Soc Coloproctol. 2008;24(6):487-491.; DOI: https://doi.org/10.3393/jksc.2008.24.6.487

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Abstract PDF: Laparoscopic surgery is popular and widely accepted method for colorectal cancer today. Especially in rectal cancer, laparoscopic TME made surgery safe and feasible with good outcome. But there are still some limits and difficulties in resection and anastomosis of low rectal cancer. We combined laparoscopic TME and posterior approach. Surgery was performed in three low rectal cancer patients. They were prepared in supine position and laparoscopic TME to pelvic floor muscles was performed. After changing the patient to Jack-knife position, post-anal median incision (between the external sphincter and coccyx) and distal rectal resection was done. Through this surgical window, proximal stump was retrieved and resected with the safety margin, and anastomosis with leak test was performed. After a drain keeping, patient's position was changed back to supine again and laparoscopic irrigation and inspection of operation field was done finally. In the course of recovery, two patients were uneventful, but the rest with FAP experienced postoperative anastomotic leakage and got perineal resection and permanent ileostomy. According to our experience, posterior approach after laparoscopic TME permit right angle resection of distal rectum which is difficult in laparoscopic transabdominal approach. In addition, manual anastomosis with various instruments, Lembert suture, easy drain keeping, accurate fibrin glue apply can also be achieved. No incision on abdomen adds cosmetic advantage. But frequent position changes, need of patience-demanding intracorporeal mesenteric dissection to anastomotic site, and wound discomfort during sitting position right after the operation remain as challenges to consider and solve.

Skeletal Muscle Metastasis from Colorectal Cancer: Report of a Case.: Choi, Pyong Wha , Kim, Chul Nam , Kim, Han Seong , Lee, Jung Min , Heo, Tae Gil , Park, Je Hoon , Lee, Myung Soo , Chang, Surk Hyo; J Korean Soc Coloproctol. 2008;24(6):492-496.; DOI: https://doi.org/10.3393/jksc.2008.24.6.492

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Abstract PDF

Metastases from colorectal cancer can occur by either lymphatic or hematogenous spread, and the sites most commonly involved are the liver and lung. Although skeletal muscle comprises a considerable portion of body mass and receives abundant blood supply, it is one of the most unusual sites of metastasis from any malignancies. We report a case of skeletal muscle metastasis from colorectal cancer. An 83-year-old female patient presented with a painful mass in the right posterior thigh. She had already undergone low anterior resection and right lobectomy of liver for rectal cancer with liver metastasis (T2N1M1) about 4 years ago. Although a follow-up computed tomography scan showed a metastatic solitary pulmonary nodule in the left lobe 2 years after the primary operation, she refused further aggressive treatment. Magnetic resonance imaging showed a localized mass in the semimembranosus muscle of the right thigh, and fine-needle aspiration cytology demonstrated clusters of atypical cells compatible with adenocarcinoma. The patient underwent excision of the painful mass located in the right semimembranosus muscle. Histologically, the thigh mass proved to be adenocarcinoma identical to the primary lesion. The patient died of heart failure on the 2nd postoperative day.

Citations

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Skeletal muscle metastasis from colorectal adenocarcinoma: A literature review
Nikhil Kulkarni, Ahmed Khalil, Shruti Bodapati
World Journal of Gastrointestinal Surgery.2022; 14(7): 696. CrossRef
Cardiac metastasis from colorectal cancer: A case report
Pyong Wha Choi, Chul Nam Kim, Sun Hee Chang, Woo Ik Chang, Chang Young Kim, Hyun Min Choi
World Journal of Gastroenterology.2009; 15(21): 2675. CrossRef

Review

Classification of Colorectal Cancer Based on Clinical, Morphological and Molecular Features.: Park, Sunhoo; J Korean Soc Coloproctol. 2008;24(6):497-504.; DOI: https://doi.org/10.3393/jksc.2008.24.6.497

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Abstract PDF: Colorectal cancer (CRC) has been assumed for many years to be a homogenous condition with the vast majority developing within preexisting-adenomas. However, over the last two-decades, it has become clear that CRC evolves through multiple pathways at the genetic and the epigenetic level. Each of these processes is associated with a unique genetic or epigenetic signature identifiable in the tumor cells. The pathway may be defined on the basis of three molecular features: 1) chromosomal instability (CIN), 2) microsatellite instability (MSI), and 3) CpG island methylator phenotype (CIMP). Those molecular pathways are determined at an early evolutionary stage and are fully established within early cancer. Recently, five subgroups were outlined by using morphological findings and associated molecular changes: type 1 (CIN-stable/ MSI-H/CIMP-H), type 2 (CIN-stable/MSI-L or MSS/ CIMP-H), type 3 (CIN-unstable/MSI-L or MSS/CIMP-L), type 4 (CIN-instable/MSS/CIMP-neg), and type 5 (CIN- stable/MSI-H/CIMP-neg). This approach to the classification of CRC should accelerate understanding of causation and will have an impact on clinical management in the areas of both prevention and treatment.

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