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Kim, Chan Wook,Yoon, Yong Sik,Park, In Ja,Lim, Seok-Byung,Yu, Chang Sik,Kim, Jin Cheon Raven Press 2013 Annals of Surgical Oncology Vol.20 No.9
<P>To evaluate stage IIA colorectal cancer in terms of recurrence so as to discover whether high preoperative serum carcinoembryonic antigen (s-CEA) levels indicate that the patient should be included in a high-risk group in stage II colorectal cancer.</P>
( Yong Sik Yoon ),( Chan Wook Kim ),( In Ja Park ),( Seok Byung Lim ),( Chang Sik Yu ),( Jin Cheon Kim ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Colorectal adenocarcinoma with microsatellite instability (MSI) has a characteristic clinicopathological profi le, typically forming right-sided, younger onset, better prognosis, and frequent histology of poor or mucinous differentiation. Mucinous adenocarcinomas (MAC) of the colorectum in general have been linked to slightly adverse prognosis in many studies. The purpose of this study was to evaluate association of MSI with clinicopathological features and oncologic outcomes in patients with MAC. Methods: Tumor tissue samples obtained during curative surgery were analyzed using MSI assay. As histological differentiation, patients were divided into MAC and adenocarcinomas (AC). Clinicopathological parameters and survival outcomes were compared according to histological differentiation and MSI status. The median follow-up period was 43 months. Results: Among 2025 patients, 84 patients (4%) were MAC and 202 patients (10%) were MSI. Patients with MAC were frequent in MSI tumors (12%) than in microsatellite stable (MSS) tumors (3%, P < 0.001). Patients with MAC had tumors characterized by younger age onset, right-colon predilection, large-size, and high frequency of MSI compared with those with AC (P < 0.001). Patients with MSI-MAC had characteristics of right-colon predilection, large-size, and remarkably infrequent lymph node metastasis compared with those with MSS-MAC (P < 0.001-0.005). Patients with MSI-MAC showed lower 4-year recurrence rates and better overall survival rates than those with MSS-MAC (P = 0.018 and P = 0.046). Conclusions: Clinicopathological characteristics of MAC were closely related with MSI. The outcome for MSI-MAC tumor is better than that of MSS-MAC, although this fi nding did not reach statistical signifi cance in multivariate analysis.
Efficacy of preoperative chemoradiotherapy in patients with cT2N0 distal rectal cancer
Park Min Young,Yu Chang Sik,Kim Tae Won,Kim Jong Hoon,Park Jin-hong,이종률,Yoon Yong Sik,Park In Ja,Lim Seok-Byung,Kim Jin Cheon 대한대장항문학회 2023 Annals of Coloproctolgy Vol.39 No.3
Purpose: This study was designed to determine the feasibility of preoperative chemoradiotherapy (PCRT) in patients with clinical T2N0 distal rectal cancer. Methods: Patients who underwent surgery for clinical T2N0 distal rectal cancer between January 2008 and December 2016 were included. Patients were divided into PCRT and non-PCRT groups. Non-PCRT patients underwent radical resection or local excision (LE) according to the surgeon’s decision, and PCRT patients underwent surgery according to the response to PCRT. Patients received 50.0 to 50.4 gray of preoperative radiotherapy with concurrent chemotherapy. Results: Of 127 patients enrolled, 46 underwent PCRT and 81 did not. The mean distance of lesions from the anal verge was lower in the PCRT group (P=0.004). The most frequent operation was transanal excision and ultralow anterior resection in the PCRT and non-PCRT groups, respectively. Of the 46 patients who underwent PCRT, 21 (45.7%) achieved pathologic complete response, including 15 of the 24 (62.5%) who underwent LE. Rectal sparing rate was significantly higher in the PCRT group (11.1% vs. 52.2%, P<0.001). There were no significant differences in 3- and 5-year overall survival and recurrence-free survival regardless of PCRT or surgical procedures. Conclusion: PCRT in clinical T2N0 distal rectal cancer patients increased the rectal sparing rate via LE and showed acceptable oncologic outcomes. PCRT may be a feasible therapeutic option to avoid abdominoperineal resection in clinical T2N0 distal rectal cancer.
( In Ja Park ),( Chang Sik Yu ),( Chan Wook Kim ),( Yong Sik Yoon ),( Seok Byung Lim ),( Jong Lyul Lee ),( Jin Cheon Kim ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: The aim of this study was to evaluate the effi cacy of using a Hyaluronate (HA) bioresorbable membrane (HA, Seprafi lmTM, Sanofi ) to prevent adhesive complication after colorectal cancer surgery. Methods: We recruited colorectal cancer patients who underwent a curative resection between 2005 and 2009. Patients were matched with age, gender, and pathologic stage according to type of surgery. We excluded patients with a previous operation history, a multivisceral resection, an extended lymphadenectomy, a total colectomy, a pouch procedure, local excision, or minimally invasive surgery. An adhesive ileus was defi ned as a symptomatic, radiological intestinal obstruction without evidence of recurrence. Adhesive complications were categorized as immediate postoperative onset, postoperative onset, re-admission in terms of timing of onset. Treatment for adhesive complications were categorized as conservative and surgical. Results: Patients who underwent right hemicolectomy (RHC) were 216, low anterior resection (LAR) 294, and abdominoperineal resection were 120. Half of the patients were each operation were applied HA. We placed the HA membrane under the midline incision in RHC, under the midline and on the retroperitoneum in LAR, and on the peritoneal cavity in APR. There was no difference between the groups regarding demographic findings and clinicopathological findings. Adhesive complication rate was not different in RHC and LAR according to addition of HA. But, in APR, adhesive complication rate was signifi cantly lower in HA group (6.7% vs. 20.0%, P=0.03). While only1 (0.7%) patient of the HA group experienced an adhesive ileus, 13 (6.2%) cases of adhesion were identifi ed 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.
( In Ja Park ),( Chang Sik Yu ),( Chan Wook Kim ),( Yong Sik Yoon ),( Seok Byung Lim ),( Jong Lyul Lee ),( Jin Cheon Kim ),( Seong Kyeong Lim ),( Moo In Park ),( Seun Ja Park ),( Won Moon ),( Sung Eun 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background and Objectives: The aim of study is to compare the effectiveness of tumor regression grade (TR) with that of pathologic stage to assess the level of response to PCRT in terms of prediction of prognosis. Methods : The patients with locally advanced (cT3-4 or cN+ by EUS or MRI) rectal carcinoma diagnosed from 2006 to 2009 and treated with PCRT and radical resection were identified from our colorectal database and records retrospectively reviewed. Response to CRT was evaluated according to tumor regression grade (TRG; no, minimal, moderate, near total, and total regression) and pathologic stage. Recurrence-free survival (RFS) was compared among patients according to TRG and pathologic stage. Results : Overall, 504 were identifi ed. Total regression represents pathologic stage 0 in 84.7%. No patients with moderate and minimal regression had p Stage 0. Except, total regression and p Stage 0, TRG was not correlated with pathologic stage. At a mean follow-up of 52 months, among patients with the same TRG category, the 3-year RFS rate differed signifi cantly according to the pathologic stage. By contrast, signifi cant differences were not found in 3-year RFS within pathologic stage according to TRG. However, for pStage III patients, 3-year RFS was different according to TRG. In multivariate analysis, pathologic stage showed stratifi ed association with RFS, but, TRG could not stratify prognostic group. Conclusion: Pathologic stage was well associated with prognosis rather than TRG for patients without metastatic lymph node. However, patients with metastatic lymph node, 3-year RFS was different according to TRG. Among patients with rectal cancer received PCRT, tumor regression grade and pathologic stage could not predict prognosis adequately as a single response assessment.