Annals of Coloproctology

Volume 15(2); June 1999

Original Articles

The Significance of CD44v Expression in the Pelvic LateralLymph Node in Distal Rectal Cancer.: Bae, Ok Suk; J Korean Soc Coloproctol. 1999;15(2):93-97.

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Abstract PDF: PURPOSE
The CD44 has been known a lymph node homing receptor on circulating lymphocytes. CD44 spliced variants have been found to be overexpressed in human cancers and metastatic cancers. The variant CD44v 6-7 in particular has been suggested to have a potential role in tumor metastasis. It has been reported that histopathological examination could occaisionally miss lymph node micrometastasis. PURPOSE: The aim of this study was to investigate the role of CD44v in metastasis of rectal carcinoma to the pelvic lateral lymph nodes around the obturator nerve, obturator vessel and superior vesical artery.
METHODS
Thirty pelvic lateral lymph nodes reported normal histopathologically from 22 patients with rectal carcinomas, 22 rectal carcinomas and their corresponding colonic mucosas. We have used RT-PCR for the detection of CD44 gene products (CD44v and CD44 v6-7) in samples.
RESULTS
The expression rates of CD44v were 2/22 (9%) for normal colonic mucosa, 20/22 (90%) for cancer tissues, and 4/30 (13.3%) for pelvic lateral lymph nodes. The rates of CD44v6-7 were also 2/22 (9%) for normal colonic mucosa 20/22 (90%) for cancer tissues, but 7/30 (23.3%) for pelvic lateral lymph nodes.
CONCLUSIONS
The analysis of CD44v might be useful for determination of pelvic lateral lymph nodes metastasis, but it should not be used as a metastatic marker in general for rectal cancer patients.

Comparison of Cell Proliferation between Chronic Ulcerative Colitisand Acute Self-limited Colitis.: Yun, Ki Jung , Yoo, Hyung Ryun , Chli, Suck Chei , Nah, Yong Ho; J Korean Soc Coloproctol. 1999;15(2):99-106.

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Abstract PDF: PURPOSE
The ulcerative colitis is a major chronic intestinal disease of unknown etiology affecting principally the rectum and left colon, and its incidence is markedly increasing in Korea. The main differential diagnosis of ulcerative colitis is an acute self-limited colitis. This study was performed to evaluate difference of cell kinetics between chronic ulcerative colitis and acute self-limited colitis.
METHODS
The normal colon (n=25), acute self-limited colitis (n=25) and chronic ulcerative colitis (n=25) were investigated by using Ki-67 immunohistochemical staining for proliferation and TUNEL method for apoptosis. The Ki-67 labeling indices and TUNEL labeling indices were determined. RESULTS: The means of Ki-67 labeling indices in normal colon, acute self-limited colitis and chronic ulcerative colitis were 5.14 5.25%, 6.81 5.73%, 13.10 10.15%, respectively. And the means of TUNEL labeling indices in normal colon, acute self-limited colitis and chronic ulcerative colitis were 1.59 0.10%, 2.54 1.60%, 2.51 1.40%, respectively.
CONCLUSIONS
The apoptosis is one of method of cell loss in both acute self-limited colitis and chronic ulcerative colitis. High proliferative activity of chronic ulcerative colitis may predispose to mutational events in colonic mucosa, therefore may be one of the increased cancer risk factors in chronic ulcerative colitis.

Total Mesorectal Excision: Is It a Valid Prognostic Factor for Recurrence?.: Woo, Seok , Suh, Kwang Wook , Cho, Yong Kwan , Kim, Myung Wook; J Korean Soc Coloproctol. 1999;15(2):107-111.

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Abstract PDF: PURPOSE
This study was aimed to identify whether total mesorectal excision (TME) is a valid prognostic factor for recurrence following curative surgery for rectal carcinoma.
METHODS
For 110 high-risk rectal carcinoma patients, recurrence rate and patterns of recurrence were compared between patients undergoing TME and those with classical dissection.
RESULTS
Both local recurrence and distant metastasis were significantly lower in TME group than those in classical dissection group. Time interval from operation to the initial recurrence was also significantly delayed in TME group. By comaparing with other prognostic variables, TME was found to be a significant prognostic factor for the recurrence.
CONCLUSIONS
We think TME is an important prognostic factor for the recurrence following curative resection in rectal carcinoma.

Pulmonary Resection for Lung Metastases from Colorectal Cancer.: Choi, Hyo Seong , Youk, Eui Gon , Park, Young Jin , Park, Kyu Joo , Lee, Jae Woong , Kim, Joo Hyun , Park, Jae Gahb; J Korean Soc Coloproctol. 1999;15(2):113-119.

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Abstract PDF: Isolated lung metastasis occurs in about 1% of all colorectal cancer cases. As in the case of isolated liver metastasis, resection of isolated lung metastasis results in 5 year survival rate of about 30%. PURPOSE: This study was performed to evaluate the survival benefit after pulmonary resection for metastatic colorectal cancer.
METHODS
Between January, 1992 and March, 1998, twelve patients underwent lung metastatectomy from colorectal cancer at the Seoul National University Hospital. We evaluated the clinical characteristics of patients and analyzed the follow-up results in 10 patients whose medical records were available. Indications for resection of pulmonary metastasis were complete resection of the primary tumor, no other organ involvement except lung, completely resectable lung lesion, and tolerable general condition of patient for lung resection.
RESULTS
Two patients had their primary tumors located in colon and 8 in rectum. Synchronous lung metastases were observed in 3 patients, and 7 patients had metachronous metastases developing 9 to 121 months (median; 33 months) after primary tumor resection. Eight patients had solitary metastatic nodule in lung, while two patients had multiple lesions confined to unilateral lung. Five patients underwent wedge resections, 4 underwent pulmonary lobectomies, and one patient had both wedge resection and lobectomy in unilateral lung. Three patients were lost during the follow-up, but remaining 7 patients are alive after median follow-up of period of 32 months and 6 of these patients have no postoperative recurrence. In addition, four of these 7 patients are alive for more than 3 years after lung metastatectomy.
CONCLUSION
Pulmonary metastasis from colorectal cancer without other organ involvement may be a candidate for lung resection. However, further studies are needed to determine the survival benefits after pulmonary resection.

Low Anterior Resection with Fixation of the Lateral Rectal Ligaments by EEA Stapler in Rectal Prolapse.: Kim, Byung Chun , Cho, Ji Woong , Kim, Hong Ki; J Korean Soc Coloproctol. 1999;15(2):121-129.

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Abstract PDF: Rectal prolapse means an abnormal descent of all layers of the rectum, with or without protrusion through the anus, and is classified into incomplete and complete rectal prolapse. Complete rectal prolapse is further divided into the first, second and third degree based on the severity. The choice of the operation for rectal prolapse is controversial. PURPOSE: The aim of this study was to evaluate the safety and effectiveness of the low anterior resection and stapled colorectal end-to-end anastomosis with fixation of the lateral rectal ligaments in rectal prolapse with redundant sigmoid colon.
METHODS
We describe our experience from January 1989 through December 1998. During this period, eight cases of complete rectal prolapse were managed at the Chunchon Sacred Heart Hospital, Hallym University. They were all men. The average age of the patients was 37 years (range, 19 to 73) and the average at onset before surgery was 19 years (range, 6 months to 33 years). At rectal examination the patients were placed in either a left supine or squatting position and were asked to strain. The duration of the follow-up assessment was ranged from one to seven years after operation. All those patients were investigated by personal interview and physical examination.
RESULTS
The most common complaint was protruding anal mass and anal bleeding. Four patients were heavy alcohol abusers. Two patients had mental retardation. Among them four patients had undergone prior anorectal procedure; two men had been treated due to hemorrhoids. The average body weight was 55 kg. The average length of the postoperative hospital stay was 16.8 days (range, 9 to 39 days). Preoperatively, there were 5 cases who had decreased anal sphincter tone. In all cases EEA stapler was used for anastomosis. The rectum was completely mobilized posteriorly and sutured to the sacrum. There was no recurrence and incontinence in all patients. The lengths of removed bowel were 15 to 20 cm (average 16.2 cm). There was no postoperative mortality, but postoperative adhesive ileus was developed in two patients, which were managed by conservative treatment.
CONCLUSIONS
In rectal prolpase, the low anterior resection of redundant sigmoid colon and stapled colorectal end-to-end anastomosis with fixation of the lateral rectal ligaments is one of the most efficient treatment.

Diagnosis of Anal Sphincter Injuries by Manometric Radial Asymmetry.: Seong, Moo Kyung , Cha, Hyung Hwan , Park, Ung Chae; J Korean Soc Coloproctol. 1999;15(2):131-136.

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Abstract PDF: PURPOSE
This study was undertaken to evaluate how well anorectal manometry diagnose anal sphincter injury, especially with regard to the parameter of radial asymmetry. METHODS: Anorectal manometry were performed in 27 male patients with anal fistula of transsphincteric type. The postoperative values of each manometric parameter including radial asymmetry (RA) were compared with preoperative ones. And also, the association between the sites of functional defect assessed by cross-sectional pressure data under station pull-through (SPT) technique and those of anatomical defect made by fistulotomy operation were determined.
RESULTS
Under rapid pull-through (RPT) technique, maximum resting pressure (MRP); 113.1 21.3 mmHg (preoperative value) vs 68.0 18.5 mmHg (p=.000) (postoperative value), RA of MRP; 16.7 3.7% vs 24.1 7.5% (p=.002), Maximum squeeze pressures (MSP); 199.0 35.2 mmHg, 169.6 48.7 mmHg (p=.006), RA of MSP; 15.5 3.7%, 22.8 3.5% (p=.000). Under SPT technique, MRP; 100.4 39.5 mmHg vs 71.2 34.6 mmHg (p=.000), RA of MRP; 16.3 7.9% vs 24.2 10.8% (p=.026), MSP; 299.1 71.6 mmHg vs 231.4 90.3 mmHg (p=.004), RA of MSP; 13.0 6.1% vs 22.0 8.4% (p=.001). Sites of functional defects interpreted upon SPT data were coincidental with sites of anatomical defects made by fistulotomy in 88.9% (MRP) and 92.6% (MSP) of cases.
CONCLUSIONS
Manometric radial asymmetry could be a useful parameter in diagnosing anal sphincter injury and locating the site of defect.

Pile Suture: An Useful Adjunct in Treating Hemorrhoids.: Kim, Jin Cheon , Ahn, Byung Yul , Lee, Dong Hee , Kim, Hee Cheol , Seo, Hun , Yu, Chang Sik; J Korean Soc Coloproctol. 1999;15(2):137-140.

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Abstract PDF: PURPOSE
A modified technique of pile suture (PS) was introduced with its principle and useful indications.
METHODS
A transfixing suture was layed onto the base of hemorrhoidal cushion including vessels, submocosal connective tissues, and internal anal sphincter. According to morphological changes in the pile, several (0~2) sutures were added downward upto the level of the dentate line. We have treated 348 patients with third and fourth degree hemorrhoids by either this technique alone (28 patients) or by combination with other techniques (320 patients). The median follow-up period was 39 months.
RESULTS
This technique showed earlier convalescence and lesser complications than the open hemorroidectomy (OH) (p<0.05): PS vs. OH, hospitalization 2.3 vs. 4.7 days; pain, 4.2 vs. 6.9 days; discharge, 0 vs. 8.6 days; dripping amount of bleeding, 3.8% vs. 13.9%. There was no recurrence in both operative techniques.
CONCLUSIONS
Because hemorrhoids present diverse shapes and symptoms, various operative techniques may be more efficient than single technique alone. Pile suture appears to be an useful armamentarium in treating hemorrhoids, especially in cases of recurrent or multiple hemorrhoids.

Case Reports

A Case of Linitis Plastica Type of Appendiceal Adenocarcinoma.: Kim, Jeong Soo , Jeon, Hae Myung , Lee, Eun Jung , Kim, Jae Sung; J Korean Soc Coloproctol. 1999;15(2):141-144.

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Abstract PDF: Primary tumor of the appendix is a rare disease entity of gastrointestinal malignancy. Most of them are discovered unexpectedly in an acute situation. The diagnosis of adenocarcinoma of the appendix is hardly made preoperatively. An unsuspected finding of appendiceal tumor during operation can cause confusion about appropriate management of the lesion. The prognosis of adenocarcinoma of appendix can be determined by Dukes' stage and is similar, stage for stage, to that of colorectal carcinoma. We experienced a patient with linitis plastica type of primary adenocarcinoma of the appendix, who complained right lower quadrant pain for twenty days. The patient underwent appendectomy only. The second curative operation could not be performed due to patient's condition.

A Case of Actinomycosis of the Greater Omentum.: Chae, Gooy Hun , So, Byung Jun , Lee, Jeong Kyun , Yun, Ki Jung , Lee, Kyung Keun; J Korean Soc Coloproctol. 1999;15(2):145-149.

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Abstract PDF: Actinomycosis is a chronic suppurative bacterial infection produced by Actinomyces israeli. The three major clinical presentation include the cervicofacial, thoracic, and abdominal regions. Abdominal actinomycosis is a rare entity which presents some difficulty in establishing a correct preoperative diagnosis. The diagnosis is usually based on histologic demonstration of sulfur granules in pus or surgically resected specimen. Recently, authors experienced a case of actinomycosis of the greater omentum in 38-years old woman. The patient underwent surgery under the impression of periappendiceal abscess. A 6cm sized firm mass was noted in the transverse colon. Histologically the mass was composed of fibroinflammatory mass with multiple actinomycosis granules.

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