Annals of Coloproctology

Volume 23(3); June 2007

Original Articles

Outcome and Predictors of Success of Biofeedback for Descending Perineum Syndrome.: Hur, Le Na , Hwang, Yong Hee , Jung, Yong Hwan; J Korean Soc Coloproctol. 2007;23(3):145-151.; DOI: https://doi.org/10.3393/jksc.2007.23.3.145

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Purpose
To determine the outcome and identify predictors of success of biofeedback for descending perineum syndrome (DPS). Methods: 103 patients diagnosed with DPS by defecography were evaluated by standardized questionnaire, before, immediately after treatment, and at follow-up. Clinical bowel symptoms and anorectal physiological studies were also analyzed. Results: At post- biofeedback, 81 patients felt improvement in symptoms, including 29 with complete symptom relief. At follow-up (median: 13 months, n=82), 58 patients felt improvement in symptoms, including 12 with complete symptom relief. There was a significant reduction in difficult defecation (from 78 to 34, 37%, from pre-biofeedback to post-biofeedback, and at follow-up respectively; P<0.001), incomplete defecation (from 88 to 44, 41%; P<0.001), hard stool (from 63 to 25, 0%; P<0.01), small caliber stool (from 63 to 0,0%; P<0.001, P<0.005), fecal incontinence (from 10 to 1,1%; P<0,01), anal pain (from 21 to 2, 6%; P<0.001, P<0.05), laxative use (from 30 to 11, 6%; P<0.001), enema use (from 16 to 0, 1%; P<0.001) and digitation (from 11 to 1%, from pre-biofeedback to at follow-up; P<0.05). Normal spontaneous bowel movement was increased from 47% pre-biofeedback to 79% post-biofeedback (P<0.001), 86% at follow-up (P<0.001). Difficult defecation predict poor outcome (96 vs. 66%; failure vs. success, P<0.01). Positive mean pressure change predict good outcome (69 vs. 35%; success vs. failure, P<0.05). Conclusions: Biofeedback is an effective option for DPS.

Citations

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An Analysis of Factors Associated with Increased Perineal Descent in Women
Jina Chang, Soon Sup Chung
Journal of the Korean Society of Coloproctology.2012; 28(4): 195. CrossRef
The Roles of Anorectal Physiologic Tests and Treatment of Chronic Constipation
Yong Hee Hwang
Journal of the Korean Society of Coloproctology.2008; 24(2): 148. CrossRef

Early Experiences with Laparoscopic- assisted Colectomy: Retrospective Comparison with Open Colectomy (Case-control Study).: Park, Ki Jae , Lee, Mi Ri , Choi, Hong Jo; J Korean Soc Coloproctol. 2007;23(3):152-160.; DOI: https://doi.org/10.3393/jksc.2007.23.3.152

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Purpose
The aim of this study was to review our experience with laparoscopic-assisted colectomy (LACs), and to evaluate its feasibility and safety for surgical treatment of colorectal diseases, including cancer. Methods: Between September 2002 and September 2005, a LAC was performed in 58 patients. Of these, 6 cases of conversion to open colectomy were excluded from the analysis. Fifty conventional open colectomy (OCs) with clinicopathologic characteristics comparable to those of the LACs were selected and matched as a control group for comparative analysis regarding short-term oncologic and perioperative outcomes. The mean follow-up period was 13.8 (2~37) months. Results: Thirteen complications, involving 11 patients, occurred. The mean operative time of the LAC was longer than that of the OC (215 min vs. 179 min; P<0.0001). However, earlier restoration of bowel function was achieved in the LAC as measured by postoperative first flatus (2.8 days vs. 3.8 days) and intake of a clear liquid diet (4.7 days vs. 5.8 days). There was no significant difference in hospital stay (LAC vs. OC, 10.2 days vs. 11.8 days). In patients with malignancy, the proximal resection margin in the LAC was significantly shorter than that in the OC (9.2 cm vs. 13.3 cm; P<0.0001). However, there were no significant differences in the mean numbers of harvested lymph nodes (LAC vs. OC, 16.6 vs. 19.3; P=0.4330) and the mean distal resection margins (LAC vs. OC, 6.9 cm vs. 6.0 cm; P=0.1359). There were 3 distant metastases and one local recurrence during follow-up in the LAC group, but no port-site recurrence. Conclusions: In this study, we could not receive an advantage of shorter hospital stay due to the relatively high complication rate for a LAC, which may reflect a learning curve. Earlier postoperative recovery of bowel function and equal pathologic extent of resection in the LAC suggest that the LAC is an acceptable alternative procedure in the treatment of colorectal diseases, including malignancy. More experience with the LAC is necessary to overcome the learning curve. Affirmative long-term oncologic outcomes of are expected for the LAC.

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Control efficacy of Lime Bordeaux Mixture against Collectotrichum gloeosporioides JAFP5 and Serratia plymuthica JABP11 in Ginseng
Min-Jeong Kim, Chang-Ki Shim, Sang-Gu Park
The Korean Journal of Pesticide Science.2021; 25(1): 63. CrossRef
Initial Experiences with a Laparoscopic Colorectal Resection: a Comparison of Short-term Outcomes for 50 Early Cases and 51 Late Cases
Jang Won Seon, Jung Wook Huh, Sang Hyuk Cho, Jae Kyoon Joo, Hyeong Rok Kim, Young Jin Kim
Journal of the Korean Society of Coloproctology.2009; 25(4): 252. CrossRef
Short-Term Outcome of Curative One-Stage Laparoscopic Resection for Obstructive Left-Sided Colon Cancers Followed by Stent Insertion: Comparative Study with Non-Obstructive Left-Sided Colon Cancers
Hyun Sil Kim, Sung Geun Kim, Chang Hyuk Ahn, Won Kyung Kang, Yun Seok Lee, In Kyu Lee, Hyung-Jin Kim, Sang Cheol Lee, Hyeon Min Cho, Jong Kyung Park, Seong Taek Oh, Jun-Gi Kim
Journal of the Korean Society of Coloproctology.2009; 25(6): 417. CrossRef
The Impacts of Obesity on a Laparoscopic Low Anterior Resection
Jin-Hee Woo, Ki-Jae Park, Hong-Jo Choi
Journal of the Korean Society of Coloproctology.2009; 25(5): 306. CrossRef

Learning Curve for Laparoscopic Colorectal Surgery: Hand Assisted Laparoscopic Surgery (HALS) versus Conventional Laparoscopic Surgery (CLS).: Yun, Hae Ran , Lee, Won Suk , Yun, Seong Hyeon , Lee, Woo Yong , Chun, Ho Kyung; J Korean Soc Coloproctol. 2007;23(3):161-166.; DOI: https://doi.org/10.3393/jksc.2007.23.3.161

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Abstract PDF

Purpose
Laparoscopic colorectal surgery is technically demanding and needs a longer learning curve than open surgery. HALS (hand-assisted laparoscopic surgery) is a useful alternative to conventional laparoscopic surgery (CLS) because of its palpability and hand dissection. We compared the learning curves between HALS and CLS for colorectal surgery. Methods: A prospective study without randomization was conducted with the participation of two colorectal surgeons who had not experienced a laparoscopic colorectal operation. The collected data included operative features, oncologic outcomes, and early clinical outcomes. Fifty patients were enrolled in each group, the HALS group and the CLS group. Results: None of the operations converted to open surgery. The operative time was significantly shorter in the HALS group than in the CLS group (149.6+/-34.6 minutes versus 179.1+/-36.5 minutes, P<0.001). On a subgroup analysis of the operative time in the anterior resection, the operative time was consistent after the 13th operation in HALS group. However, in CLS group, there was a continuous fluctuation of the operative time until 25 cases. In regard to the oncologic outcome, the numbers of total harvested lymph nodes and the proximal and the distal margins in the anterior resection showed no statistical differences (P=0.400, P=0.908, and P=0.073, respectively). The early clinical results were similar in both groups.
Conclusions
In the learning curve study, the HALS group had a shorter operative time and reached a learning curve plateau earlier than the CLS group. Other parameters, such as the oncologic results and the early postoperative clinical outcomes, showed no differences between the two groups.

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Comparison and short-term outcomes between hand-assisted laparoscopic surgery and conventional laparoscopic surgery for anterior resections of left-sided colon cancer
Hae Ran Yun, Yong Kwon Cho, Yong Beom Cho, Hee Cheol Kim, Seong Hyeon Yun, Woo Yong Lee, Ho-Kyung Chun
International Journal of Colorectal Disease.2010; 25(8): 975. CrossRef

Laparoscopic Surgery for Splenic Flexure Colon Cancer.: Lee, Yoon Suk , Heo, Yoon Jung , Lee, In Kyu , Cho, Hyun Min , Kang, Won Kyung , Park, Jong Kyung , Ahn, Chang Hyuk , Lee, Do Sang , Oh, Seung Teak , Kim, Jun Gi , Kim, Young Ha; J Korean Soc Coloproctol. 2007;23(3):167-171.; DOI: https://doi.org/10.3393/jksc.2007.23.3.167

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Abstract PDF: Purpose
While a carcinoma of the splenic flexure is uncommon, is associated with a high risk of obstruction, and has a dual lymphatic drainage system, A COST study excluded transverse colon cancer, including splenic flexure colon cancer. This study reviews our experience with splenic flexure colon cancer treated laparoscopically and discusses a appropriate, safe laparoscopic surgical procedure.
Methods
The authors reviewed the medical records of patients who underwent laparoscopic surgery for splenic flexure colon cancer from January 1995 to June 2006. The splenic flexure colon was defined as 5 cm from the splenic flexure proximally and distally by using radiologic studies. Curative surgery for splenic flexure colon cancer was defined as: primary cancer removal, a safe resected margin, no metastasis, and a complete lymphadenectomy including high ligation of left colic artery and of the left branch of the middle colic artery. Results: A total of 407 patients underwent laparoscopic surgery for colon cancer; among them, 15 patients underwent a laparoscopic left colectomy for splenic flexure colon cancer. The mean age of the patients was 63.8 years, and the male-to-female ratio was 9:6. The mean operation time was 325.3+/-95.1 minutes, and the average hospital stay was 15.8+/-4.9 days. The average number of harvested lymph nodes was 12.3+/-9.7, the average distal resection margin was 15.3+/-7.6 cm, and the average proximal margin was 10.7+/-3.2 cm. One case of chyle discharge and one case of ileus developed, but were treated conservatively. There was no surgical mortality.
Conclusions
A laparoscopic left colectomy for splenic flexure colon cancer is a technically feasible and safe procedure with acceptable short-term outcomes in experienced hands.

In-vitro Chemosensitivity Test for Colorectal Cancer using an Adenosine-triphosphate-based Chemotherapy Response Assay (ATP-CRA).: Huh, Jung Wook , Park, Yoon Ah , Sohn, Seung Kook , Choi, Sung Ho; J Korean Soc Coloproctol. 2007;23(3):172-179.; DOI: https://doi.org/10.3393/jksc.2007.23.3.172

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Abstract PDF

Purpose
The adenosine-triphosphate-based chemotherapy response assay (ATP-CRA) is a well-documented and validated technology for individualizing chemotherapy in cancer patients. We evaluate the feasibility of ATP-CRA in colorectal cancer patients. This study will illustrate the assay's success rate, the mean coefficient of variation, and the turnaround time as a validation tool for a chemosensitivity test. Methods: A total of 118 patients, treated by surgery between June 2004 and September 2005 were evaluated for chemosensitivity to seven anticancer agents (5-fluorouracil (5-FU), oxaliplatin, irinotecan, epirubicin, etoposide, gemcitabine, and paclitaxel) by using an ATP-CRA. To allow a comparison between samples, we calculated the chemosensitivity index (CI) based on the percentage cell death rate (CDR, %) at each test drug concentration.
Results
The assay success rate was 85.5% (118/138), and the mean coefficient of variation, indicating intra-assay error level, was 9.2%. CDR measured at a therapeutic peak plasma concentration ranged from 0% to 93.6% with a median of 31.0% for 5-FU, 28.5% for oxaliplatin, 34.0% for irinotecan, 25.0% for epirubicin, 21.0% for etoposide, 22.0% for gemcitabine, and 25.2% for paclitaxel. According to the CI, the most sensitive drug varied from patient to patients 10.9% for 5-FU, 10.9% for oxaliplatin, 24.7% for irinotecan, 11.8% for epirubicin, 22.4% for etoposide, 1.1% for gemcitabine, and 23.3% for paclitaxel. Conclusions: Our data suggest that the ATP- CRA is a feasible in-vitro chemosensitivity test in colorectal cancer and that patients show heterogeneous chemosensitivity. A study evaluating the predictive value of ATP-CRA directed therapy is needed to determine the clinical usefulness of the test.

Citations

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Correlation between the molecular subtype of breast cancer and thein vitroadenosine triphosphate-based chemosensitivity assay
Jina Chang, Anbok Lee, Jihyun Lee, Woosung Lim, Sun Hee Sung, Byung-In Moon
Journal of the Korean Surgical Society.2013; 84(6): 313. CrossRef
Heterogeneity of Adenosine Triphosphate-Based Chemotherapy Response Assay in Colorectal Cancer - Secondary Publication
Jung Wook Huh, Yoon Ah Park, Kang Young Lee, Seung-Kook Sohn
Yonsei Medical Journal.2009; 50(5): 697. CrossRef
Complete Remission of Unresectable Colon Cancer after Preoperative Chemotherapy Selected by Adenosine Triphosphate-Based Chemotherapy Response Assay
Jung Wook Huh, Yoon Ah Park, Eun Joo Jung, Kang Young Lee, Ji Eun Kwon, Seung-Kook Sohn
Journal of Korean Medical Science.2008; 23(5): 916. CrossRef

Oncological Safety of a Metallic Stent for a Left-sided Obstructive Colorectal Carcinoma.: Oh, Seung Yeop , Park, Seung Hyun , Lee, Kwang Jae , Kim, Jin Hong , Suh, Kwang Wook; J Korean Soc Coloproctol. 2007;23(3):180-185.; DOI: https://doi.org/10.3393/jksc.2007.23.3.180

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Abstract PDF: Purpose
There is a controversy about the treatment of left-sided obstructive colorectal cancer. Recently, experience using an expandable metallic stent for relief of the obstruction has been increasing, but its oncological safety has not been confirmed. Therefore, we designed this study to evaluate the oncological safety of a metallic stent for the treatment of left-sided obstructive colorectal cancer. Methods: Forty-six patients with left-sided obstructive colorectal cancer who underwent a curative resection from 1994 to 2004, were retrospectively evaluated. Nineteen emergency operations (1994~2003) and 27 metallic stent insertions (2000~2004) were compared based on clinicopathologic features, postoperative complications, recurrence rates, and survival rates. Results: There were no significant differences in age, location, sex, and recurrence rate between the two groups. The complication rate in the emergency group was higher than it was in the stent group, but this difference was not statistically significant (26.3% vs. 14.8%; P=0.33). The overall and the disease-free survival rates were not significantly different. Conclusions: Because there was no significant differences in survival rate and recurrence rate between the two groups, metallic stent insertion can be used safely in the preoperative treatment of obstructive left-sided colorectal cancer.

The Long-term Oncological Outcome of a Sphincter-saving Resection and an Abdominoperineal Resection for Lower Rectal Cancer.: Jung, Sang Hun , Yu, Chang Sik , Choi, Pyong Wha , Kim, Dae Dong , Hong, Dong Hyun , Kim, Hee Cheol , Kim, Jin Cheon; J Korean Soc Coloproctol. 2007;23(3):186-193.; DOI: https://doi.org/10.3393/jksc.2007.23.3.186

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Purpose
The oncological safety of a sphincter-saving resection (SSR) in lower rectal cancer is widely accepted, and both an abdominoperineal resection (APR) and a SSR are used in potentially curative surgery. This retrospective study was performed to compare the long-term oncological outcomes after an APR and a SSR in patients with lower rectal cancer (within 5 cm from the anal verge). Methods: We recruited 441 lower rectal cancer patients who underwent curative resections (APR: 305, SSR: 136) between 1995 and 2000. A total mesorectal excision and autonomic nerve preservation were routinely performed. The median follow- up period was 65 months. Results: Most demographic findings were comparable between the groups; however, the APR groups revealed more advanced pathological characteristics (tumor depth, size, cell differentiation, and metastatic LN number). The local recurrence rates after an APR and a SSR were 12.8% and 7.4%, respectively (P= 0.09). An independent risk factor of local recurrence was LN metastasis only. Distant recurrence was higher in the APR group (26.4%) than in the SSR group (13.2%), but on multivariate analysis the difference was not significant (P=0.17). The 5-year cancer-specific survival rates after an APR and a SSR were 73.2% and 87.6%, respectively (P<0.05). Particularly, there was a significant survival difference for stage III patients (APR: 59.0% vs. SSR: 83.0%, P<0.05). However, an APR was not an independent prognostic factor for cancer-specific survival in the multivariate analysis (P=0.07). Conclusions: An APR per se did not influence local recurrence after a curative resection for lower rectal cancer. The poor cancer-specific survival in the stage III APR group might be attributed to increased distant metastasis due to its more distal location.

Citations

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Essential knowledge and technical tips for total mesorectal excision and related procedures for rectal cancer
Min Soo Cho, Hyeon Woo Bae, Nam Kyu Kim
Annals of Coloproctology.2024; 40(4): 384. CrossRef
Long-term Result for Rectal Cancer in Cases of a Curative Resection after Preoperative Chemoradiotherapy
Dong Hyun Lee, Sang Hun Jung, Jae Hwang Kim, Min Chul Shim
Journal of the Korean Society of Coloproctology.2007; 23(6): 503. CrossRef

Case Reports

A Case of Colon Cancer Associated with Colonic Tuberculosis.: Yun, Sang Chul , Shin, Eung Jin , Song, Ok Pyung , Kim, Hyung Chul , Lim, Cheol Wan , Cho, Gyu Seok , Chu, Chong Woo , Lee, Hyo Won; J Korean Soc Coloproctol. 2007;23(3):194-198.; DOI: https://doi.org/10.3393/jksc.2007.23.3.194

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Abstract PDF: Inflammatory bowel disease, such as ulcerative colitis and Crohn's disease, has a potential risk of developing into colorectal cancer. However, there is little relationship between intestinal tuberculosis and colon cancer because intestinal tuberculosis is a curable disease and has a relatively short disease course. Nevertheless, there have been a few case reports of intestinal tuberculosis associated with colon cancer. There was a case report in which the carcinoma facilitated entry of tubercle bacilli with development of a secondary infection, and ulcerative lesions of tuberculosis may be precursors of carcinomas. We experienced a 77-year-old woman who had intestinal tuberculosis combined with ascending colon cancer. She visited our hospital because of abdominal pain and constipation. Colonoscopy showed a luminal obstruction mass in the ascending colon. Histologic examination revealed an adenocarcinoma. After surgery, the surgical specimen disclosed an adenocarcinoma in the cecum and ascending colon and intestinal tuberculosis around the cancer site of the cecum. Herein, we report a rare case of colon cancer co-existing with colonic tuberculosis with a review of the literature.

A Case of an Adenocarcinoid Tumor in the Cecum.: Lee, Seung Hyun , Ahn, Byung Kwon , Baek, Sung Uhn , Park, Seun Ja , Chang, Hee Kyung; J Korean Soc Coloproctol. 2007;23(3):199-202.; DOI: https://doi.org/10.3393/jksc.2007.23.3.199

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Abstract PDF: An adenocarcinoid of the cecum is a tumor that has seldom been reported in the literature. Its has the histologic features of both an adenocarcinoma and a carcinoid tumor. However, the malignancy potential and the prognostic behavior are still unclear. We treated one patient with this unusual tumor. A 64-year-old man was admitted with a complaint of right lower quadrant abdominal pain for 2 months. On colonoscopy and histological examination, the patient was diagnosed as having a cecal adenocarcinoma. A radical right hemicolectomy was done. Postoperative histologic analysis revealed that the tumor was composed of well-differentiated adenocacinoma and carcinoid components. Lymph node metastases were found in the three lymph nodes with only the carcinoid component.

Sigmoid Colon Cancer with Metastasis to the Right Spermatic Cord.: Kim, Hyung Jin , Moon, Eun Jung , Kang, Won Kyung , Hong, Seong Hu , Jung, Chan Kwon , Oh, Seong Taek; J Korean Soc Coloproctol. 2007;23(3):203-205.; DOI: https://doi.org/10.3393/jksc.2007.23.3.203

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Metastatic tumors involving the spermatic cord are very rare, and the prognosis for such patients is poor. The primary tumors that are frequently metastatic to the spermatic cord are gastric and colon carcinomas. We report a case of a 35-year-old male with a metastatic spermatic cord tumor following a palliative anterior resection for sigmoid colon cancer with peritoneal seeding. The patient complained of a tender mass in a right inguinal lesion. A right orchiectomy was performed, and the pathologic finding was a poorly differentiated adenocarcinoma similar to that of the sigmoid colon cancer.

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Metastatic Spermatic Cord Tumor From Colorectal Cancer
Ji Geon Jang, Hye Yun Jeong, Ki Soo Kim, Mi Jung Park, Jin Sook Lee, Sang Su Kim, Ho Young Kim
Annals of Coloproctology.2015; 31(5): 202. CrossRef
Skeletal Muscle Metastasis from Colorectal Cancer: Report of a Case
Pyong Wha Choi, Chul Nam Kim, Han Seong Kim, Jung Min Lee, Tae Gil Heo, Je Hoon Park, Myung Soo Lee, Surk Hyo Chang
Journal of the Korean Society of Coloproctology.2008; 24(6): 492. CrossRef

Review

Evaluation and Treatment of Pelvic Floor Disorders.: Lee, Sang Jeon; J Korean Soc Coloproctol. 2007;23(3):206-220.; DOI: https://doi.org/10.3393/jksc.2007.23.3.206

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Abstract PDF: Pelvic floor disorders are of interest to many surgeons who specialize in organ systems within this region. Colorectal surgeons are especially interested in disorders of the posterior compartment, which may broadly be divided into defecation disorders and fecal incontinence. These disorders distress patients socially and psychologically and greatly impair their quality of life. The underlying anatomical and pathophysiological changes are complex, are often incompletely understood, and cannot always be determined. However, over the past decades, advances in the understanding of these disorders, together with rational methods of evaluation in anorectal physiology laboratories, radiology studies, and new surgical techniques, have led to promising results. This review summarizes the evaluation and treatment strategies, as well as the recent updates on the clinical and the therapeutic aspects of pelvic floor disorders.

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