Annals of Coloproctology

Volume 25(2); April 2009

Original Articles

Re-evaluation of the Clinical Significance of the Fatigue Rate Index in the External Anal Sphincter.: Seong, Moo Kyung , Shim, Jin Suk; J Korean Soc Coloproctol. 2009;25(2):75-80.; DOI: https://doi.org/10.3393/jksc.2009.25.2.75

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PURPOSE
The fatigue rate index (FRI) has been developed to access sustained voluntary contraction of the external anal sphincter. This study is designed to refine the technical aspects of measuring the FRI and to re-evaluate its clinical significance. METHODS: Thirty-eight patients with fecal incontinence (19 males, 19 females) and 37 (21 males, 16 females) controls were studied. Anal manometry was performed by using standard protocols. Fatigue was measured over a 20-sec squeeze at a high-pressure zone. The FRI was calculated from the maximum squeeze pressure (MXSP) and the fatigue rate. For the accuracy of the calculation, the mean resting pressure (MRP) was calibrated to zero before the metric procedure, representative segments of the calculation were selectively designated as those denoting sustained squeeze, and representative channels were designated from among 8 channels by using 3 or more of those showing typical sustaining-pressure curves. RESULTS: No difference in demographic factors was detected between the two groups. Basic manometric parameters were significantly different between the two groups (MRP, 29.4+/-21.3 vs. 44.4+/-17.8 mmHg, P=0.0015; MXSP, 205.9+/-98.0 vs. 274.2+/-106.5 mmHg, P=0.0051). The FRI was also significantly different (29.8+/-14.3 vs. 86.3+/-127.1 sec, P=0.0108). The areas under the receptor operating-characteristic curves for the MRP, the MXSP, and the FRI were 0.72, 0.69, and 0.84, respectively. The sensitivity and the specificity of the FRI for detecting fecal incontinence were 80% and 65% at 40 sec as a cut-off point. CONCLUSION: The FRI was proven to be more accurate than the MRP and the MXSP in detecting incontinence. With adequate modifications of the measuring method, measurement of the FRI could be done more easily and conveniently, but its cut-off point for detecting fecal incontinence was lower than previously reported.

Citations

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Anal sphincter fatigability in assessing anal incontinence: A systematic review
Dakshitha Wickramasinghe, Nilanka Wickramasinghe, Sohan Anjana Kamburugamuwa, Nandadeva Samarasekera, Janindra Warusavitarne, Carolynne Vaizey
Neurogastroenterology & Motility.2022;[Epub] CrossRef
Increased fatigability of external anal sphincter in inflammatory bowel disease: Significance in fecal urgency and incontinence
Athanasios A. Papathanasopoulos, Konstantinos H. Katsanos, Athina Tatsioni, Dimitrios K. Christodoulou, Epameinondas V. Tsianos
Journal of Crohn's and Colitis.2010; 4(5): 553. CrossRef
Effects of Age and Sex on Anorectal Manometry
Seung Chul Heo, Sung-Bum Kang, Kyu-Joo Park, Jae-Gahb Park
Journal of the Korean Society of Coloproctology.2009; 25(5): 285. CrossRef

Complication and Relevant Factors after an Ileostomy for Fecal Diversion in a Patient with Rectal Cancer.: Kim, Jeong Yeon , Kim, Jin Soo , Hur, Hyuk , Min, Byung Soh , Kim, Nam Kyu , Sohn, Seung Kook , Cho, Chang Hwan; J Korean Soc Coloproctol. 2009;25(2):81-87.; DOI: https://doi.org/10.3393/jksc.2009.25.2.81

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Abstract PDF

PURPOSE
The proportion of sphincter-saving operations for lower rectal cancer is increasing with improved surgical techniques and additional concurrent preoperative chemo-radiation therapy. A defunctioning ileostomy or colostomy is performed after a sphincter-saving operation in the belief that diverting the fecal stream will prevent anastomotic leakage. This study was undertaken to assess all morbidity and combined problems associated with a temporary loop ileostomy. METHODS: A total of 167 patients who had undergone an ileostomy after a proctectomy between July 1997 and May 2007 were enrolled in this study. All patients were analyzed retrospectively, and the enrolled patients were registered in the Colorectal Cancer Database and were followed prospectively. Three patients did not receive an ileostomy take-down operation because of tumor recurrence.
RESULTS
Complications of ileostomy formation developed in 20 (11.9%) cases. There were no significant relevant factors influencing the complications of ileostomy formation. Complications related with ileostomy take-down developed in 33 (17.9%) cases. Longer operation time, perioperative transfusion, and postoperative radiotherapy were statistically significant factors related to the complications of ileostomy take-down (P=0.047, P=0.019, P=0.042). After ileostomy take-down, six patients were identified with complications, such as a rectovaginal fistula or an anastomotic stenosis, related with rectal cancer surgery. CONCLUSIONS: The useful ileostomy sometimes carries certain morbidity; therefore, an ileostomy should be performed selectively, and the decision should be made with care. Also, a careful evaluation of the distal part of an ileostomy is necessary before and after an ileostomy take-down.

Citations

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Risk and consequences of dehydration following colorectal cancer resection with diverting ileostomy. A systematic review and meta‐analysis
Joseph P. Borucki, Sarah Schlaeger, Jasmine Crane, James M. Hernon, Adam T. Stearns
Colorectal Disease.2021; 23(7): 1721. CrossRef
Multivariate Analysis of the Survival Rate for Treatment Modalities in Incurable Stage IV Colorectal Cancer
Sung Kang Kim, Chang Ho Lee, Min Ro Lee, Jong Hun Kim
Journal of the Korean Society of Coloproctology.2012; 28(1): 35. CrossRef
Conventional Linear versus Purse-string Skin Closure after Loop Ileostomy Reversal: Comparison of Wound Infection Rates and Operative Outcomes
Jung Ryeol Lee, Young Wan Kim, Jong Je Sung, Ok-Pyung Song, Hyung Chul Kim, Cheol-Wan Lim, Gyu-Seok Cho, Jun Chul Jung, Eung-Jin Shin
Journal of the Korean Society of Coloproctology.2011; 27(2): 58. CrossRef

Comparison of a Straight, a Coloplasty, and a Colonic J-pouch Anastomosis after a Proctectomy for Rectal Cancer.: Choi, Sang Hong , Lee, Seung Hyun , Ahn, Byung Kwon , Baek, Sung Uhn; J Korean Soc Coloproctol. 2009;25(2):88-93.; DOI: https://doi.org/10.3393/jksc.2009.25.2.88

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Abstract PDF

PURPOSE
Colonic pouches have been used to improve the reservoir function of the neorectrum after a ultra-low anterior resection for treatment of rectal cancer. The purpose of this study was to compare the safety and the functional outcome between a straight anastomosis, an anastomosis using coloplasty, and that using a colonic J-pouch in patients who had undergone an ultralow anterior resection. METHODS: From 2004 through 2006, 60 patients underwent a coloanal straight (straight group: n=23), coloplasty (coloplasty group: n=19), or colonic J-pouch (J-pouch group: n=18) anastomosis to the anal canal after a total mesorectal excision of the rectal cancer. We retrospectively reviewed the medical records of those patients for clinical outcomes according to the reservoir type. The median follow-up interval was 23.7 (4.4-40.9) mo.
RESULTS
The anastomotic leakage rate was higher in the coloplasty group (21.1%) than in the straight group (8.7%) or in the J-pouch group (0%), but the difference was not significant (P=0.1). The mean number of bowel movements per day was significantly lower in the coloplasty group (3.6) and in the pouch group (3.1) than in the straight group (6.2) (P=0.015). No statistically significant differences were found among the three groups regarding other functional outcomes, including use of antidiarrheal drugs (P=0.971), gas incontinence (P=0.256), fecal incontinence (P=0.544), use of pads (P=0.782), difficulty of evacuation (P=0.496), and use of enemas (P=0.712). CONCLUSION: Reconstruction with a coloplasty or a colonic J-pouch in patients undergoing a low colorectal or coloanal anastomosis after rectal cancer surgery seems to decrease the number of daily bowel movements compared to a straight anastomosis. However, the anastomotic leakage rate of coloplasty group was higher than that of the straight-anastomosis group.

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End-to-end anastomosis provides similar quality-of-life, compared with other reconstructive techniques six months following total mesorectal excision: Systematic review and meta-analysis
Sarolta Beáta Kávási, Diana - Elena Iov, Anett Rancz, Ádám Zolcsák, Dániel Sándor Veres, Katalin Lenti, Pál Miheller, Péter Hegyi, Szabolcs Ábrahám
European Journal of Surgical Oncology.2024; 50(10): 108599. CrossRef
A Case Study of Rectal Cancer Patient Treated with Dokhwaljihwang-tang
Anna Song, Ji-Hye An, Seong-Heun Choi, Eun-Hee Kim, So-Jeong Park, Kyung-Suk Kim, Soo-Kyung Lee
Journal of Sasang Constitutional Medicine.2013; 25(1): 62. CrossRef

Concomitant Adjacent Organ Resection in Locally Advanced Colon Cancer.: Cho, Sung Wook , Lee, Ryung Ah , Chung, Soon Sup , Kim, Kwang Ho; J Korean Soc Coloproctol. 2009;25(2):94-99.; DOI: https://doi.org/10.3393/jksc.2009.25.2.94

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PURPOSE
In locally advanced adherent colon cancer surgery, a mutivisceral resection is known to reduce local recurrence and improve survival. Practically, the benefit of using this procedure may outweigh the risk of associated morbidity, but the procedure may not be performed uniformly. We reviewed the results of multivisceral resections for locally advanced colon cancer. METHODS: From 2003 January to 2008 January, 476 colon cancer patients underwent surgery for locally advanced colon cancer in our hospital. Out of the 476 patients, 36 patients with pT3-pT4 who underwent any kind of adjacent organ resection other than a resection of the colon were reviewed retrospectively. RESULTS: Out of the 36 patients, 22 were male and 14 were female, and the mean age was 63.44+/-13.26 yr. The sigmoid colon was the most common location for the primary lesion, followed by the ascending colon, the transverse colon, and the cecum. Invaded organs were the abdominal or pelvic wall in 5 patients, the visceral organs in 26 patients, the retroperitoneum in 2 patients. All patients received an en-bloc resection of the invaded organs. Ten patients were stage II, 14 patients were stage III, and 12 patients were stage IV. Fifteen patients were disease free at the end of this study, local recurrence had occurred in 1 patient, 6 patients had an intraabdominal recurrence, and 2 patients had developed a distant metastasis. The overall complication rate was 28%. The 5-yr survival rate of each stage according to the surgical approach did not show any meaningful difference. CONCLUSION: A multivisceral en-bloc resection has been recommended for locally advanced adherent colon cancer patients. To improve the outcome, we suggest progressive surgical treatment in such patients.

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Analysis of the Prognostic Effectiveness of a Multivisceral Resection for Locally Advanced Colorectal Cancer
Sejin Park, Yun Sik Lee
Journal of the Korean Society of Coloproctology.2011; 27(1): 21. CrossRef

Health-related Quality of Life of Patients with Rectal Cancer.: Min, Hyo Suk , Kim, Ji Yeon; J Korean Soc Coloproctol. 2009;25(2):100-106.; DOI: https://doi.org/10.3393/jksc.2009.25.2.100

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Abstract PDF

PURPOSE
This study was a latitudinal descriptive effort to understand the degree of quality of life of patients who had undergone a rectal cancer operation. METHODS: The Korean versions of European Orgaization for Research and Treatment of Cancer (EORTC)-Quality of life Questionnaire 30 (QLQ-C30) and Colorectal Cancer-specific Core Questionnaire (QLQ-CR38) were used to examine the degree of quality of life of patients who had undergone a rectal cancer operation. The subjects of this study were 155 patients who had been diagnosed as having rectal cancer and who had received an anterior resection (AR), a low anterior resection (LAR), or an abdominoperineal resection (APR).
RESULTS
In our study, patients' responses were combined and converted to a 0-100 scale according to the guidelines provided by the EORTC Center. From these guidelines, high functional scores (0-100) represent good function and high symptom scores (100-0) signify more problems. The APR patients had their social and family life disrupted (social functioning) and were less able to get about and look after themselves (physical functioning), and they felt themselves to be less attractive (body image). In addition, the scores for stoma problems were worse than those for pain and for male sexual problems. The AR patients and the LAR patients, despite suffering diarrhea, symptoms of insomnia, and defecation problems, had better quality of life than the APR patients without anorectal function. CONCLUSION: If the quality of life of rectal cancer patients is to be maintained and their rate of survival is to be increased, an understanding of the patients' situation, education on self-management related to stoma, and active provision of support from medical teams to solve the discomfort caused by the operation are needed.

Citations

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The Effect of Nutrition Intervention with Oral Nutritional Supplements on Pancreatic and Bile Duct Cancer Patients Undergoing Chemotherapy
Seong Hyeon Kim, Song Mi Lee, Hei Cheul Jeung, Ik Jae Lee, Joon Seong Park, Mina Song, Dong Ki Lee, Seung-Min Lee
Nutrients.2019; 11(5): 1145. CrossRef
Factors Influencing Quality of Life during Chemotherapy for Colorectal Cancer Patients in South Korea
Yongae Baek, Myungsun Yi
Journal of Korean Academy of Nursing.2015; 45(4): 604. CrossRef
Sexual Function After a Proctectomy for the Treatment of Rectal Cancer
Young Wan Kim, Ik Yong Kim
Annals of Coloproctology.2014; 30(5): 205. CrossRef
Relationships between Anxiety, Depression, Low Anterior Resection Syndrome, and Quality of Life Following Lower Anterior Resection for Rectal Cancer
Eun Lee, Keum Soon Kim
Perspectives in Nursing Science.2014; 11(1): 74. CrossRef

Clinical Significance of p53 and Ki-67 Expression in Colorectal Cancer.: Huh, Jung Wook , Kim, Hyeong Rok , Cho, Sang Hyuk , Kim, Young Jin; J Korean Soc Coloproctol. 2009;25(2):107-112.; DOI: https://doi.org/10.3393/jksc.2009.25.2.107

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Abstract PDF: PURPOSE
This study aimed to evaluate the clinical significance of p53 and Ki-67 expressions in patients with colorectal cancer. METHODS: Immunohistochemical expressions of p53 and Ki-67 in 205 patients with colorectal cancer were examined. Results were correlated with clinical and pathological parameters. RESULTS: Overexpression of p53 was significantly associated with a proximal location of the tumor (P=0.031) and with lymph node involvement (P=0.030); however, Ki-67 expression was not correlated with any of the clinicopathological variables. Positive p53 staining was significantly associated with a higher level of Ki-67 (P=0.009). CONCLUSIONS: Overexpression of p53 was strongly correlated with lymph node metastasis in colorectal cancer; thus, p53 may be used as a possible prognostic marker in patients with colorectal cancer.

Usefulness of Self-expandable Metallic Stents for Malignant Colon Obstruction.: Kim, Ho Hyun , Kim, Ho Kun , Cho, Sang Hyuk , Huh, Jung Wook , Rhyu, Seong Yeop , Kim, Heong Rok , Kim, Dong Yi , Kim, Young Jin , Ju, Jae Kyun; J Korean Soc Coloproctol. 2009;25(2):113-116.; DOI: https://doi.org/10.3393/jksc.2009.25.2.113

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PURPOSE
Treatment for malignant colonic obstruction consists of a multiple-staged emergency operation. In recent years, some authors have reported low morbidity and mortality rates using self-expandable metallic stents. This study is designed to evaluate the usefulness of self-expandable metallic stents in patients with malignant colonic obstruction. METHODS: The records of 38 patients who had undergone surgery for malignant colonic obstruction at our institution between January 2004 and August 2006 were reviewed retrospectively. Seventeen patients were treated with elective surgery after stent insertion, bowel decompression, and bowel preparation (stent group), and 21 patients were treated with emergency surgery without stent insertion (control group). RESULTS: There were no significant differences in age, sex, tumor node metastasis (TNM) stage, or cancer position between the two groups (elective operation after stent insertion vs. emergency operation). Of the 17 patients who underwent elective operation after stent insertion, primary anastomosis was possible in 15 (88.2 vs. 57.1% in the control group), with a lower need for a colostomy (11.8 vs. 42.9% in the control group, P=0.036). Also, the number of patients with severe complications (17.6 vs. 47.6% in the control group, P=0.048) and the hospital stay (10.82 vs. 13.43 days in the control group, P=0.032) were significantly lower in the study group.
CONCLUSION
Placement of a self-expandable metallic stent for malignant colonic obstruction is a safe and effective procedure. It can reduce the colostomy, mortality, and morbidity rates and the hospital fee for treatment.

Citations

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Management of left-sided malignant colorectal obstructions with curative intent: a network meta-analysis
Tyler McKechnie, Jeremy E. Springer, Zacharie Cloutier, Victoria Archer, Karim Alavi, Aristithes Doumouras, Dennis Hong, Cagla Eskicioglu
Surgical Endoscopy.2023; 37(6): 4159. CrossRef
Oncologic safety of self-expanded metal stent insertion as a bridge to elective surgery in malignant colorectal obstruction
Se Hui Oh, Nak Jun Choi, Sang Hyuk Seo, Min Sung An, Kwang Hee Kim, Ki Beom Bae, Jin Won Hwang, Sang Heon Lee, Ji Hyun Kim, Sam Ryong Jee, Mi Seon Kang, Kwan Hee Hong
Korean Journal of Clinical Oncology.2016; 12(1): 48. CrossRef
Comparison of short-term outcomes after elective surgery following endoscopic stent insertion and emergency surgery for obstructive colorectal cancer
Gil Jae Lee, Hyo Jun Kim, Jeong-Heum Baek, Won-Suk Lee, Kwang An Kwon
International Journal of Surgery.2013; 11(6): 442. CrossRef
Multivariate Analysis of the Survival Rate for Treatment Modalities in Incurable Stage IV Colorectal Cancer
Sung Kang Kim, Chang Ho Lee, Min Ro Lee, Jong Hun Kim
Journal of the Korean Society of Coloproctology.2012; 28(1): 35. CrossRef

Case Reports

A Case of Acute Appendicitis due to Appendicular Tuberculosis.: Shin, Seong Hwan , Kim, Yong Ho; J Korean Soc Coloproctol. 2009;25(2):117-120.; DOI: https://doi.org/10.3393/jksc.2009.25.2.117

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Abstract PDF: The most common presentation of abdominal tuberculosis is an ileocecal disease, but isolated appendicular involvement is rarely seen. It is difficult to make diagnosis of intestinal tuberculosis because it may mimic many other intestinal diseases. The symptoms are nonspecific such as fever, fatigue and weight loss. A 35-yr-old woman with no remarkable past medical history was admitted due to intermittent abdominal pain of 3 mo duration. The patient underwent laparoscopy-assisted partial ileocecectomy including diseased appendix. Tuberculous appendicitis was finally diagnosed with all considerations of possible pathological results. We report a case of acute appendicitis due to tuberculous involvement with a review of the literature.

Adult Sigmoido-recto-anal Intussusception by a Sigmoid Colon Adenoma.: Park, Young Jin; J Korean Soc Coloproctol. 2009;25(2):121-124.; DOI: https://doi.org/10.3393/jksc.2009.25.2.121

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Although rectal procidentia is not an uncommon disease, presentation of more proximal segments of the large bowel through the anus is extremely rare. A case with sigmoido-recto-anal prolapse secondary to a large adenoma of the sigmoid colon is reported herein. A 28-yr-old man with an anal prolapsing mass was admitted to our hospital. Preoperative CT scan showed a sigmoid-recto-anal prolapse. An emergency operation was decided upon because the prolapsed segment was irreducible and because its viability was questionable. After a manual reduction of the mass, an anterior resection was performed under general anesthesia. The pathologic diagnosis of the resected specimen was a large villo-tubular adenoma.

Citations

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Laparoscopic Treatment of Adult Sigmoidorectal Intussusception Caused by a Mucinous Adenocarcinoma of the Sigmoid Colon: A Case Report
Seok Youn Lee, Won Cheol Park, Jeong Kyun Lee, Dong Baek Kang, Young Kim, Ki Jung Yun
Journal of the Korean Society of Coloproctology.2011; 27(1): 44. CrossRef

A Case of Colonic Cavernous Hemangioma Misdiagnosed as a Pedunculated Polyp.: Yi, Kum Ho , Hahm, Ki Baik; J Korean Soc Coloproctol. 2009;25(2):125-128.; DOI: https://doi.org/10.3393/jksc.2009.25.2.125

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Abstract PDF: Gastrointestinal hemangioma is a relatively uncommon benign vascular tumor that can occur anywhere in the gastrointestinal tract. It is the second most common vascular lesion of the colon and a clinically important entity because of the possibility of massive hemorrhage when complicated. In gross appearance, hemangioma presents variously as a pedunculated, subpedunculated, or flat elevated lesion similar to a submucosal tumor. A typical case of hemangioma is relatively easy to diagnose because the lesion presents as translucent blue-purple vessels under the mucosa. However, it can be difficult to diagnose in some cases, especially if it does not have its usual characteristic color or is covered with normal mucosa. We incidentally found a colonic hemangioma that had the unusual appearance of a pedunculated polypoid lesion with normal mucosa. It was misdiagnosed as a pedunculated polyp with a long, thick neck and treated by using an endoscopic mucosal resection.

Review

Genomic Instability in Colorectal Cancer; from Bench to Bed.: Lee, Kang Young; J Korean Soc Coloproctol. 2009;25(2):129-138.; DOI: https://doi.org/10.3393/jksc.2009.25.2.129

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Abstract PDF: Colorectal cancer is a disease developed by the accumulation of genomic alteration. Two genomic instability pathways, chromosomal instability pathway and microsatellite instability pathway, are known as the main pathways of the development of colorectal cancer. These are almost always mutually exclusive and tumors developed through each pathways show distinct clinicopathologic features. For the reason, molecular markers which represent each genomic instability pathways have been a candidate for translational research to find out prognostic or predictive factors. Loss of heterozygosity and aneuploidy are the hallmark of chromosomal instability and regarded as poor prognostic markers, whereas tumors with high frequency of microsatellite instability show better prognosis than microsatellite stable tumor. As a predictive factor of response from chemotherapy, loss of heterozygosity seems to be associated with a survival benefit from 5-FU adjuvant therapy. MSI-H has been reported as a predictive factor for poor response to 5-FU adjuvant chemotherapy. However, these molecular markers are not accepted to use in the clinic yet, since some of this kind of studies reported contradictory results. Further study will be needed to make more concrete evidences for these markers and to identify new molecular markers for routine use in the clinic.

Original Article

ERRATUM:Dual Therapy and Triple Therapy of Prophylactic Antibiotics After Elective Colorectal Surgery: A Comparative Study.: Kim, Yoon Seok , Lee, Seung Hyun , Ahn, Byung Kwon , Baek, Sung Uhn; J Korean Soc Coloproctol. 2009;25(2):142-142.; DOI: https://doi.org/10.3393/jksc.2009.25.2.142

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Abstract PDF: he conclusion should be corrected as The addition of aminoglycoside to dual antibiotic therapy, second cephalosporinmetronidazole showed no advantage in prevention of postoperative wound complications. Journal of The Korean Society of Coloproctology apologizes to the readers for this error.

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