Annals of Coloproctology

Volume 25(4); August 2009

Original Articles

Early Experience with Doppler-guided Hemorrhoidal Artery Ligation.: Lim, Minho , Kim, Kwang Ho , Chung, Soon Sup , Nam, Sun Young , Lee, Ryung Ah; J Korean Soc Coloproctol. 2009;25(4):215-220.; DOI: https://doi.org/10.3393/jksc.2009.25.4.215

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PURPOSE
Doppler-guided hemorrhoidal artery ligation (HAL) is an alternative technique to the standard Milligan-Morgan hemorrhoidectomy. The purpose of this pilot study is to introduce the HAL technique for grade 2-3 internal hemorrhoids and to evaluate the efficacy of this technique in Korea in terms of results and patient satisfaction.
METHODS
The HAL procedure was performed on 29 patients with grade 2 or 3 internal hemorrhoids. Twenty-eight procedures were performed under local anesthesia with lidocaine, and one procedure was performed under general anesthesia due to synchronous surgery for gallstones. With the lithotomy position, the pulsation of the hemorrhoidal artery was localized using a doppler probe, and 3-6 branches of the hemorrhoidal artery were ligated with vicryl 2-0. Patient course was evaluated before and after the procedure by using questionnaires with a visual analog scale. RESULTS: The mean age of the patients was 44+/-24 yr. There were no significant complications with this procedure. At 3 mo after the operation, symptom scores of anal pain, anal bleeding, and anal prolapse were significantly improved (0.4, 1.0, and 2.4, respectively) compared to the symptom scores before the operation (3.4, 4.6, and 5.9, respectively). The postoperative satisfaction score was 8.1, and the recommendation score was 8.5. CONCLUSION: HAL is a safe and effective technique to relieve anal pain, bleeding, and prolapse of internal hemorrhoids. A comparative study with other procedures and a long-term follow-up after HAL should be the basis for valdating the efficacy of this procedure.

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Early Experience of Treatment for Symptomatic Hemorrhoids with Doppler Guided Hemorrhoidal Artery Ligation and Recto-anal Repair
Byoung-Hoon Jo, Jong Kyung Park, In Kyu Lee, Hyung-Jin Kim, Yoon-Suk Lee, Jae-Im Lee, Soo-Hong Kim, Won-Kyung Kang
Journal of the Korean Surgical Society.2010; 79(2): 116. CrossRef

Prognosis and Recurrent Patterns of Sporadic Primary Colon Cancers According to Location.: Park, Jin Seok , Yu, Chang Sik , Kim, Chan Wook , Jeong, Kwang Yong , Shin, Ui Sup , Yoon, Sang Nam , Lim, Seok Byung , Kim, Jin Cheon; J Korean Soc Coloproctol. 2009;25(4):221-226.; DOI: https://doi.org/10.3393/jksc.2009.25.4.221

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PURPOSE
We aimed to compare the prognosis and the recurrence patterns of sporadic primary colon cancers according to the location of the cancer. METHODS: One thousand four-hundred eighty-three (1,483) stage II, III colon cancer patients who had undergone a consecutive curative resection between January 1989 and December 2003 were analyzed. Hereditary, synchronous, metachronous, and recurrent colon cancers were excluded. The right colon was defined as being from the cecum to the transverse colon, and the left colon was defined as being from the splenic flexure colon to the rectosigmoid colon. The median follow-up time was 63 (3-228) mo. RESULTS: Poorly differentiated and mucinous cell type tumors were more frequent in the right colon. T3 tumors were more frequent in the right colon. Lymph-node-positive tumors were more frequent in the left colon. The recurrence rate was higher in the left colon, but the patterns of recurrence were not different according to the tumor's location. By univariate analysis, age, preoperative serum CEA level, T-stage, N-stage, lymphovascular invasion, postoperative chemotherapy, and tumor location were significant prognostic factors associated with recurrence. By multivariate analysis, sex, preoperative serum CEA level, T-stage, N-stage, postoperative chemotherapy, and tumor location were significant prognostic factors associated with recurrence. The 5-yr disease-free survival rates were 84.0% for right colon cancer and 77.1% for left colon cancer (P=0.005). The recurrence rates for cancers in the sigmoid colon and the rectosigmoid colon were higher than those for cancers in the cecum and the ascending colon. CONCLUSION: The tumor's location was an independent prognostic factor for recurrence, but the pattern of recurrence did not vary with the tumor's location.

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Survival analysis for colon subsite and rectal cancers: Experience from a single surgeon
Inhwa Lee, Seung-Hyun Baek, Hyunsung Kim, Hong-Jae Jo, Nahm-Gun Oh, Sanghwa Ko
Korean Journal of Clinical Oncology.2015; 11(2): 114. CrossRef

Hand-foot Syndrome Following Capecitabine (Xeloda(R)) Monotherapy for Colorectal Cancer.: Park, Soon Do , Lee, Kil Yeon , Park, Sun Jin , Lee, Suk Hwan , Lee, Sang Mok; J Korean Soc Coloproctol. 2009;25(4):227-233.; DOI: https://doi.org/10.3393/jksc.2009.25.4.227

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PURPOSE
Capecitabine (Xeloda(R)), which is a systemic prodrug of 5-fluorouracil, can be used in oral formulation for treatment of advanced colorectal cancer as a 1st line or an alternative modality to I.V. 5-fluorouracil-based chemotherapy. One of the most common side effects of this drug is hand-foot syndrome (HFS), palmar-plantar erythrodysesthesia syndrome. We planned this study to clarify the incidence and the clinical course of severe hand-foot syndrome (WHO classification, grade 3 or 4) following capecitabine monotherapy for adjuvant treatment of colorectal cancer. METHODS: From August 2006 to August 2008, 45 colorectal cancer patients were treated with capecitabine, 1,250 mg/m2, orally administered twice daily for 2 wk, followed by 1 wk of rest, given as 3-wk cycles. Seven of them discontinued the drug within 3rd cycle due to poor performance status, gastrointestinal troubles, or other causes. We retrospectively analyzed the remaining 38 patients' medical records and defined the incidence and the clinical course of HFS. RESULTS: Of the 38 patients, 17 (44.7%) suffered severe HFS after capecitabine monotherapy. Of those 17, 5 (29.4%) had severe symptoms after the 1st chemotherapy cycle, and 14 patients (82.4%) had severe symptoms within the 4th cycle. Three of the 14 female and 14 of the 24 male patients complained of severe HFS, showing a statistical male predominance (P=0.043). Eventually, we had to decrease capecitabine to 75% of the daily dose in 12 patients and to 50% in one patient, and to discontinue its use in 4 patients. CONCLUSION: Capecitabine monotherapy very frequently provokes severe HFS, especially in the early cycles of chemotherapy and in males.

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Analysis of data on capecitabine-related adverse drug reactions from the Korean adverse event reporting system database
Jeong Yun Park
European Journal of Oncology Nursing.2018; 34: 55. CrossRef

Synchronous Colorectal Cancer.: Lee, Hui Song , Park, Jun Ho , Lee, Ru Ji , Cho, Yong Kwon , Yun, Hae Ran , Cho, Yong Beom , Yun, Seong Hyeon , Kim, Hee Cheol , Lee, Woo Yong , Chun, Ho Kyung; J Korean Soc Coloproctol. 2009;25(4):234-240.; DOI: https://doi.org/10.3393/jksc.2009.25.4.234

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PURPOSE
Synchronous colorectal cancer is clinically significant because there is a chance to miss concurrent lesions. The aim of this study is to investigate the clinical features of synchronous colorectal cancer. METHODS: Retrospectively, the records of 4,494 colorectal cancer patients who underwent a potentially curative resection for colorectal cancer from September 1994 to December 2005 were reviewed. Synchronous colorectal cancer was defined according to the following two criteria: 1) two or more colorectal cancers had to be found simultaneously in the same patient and 2) each of the tumors had to be distinctly separated by an intact bowel wall. RESULTS: Synchronous colorectal cancer was diagnosed in 114 patients (2.5%). Synchronous colorectal cancer shows different features compared with single colorectal cancer. Synchronous colorectal cancer occurs at a older age, occurs more frequently in the colon, has a bigger size, and has more polyps. There was no difference of stage based on survival rate between synchronous and single colorectal cancer patients. The preoperative diagnosis rate of synchronous colorectal cancer was 74.6%. Eleven (9.6%) synchronous colorectal cancer patients underwent a total colectomy, and there were no significant differences in survival or complications compared with the other group. CONCLUSION: Synchronous colorectal cancer is difficult to diagnose preoperatively. Early postoperative examination for synchronous colorectal cancer is required, especially in patients who did not have a complete preoperative evaluation.

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Computed tomography has low sensitivity for the diagnosis of early colon cancer
I‐H. Lao, H. Chao, Y.‐J. Wang, C.‐W. Mak, W.‐S. Tzeng, R.‐H. Wu, S.‐T. Chang, J.‐L. Fang
Colorectal Disease.2013; 15(7): 807. CrossRef
Barium Zirconium Titanate Powders Prepared by Sol–Gel Method
Xiao Ling Deng, Dong Jiao Guo, Wei Cai, Chun Lin Fu
Advanced Materials Research.2011; 412: 86. CrossRef

Mucinous Histology as a Predictive Marker of 5-Fluorouracil-based Adjuvant Chemotherapy for Colon Cancer.: Kang, Jeonghyun , Min, Byung Soh , Park, Yoon Ah , Kim, Nam Kyu , Sohn, Seung Kook , Cho, Chang Hwan , Lee, Kang Young; J Korean Soc Coloproctol. 2009;25(4):241-247.; DOI: https://doi.org/10.3393/jksc.2009.25.4.241

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PURPOSE
The aim of this study was to evaluate the value of mucinous histology as a predictive marker of 5-Fluorouracil (FU)-based adjuvant chemotherapy in stage II, III colon cancer. METHODS: Between January 1995 and December 2004, 987 patients who underwent curative resections for stage II, III sporadic colon cancer were classified into two groups, a mucinous carcinoma (MC) group and a non-mucinous carcinoma (NMC) group, based on the histology of the primary tumor. The differences in their clinicopathological characteristics and the prognostic impact of 5-FU-based adjuvant chemotherapy for various tumor histologies were analyzed.
RESULTS
Of the 987 patients, MCs accounted for 6.8% (68 patients). MCs were more frequently located in the Rt. Colon (P<0.001) and were more frequently seen in young patients (less than 40 yr old) (P=0.028). The 5-yr survival rates between MC and NMC did not show any statistically significant difference. Patients, including both MC and NMC patients, who received 5-FU-based chemotherapy, revealed a better overall survival rate than patients with no adjuvant chemotherapy. In the multivariate analysis for the prognosis in NMC patients, 5-FU-based adjuvant chemotherapy, initial negative nodal status, and preoperative CEA <5 ng/mL were statistically significant prognostic factors (P values: <0.001, <0.001, and <0.001, respectively). In contrast, there was no statistically independent significance of 5-FU-based adjuvant chemotherapy in MC patients. CONCLUSION: In stage II and stage III sporadic colon cancer patients, response to 5-FU-based adjuvant chemotherapy in MC patients might be poor than it is in NMC patients.

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Early recurrence in patients undergoing curative surgery for colorectal cancer: is it a predictor for poor overall survival?
Jung Wook Huh, Chang Hyun Kim, Sang Woo Lim, Hyeong Rok Kim, Young Jin Kim
International Journal of Colorectal Disease.2013; 28(8): 1143. CrossRef

Colon Cancer Secondary to Hematologic Disease.: Kim, Do Hyoung , Jee, Sung Bae , Si, Youn , Lee, Yoon Suk , Kang, Won Kyung , Oh, Seong Taek , Lee, In Kyu; J Korean Soc Coloproctol. 2009;25(4):248-251.; DOI: https://doi.org/10.3393/jksc.2009.25.4.248

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Abstract PDF: PURPOSE
The incidence of secondary malignancies in hematologic patients is known to be higher than it is in other patients. However, the characteristics of secondary malignancy and surveillance have not yet been established for colorectal cancer in leukemic patients. METHODS: From 1995 to 2007, 6,030 patients who were diagnosed with acute myeloid leukemia (AML), acute lymphoid leukemia (ALL), chronic myeloid leukemia (CML), chronic lymphoid leukemia (CLL), and multiple myeloma (MM) were enrolled in this study. Among them, 9 patients were diagnosed with colorectal cancer at St. Mary's Hospital and were analyzed retrospectively. RESULTS: Three of the 2,570 patients with AML, 1 of the 1,158 patients with CML, 2 of the 83 patients with CLL, 2 of the 422 patients with MM, and none of the 1,797 patients with ALL were found to have colorectal cancer. There were no operative mortalities, but 2 patients refused to have surgery. The ratio of observed to expected subsequent colorectal cancer in CLL was higher than it was in the other groups, indicating that the relative risk of colorectal cancer is higher in patients with CLL.
CONCLUSION
Compared to the Surveillance, Epidemiology and End-Result (SEER) program at the National Cancer Institute (NCI) in the United State, we have the same high relatively risk in CLL patients. Careful attention should be paid to the possibility of colorectal cancer in CLL patients.

Initial Experiences with a Laparoscopic Colorectal Resection: a Comparison of Short-term Outcomes for 50 Early Cases and 51 Late Cases.: Seon, Jang Won , Huh, Jung Wook , Cho, Sang Hyuk , Joo, Jae Kyoon , Kim, Hyeong Rok , Kim, Young Jin; J Korean Soc Coloproctol. 2009;25(4):252-258.; DOI: https://doi.org/10.3393/jksc.2009.25.4.252

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PURPOSE
The present study aimed to investigate the safety and the feasibility of laparoscopic colorectal surgery performed by a surgeon during a learning period. METHODS: Between April and December 2008, 101 consecutive patients with colorectal cancers underwent laparoscopic surgery by one colorectal surgeon who previously had no experience with laparoscopic colorectal surgery. Standard laparoscopy with a lymphadenectomy using a 5-port technique was performed according to the tumor location. The patients were divided into two chronological groups: 50 cases early in learning period (early cases) and 51 cases later in the learning period (late cases). RESULTS: The operations were 29 right hemicolectomies, 9 left hemicolectomies, 18 anterior resections, 35 low anterior resections, 6 intersphincteric resections, 2 abdominoperineal resections, and 2 Hartmann's operation. There were 7 conversions (6.9%). The median operating time was 205 (range, 95-385) min, and the median blood loss was 258 (50-800) mL. The median times to flatus per anus and to feeding of soft diet were 2 (1-5) and 4 (2-13) days, respectively. The median hospital stay was 9 (6-27) days. There were 21 postoperative complications, including 7 anastomotic complications (3 leakages, 3 abscesses, and 1 stenosis). The median number of lymph nodes harvested was 20 (4-65). The operating time, blood loss, and complication rates were significantly decreased in the late group. CONCLUSION: Our initial experience with laparoscopic colorectal surgery appears to have acceptable perioperative results and short-term oncologic outcomes, which improved with the experience of the surgeon.

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Initial experience of a surgical fellow in laparoscopic colorectal cancer surgery under training protocol and supervision: comparison of short-term results for 70 early cases (under supervision) and 73 late cases (without supervision)
Ji-Hun Kim, In-Kyu Lee, Won-kyung Kang, Seung-Teak Oh, Jun-Gi Kim, Yoon-Suk Lee
Surgical Endoscopy.2013; 27(8): 2900. CrossRef

Case Reports

Plexiform Neurofibroma Involving the Ascending Colonic Mesentery in Neurofibromatosis Type I.: Park, Sun Jin , Choi, Sung Il , Lee, Suk Hwan , Lee, Kil Yeon; J Korean Soc Coloproctol. 2009;25(4):259-263.; DOI: https://doi.org/10.3393/jksc.2009.25.4.259

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We report a rare case of plexiform neurofibroma involving the ascending colonic mesentery in von Recklinghausen disease. A 20-yr-old male with neurofibromatosis type I was admitted because of abdominal pain, nausea, and vomiting. On physical examination, there were multiple cafe-au-lait spots over the patient's entire body. An abdominal computed tomography scan showed a hypodense mass in the ascending colonic mesentery. He underwent a laparoscopic right hemicolectomy with complete excision of the mass. The histological examination showed that the mass consisted of wavy, long-spindled cells, and the immunohistochemical stain for S-100 protein confirmed the mass to be a neurofibroma of the mesentery. The patient had an uneventful postoperative course and no signs of recurrence 16 mo after operation.

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Sigmoid colon plexiform neurofibroma as a colonic subepithelial mass: a case report
Hee Won Baek, Eun Jeong Choi, Seung Jung Yu, Myeongpyo Kim, Sang Heon Lee, Sam Ryong Jee, Hyungjoo Baik, Hong Sub Lee
Kosin Medical Journal.2023; 38(2): 138. CrossRef

Solitary Polypoid Ganglioneuroma of the Cecum.: Park, Ji young , Kang, Yu Na , Park, Kyung Sik , Choe, Misun; J Korean Soc Coloproctol. 2009;25(4):264-267.; DOI: https://doi.org/10.3393/jksc.2009.25.4.264

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A ganglioneuroma is a very rare neoplasm in the gastrointestinal tract and consists of ganglion cells, nerve fibers, and supporting cells. A gastrointestinal ganglioneuroma is occasionally related to inherited diseases, like neurofibromatosis type I and multiple endocrine neoplasm type 2b. We have experienced a case of a solitary polypoid ganglioneuroma in the cecum of a patient with no history of inherited diseases. The patient was a 56-yr-old male who had suffered from dyspepsia for a year. On the colonoscopic examination, a sessile polyp, measuring 0.7 x 0.7 cm in greatest dimensions, was discovered and eliminated. The remaining large intestine was unremarkable. Microscopically, the polyp was composed of isolated or nested ganglion cells admixed with a proliferation of spindle cells in the mucosa and the submucosa. The background showed interspersed cystic glands in an expanded lamina propria. Immunohistochemically, the ganglion cells were positive for NSE and NeuN while the spindle cells demonstrated a positive response to S-100 protein. Since a ganglioneuroma has a benign nature, complete resection is the treatment of choice.

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Diffuse Ganglioneuromatosis of the Colon Presenting as a Large Subepithelial Tumor in Adults: Report of Two Cases
Tae-Jun Kim, Hyun Lim, Ho Suk Kang, Sung Hoon Moon, Jong Hyeok Kim, Choong Kee Park, Mi Jung Kwon, Bong Hwa Lee
The Korean Journal of Gastroenterology.2015; 66(2): 111. CrossRef
A Case of Isolated Ileal Ganglioneuroma
Ju Hyung Song, Byong Duk Ye, Yong Sik Yoon, Mi-Jung Kim, Dong-Hoon Yang, Kee Wook Jung, Kyung-Jo Kim, Jung-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Jin-Ho Kim
Intestinal Research.2011; 9(1): 46. CrossRef

Laparoscopic Right Hemicolectomy and Cholecystectomy for a Cholecystocolic Fistula.: Jung, So Young , Lee, Seung Jin , Cho, Ji Woong , Jung, Jae Pil , Kim, Jin Bae , Woo, Ji Young , Kim, Byung Chun; J Korean Soc Coloproctol. 2009;25(4):268-272.; DOI: https://doi.org/10.3393/jksc.2009.25.4.268

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A cholecystocolic fistula (CF) is an uncommon complication of the gallbladder and colonic disease. We report a case of a CF that was successfully managed by using a laparoscopic right hemicolectomy and cholecystectomy. A 49-yr-old woman was admitted to the Department of Internal Medicine because of intermittent and progressive right upper quadrant pain. She was obese (body mass index: 34 kg/m2) and had a previous history of three abdominal surgeries. She was diagnosed with a CF by using abdominal computed tomography. The fistula between the gallbladder and the hepatic flexure of the colon was also characterized by using technetium-99m diisopropyl iminodiacetic acid ((99m)Tc-DISIDA) cholescintigraphy, a double-contrast Barium enema, and colonoscopy. Multiple polyps with severe inflammation were observed around the orifice of the fistula. Because of the risk of malignancy and appendicolith on CT, a laparoscopic en block excision of the gallbladder and the right colon following adhesiolysis was performed. The postoperative course was uneventful, and the patient was discharged on postoperative day 9. This case shows that the laparoscopic combined resection is safe and effective in the experienced hands of the laparoscopic surgeon even though a CF has traditionally been considered as a contraindication to laparoscopic surgery. While the incidence of successful management of biliary-enteric fistulas through laparoscopic repair is increasing, this is the first report of a laparoscopic combined resection of a CF in an obese patient with severe intraabdominal adhesion.

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Cholecystocolic fistula caused by gallbladder carcinoma: Preoperatively misdiagnosed as hepatic colon carcinoma
Gi Won Ha, Min Ro Lee, Jong Hun Kim
World Journal of Gastroenterology.2015; 21(15): 4765. CrossRef

Review

Role of Radiation Therapy as an Adjuvant Treatment in Rectal Cancer Management.: Oh, Jae Hwan , Kim, Dae Yong; J Korean Soc Coloproctol. 2009;25(4):273-282.; DOI: https://doi.org/10.3393/jksc.2009.25.4.273

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Surgical resection is a mainstay in the treatment for patients with locally advanced rectal cancer. Despite the introduction of total mesorectal excision, which greatly reduces local recurrence, radiation therapy and chemotherapy have prevailed as integral parts of the modern treatment concept. Phase III studies have shown that postoperative chemoradiotherapy (CRT) improves the local control and overall survival compared with surgery alone in treating patients with stage II, III rectal cancer. Recently, a prospective randomized study with a large sample size and long-term follow-up reported that preoperative CRT resulted in improved local control and sphincter preservation, reduced toxicities, and improved overall survival compared with postoperative CRT. The results of this study provide evidence for the use of preoperative CRT in the treatment of patients with clinical stage II and III rectal cancer. However, accurate pretreatment staging is required to minimize overtreatment and adverse effects.

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An Update on Preoperative Radiotherapy for Locally Advanced Rectal Cancer
Seung-Gu Yeo, Dae Yong Kim
Journal of the Korean Society of Coloproctology.2012; 28(4): 179. CrossRef

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