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Malignant disease
How to Prevent Anastomotic Leak in Colorectal Surgery? A Systematic Review
Mohamed Ali Chaouch, Tarek Kellil, Camillia Jeddi, Ahmed Saidani, Faouzi Chebbi, Khadija Zouari
Ann Coloproctol. 2020;36(4):213-222.   Published online August 31, 2020
DOI: https://doi.org/10.3393/ac.2020.05.14.2
  • 12,242 View
  • 373 Download
  • 27 Web of Science
  • 32 Citations
AbstractAbstract PDF
Anastomosis leakage (AL) after colorectal surgery is an embarrassing problem. It is associated with poor consequence. This review aims to summarize published evidence on prevention of AL after colorectal surgery and provide recommendations according to the Oxford Centre for Evidence-Based Medicine. We conducted bibliographic research on January 15, 2020, of PubMed, Cochrane Library, Embase, Scopus, and Google Scholar. We retained meta-analysis, reviews, and randomized clinical trials. We concluded that mechanical bowel preparation did not reduce AL. It seems that oral antibiotic or oral antibiotic with mechanical bowel preparation could reduce the risk of AL. The surgical approach did not affect the AL rate. The low ligation of the inferior mesenteric artery could reduce the AL rate. The mechanical anastomosis is superior to handsewn anastomosis only in case of right colectomies, with similar results in rectal surgery between the 2 anastomosis techniques. In the case of right colectomies, this anastomosis could be performed intracorporeally or extracorporeally with similar outcomes. The air leak test did not reduce AL. There is no interest of external drainage in colonic surgery but drains reduced the rate of AL and rate of reoperation after low anterior resection. The transanal tube reduced the rate of AL.

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Case Report
Regression of Colonic Adenomas After Treatment With Sulindac in Familial Adenomatous Polyposis: A Case With a 2-Year Follow-up Without a Prophylactic Colectomy
Kyu Young Kim, Seong Woo Jeon, Jung Gil Park, Chung Hoon Yu, Se Young Jang, Jae Kwang Lee, Hee Young Hwang
Ann Coloproctol. 2014;30(4):201-204.   Published online August 26, 2014
DOI: https://doi.org/10.3393/ac.2014.30.4.201
  • 7,121 View
  • 38 Download
  • 9 Web of Science
  • 9 Citations
AbstractAbstract PDF

Familial adenomatous polyposis (FAP) is an autosomal dominant disorder characterized by hundreds of colorectal adenomatous polyps that progress to colorectal cancer. Management of patients with FAP is with a total colectomy. Chemopreventive strategies have been studied in FAP patients in an effort to delay the development of adenomas in the upper and the lower gastrointestinal tract and to prevent recurrence of adenomas in the retained rectum of patients after prophylactic surgery. Sulindac, a nonsteroidal anti-inflammatory drug, causes regression of colorectal adenomas in the retained rectal segment of FAP patients. However, evidence regarding long-term use of this therapy and its effect on the intact colon has been insufficient. We report a case in which the long-term use of sulindac was effective in reducing the size and the number of colonic polyps in patients with FAP without a prophylactic colectomy and polypectomy; we also present a review of the literature.

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Review
Risk Factors of Colorectal Cancer.
Kim, Dong Hyun
J Korean Soc Coloproctol. 2009;25(5):356-362.
DOI: https://doi.org/10.3393/jksc.2009.25.5.356
  • 3,726 View
  • 94 Download
  • 18 Citations
AbstractAbstract PDF
Colorectal cancer has been rapidly increasing in Korea during the past decades, which was known as low risk area. The age-standardized mortality rates increased from 3.0 to 14.5 in 100,000 for men and from 2.3 to 7.9 in 100,000 for women between 1983 and 2008. According to the National Cancer Registry, the age-standardized incidence rates of total colorectal cancer were increased by 7.3% and 5.5% for men and women, respectively, between 1999 and 2005, while the incidence rates of the most prevalent cancers in Korea, such as stomach, liver, and cervical cancers, have decreased during the same period. Westernized dietary and lifestyle-related factors seem to be closely related to the increased risk of colorectal cancer. Higher intakes of red and processed meat, a lack of physical activity, obesity, and alcohol drinking have been suggested to be risk factors for colorectal cancer in the numerous epidemiologic studies, while higher intakes of dietary fiber, green leafy vegetables, some micronutrients abundant in vegetables and fruits, such as folate, and calcium were reported to be protective factors. Since many of the diet and lifestyle-related factors for colorectal cancer are modifiable, it is urgently needed to set up comprehensive primary prevention program against colorectal cancer to effectively cope with the rapidly increasing cancer in Korea.

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Original Articles
The Effect of Hyaluronate Membrane on Prevention of Adhesion after Rectal Cancer Surgery: a Prospective Study.
Yu, Chang Sik , Kim, Hee Cheol , Park, In Ja , Lee, Kang Hong , Kim, Jin Cheon
J Korean Soc Coloproctol. 2005;21(2):76-81.
  • 1,421 View
  • 6 Download
AbstractAbstract PDF
PURPOSE
The aim of this study was to evaluate the efficacy of using a Hyaluronate (HA) bioresorbable membrane (SeprafilmTM, Genzyme Corp., Cambridge, MA) to prevent adhesion after rectal cancer surgery.
METHODS
We recruited 362 rectal cancer patients who underwent a curative resection between April 2001 and December 2002. We excluded patients with a previous operation history, a stoma procedure, a multivisceral resection, an extended lymphadenectomy, a total colectomy, or a pouch procedure. An adhesive ileus was defined as a symptomatic, radiological intestinal obstruction without evidence of recurrence.
RESULTS
We placed the HA membrane under the midline incision in 153 patients. There was no difference between the groups regarding demographic findings and clinicopathological findings, including locations of the tumors, surgery performed, AJCC stage, and adjuvant treatment. While only 1 (0.7%) patient of the HA group experienced an adhesive ileus, 13 (6.2%) cases of adhesion were identified in the control group (P=0.008). Every patient, except 1 in the control group, underwent conservative management.
CONCLUSIONS
A Hyaluronate membrane may be effective in preventing an adhesive ileus after rectal cancer surgery. However, a prospective, randomized, double-blind study is needed.
Clinical Significance of Cyclooxygenase-2 Expression in Colorectal Adenoma and Carcinoma.
Rhyou, Jai Hyun , Kim, Kwang Ho , Shim, Kang Sup , Koo, Hae Soo , Park, Eung Bum
J Korean Soc Coloproctol. 2000;16(6):351-355.
  • 1,339 View
  • 17 Download
AbstractAbstract PDF
PURPOSE
Interest is mounting in developing prevention strategies for patients at high risk of developing colorectal cancer. Recent epidemiological investigations indicate an inverse relationship between the intake of NSAIDs and colorectal cancer risk. Cyclooxygenase (COX) enzyme may be involved in the initiation and/or the promotion of carcinogenesis. A major action of NSAIDs is the inhibition of COX. We have studied the clinical significance of COX-2 expression in colorectal adenoma and carcinoma.
METHODS
We studied 19 patients with colorectal adenomas (15 males and 4 females: ages 30~73 years) and 20 patients with colorectal carcinoma (12 males and 8 females: ages 35~80 years). COX-2 status were determined by immunohistochemical methods using the mouse monocolnal antibody for COX-2 (Transduction Lab, USA) on paraffin sections.
RESULTS
Immunoreactive COX-2 were expressed in 9 patients (47%) of colorectal adenoma and 9 patients (45%) of colorectal carcinoma. 57% of villous adenoma and 42% of tubular adenoma were positive for COX-2 in colorectal adenoma (p=0.650). COX-2 were expressed in 12.5% of stage B and 73% of stage C of colorectal cancer (p=0.006). COX-2 expression did not relate with the size of adenoma and carcinoma.
CONCLUSIONS
The data suggest that COX-2 may be more expressed in villous adenoma and advanced carcinoma. Therefore, enhanced expression of COX-2 may play a role in the carcinogenesis of colorectal cancer.
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