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Lee, Hyebin,Park, Hee Chul,Park, Won,Choi, Doo Ho,Kim, Young-Il,Park, Young Suk,Park, Joon Oh,Chun, Ho-Kyung,Lee, Woo-Yong,Kim, Hee Cheol,Yun, Seong Hyeon,Cho, Yong Beom,Park, Yoon Ah The Korean Society for Radiation Oncology 2012 Radiation Oncology Journal Vol.30 No.3
Purpose: Although anemia is considered to be a contributor to intra-tumoral hypoxia and tumor resistance to ionizing radiation in cancer patients, the impact of pretreatment anemia on local control after neoadjuvant concurrent chemoradiotherapy (NACRT) and surgery for rectal cancer remains unclear. Materials and Methods: We reviewed the records of 247 patients with locally advanced rectal cancer who were treated with NACRT followed by curative-intent surgery. Results: The patients with anemia before NACRT (36.0%, 89/247) achieved less pathologic complete response (pCR) than those without anemia (p = 0.012). The patients with pretreatment anemia had worse 3-year local control than those without pretreatment anemia (86.0% vs. 95.7%, p = 0.005). Multivariate analysis showed that pretreatment anemia (p = 0.035), pathologic tumor and nodal stage (p = 0.020 and 0.032, respectively) were independently significant factors for local control. Conclusion: Pretreatment anemia had negative impacts on pCR and local control among patients who underwent NACRT and surgery for rectal cancer. Strategies maintaining hemoglobin level within normal range could potentially be used to improve local control in rectal cancer patients.
Local recurrence after curative resection for rectal carcinoma : The role of surgical resection
Yun, Jung-A,Huh, Jung Wook,Kim, Hee Cheol,Park, Yoon Ah,Cho, Yong Beom,Yun, Seong Hyeon,Lee, Woo Yong,Chun, Ho-Kyung Williams & Wilkins Co 2016 Medicine Vol.95 No.27
<▼1><P>Supplemental Digital Content is available in the text</P></▼1><▼2><P><B>Abstract</B></P><P>Local recurrence of rectal cancer is difficult to treat, may cause severe and disabling symptoms, and usually has a fatal outcome. The aim of this study was to document the clinical nature of locally recurrent rectal cancer and to determine the effect of surgical resection on long-term survival.</P><P>A retrospective review was conducted of the prospectively collected medical records of 2485 patients with primary rectal adenocarcinoma who underwent radical resection between September 1994 and December 2008.</P><P>In total, 147 (5.9%) patients exhibited local recurrence. The most common type of local recurrence was lateral recurrence, whereas anastomotic recurrence was the most common type in patients without preoperative concurrent chemoradiotherapy (CCRT). Tumor location with respect to the anal verge significantly affected the local recurrence rate (<I>P</I> < 0.001), whereas preoperative CCRT did not affect the local recurrence rate (<I>P</I> = 0.433). Predictive factors for surgical resection of recurrent rectal cancer included less advanced tumor stage (<I>P</I> = 0.017, RR = 3.840, 95% CI = 1.271–11.597), axial recurrence (<I>P</I> < 0.001, RR = 5.772, 95% CI = 2.281–14.609), and isolated local recurrence (<I>P</I> = 0.006, RR = 8.679, 95% CI = 1.846–40.815). Overall survival after diagnosis of local recurrence was negatively influenced by advanced pathologic tumor stage (<I>P</I> = 0.040, RR = 1.867, 95% CI = 1.028–3.389), positive CRM (<I>P</I> = 0.001, RR = 12.939, 95% CI = 2.906–57.604), combined distant metastases (<I>P</I> = 0.001, RR = 2.086, 95% CI = 1.352–3.218), and nonsurgical resection of recurrent tumor (<I>P</I> < 0.001, RR = 4.865, 95% CI = 2.586–9.153).</P><P>In conclusion, the clinical outcomes of local recurrence after curative resection of rectal cancer are diverse. Surgical resection of locally recurrent rectal cancer should be considered as an initial treatment, especially in patients with less advanced tumors and axial recurrence.</P></▼2>
Kim, Seung Tae,Ha, Sang Yun,Lee, Jeeyun,Hong, Sung No,Chang, Dong Kyung,Kim, Young Ho,Park, Yoon Ah,Huh, Jung Wook,Cho, Yong Beom,Yun, Seong Hyeon,Lee, Woo Yong,Kim, Hee Cheol,Park, Young Suk Wolters Kluwer Health 2016 Medicine Vol.95 No.19
<P><B>Abstract</B></P><P>The clinicopathologic features of hindgut neuroendocrine tumor (NET) as well as the treatment outcomes are not well known. There are currently no published data on treatment outcomes for patients with metastatic hindgut NET. The aim of this study was to conduct a comprehensive analysis of clinicopathologic features, treatments and survival in hindgut NET patients. Among patients who were pathologically diagnosed with hindgut NET at Samsung Medical Center between March 2001 and February 2015, 607 were analyzed in this study. Hindgut NETs were defined as NETs that originated from the transverse and distal colon, rectum, and anus. Primary sites included 81 colon (13.3%) and 526 rectum (86.7%). According to the WHO classification, 578 patients (95.2%) had grade 1 NETs, 17 (2.8%) grade 2 NETs, and 12 (2.0%) had neuroendocrine carcinoma (NEC). Forty-two patients (6.9%) had extensive disease, while the majority (93.1%, 565 patients) only exhibited localized disease. The 5- and 10-year survival rates of 565 localized NET patients were 98.1% and 95.3%, respectively. The median OS in 42 patients with extensive disease was 24.8 months (95% CI, 10.7–38.8). Among 565 patients with localized disease, the majority (484 patients, 85.7%) were treated with endoscopic procedure by gastroenterologists. For 42 patients with extensive disease, 17 patients were managed by supportive care, 3 by concurrent chemoradiotherapy (CCRT), and 22 by systemic therapy. Among these 22 patients, 12 patients received only first-line therapy, 8 had second-line, and only 2 patients had third-line therapy. As first-line chemotherapy, the most commonly used regimens were etoposide plus cisplatin (N = 7) and long acting octreotide (N = 7). During treatment courses, the most commonly used regimen was long-acting octreotide. The median OS in 22 metastatic NET patients receiving systemic therapy was 19.3 months (95% CI, 3.2–35.3). Multivariate analysis in all 607 hindgut NETs patients suggested that the extent and the primary site of disease were significant independent prognostic factors for long term survival. This analysis provides useful information about the clinicopathologic features, treatments and survival outcomes for hindgut NET patients.</P>
Ah Jung Seo,Jung Kyoung Shin,Yoon Ah Park,Jung Wook Huh,Yong Beom Cho,Hee Cheol Kim,Seong Hyeon Yun,Woo Yong Lee 대한종양외과학회 2019 Korean Journal of Clinical Oncology Vol.15 No.2
Purpose: Although laparoscopic surgery is widely accepted in the treatment of colorectal cancer, conversion to open surgery is associated with the rate of unfavorable outcomes. The aim of this study was to determine the factors associated with open conversion from laparoscopic surgery for colorectal cancer. Methods: A total of 3,002 patients who underwent laparoscopic colectomy as an initial plan for the treatment of colorectal cancer located from the sigmoid colon to the rectum were retrospectively evaluated between January 2009 and December 2018 at Samsung Medical Center in Korea. Risk factors significantly associated with open conversion were determined using univariate and multivariate regression models. Results: Among the 3,002 patients, open conversion was performed in 120 patients (4%). Age >60 years (adjusted odds ratio [AOR], 2.370), preoperative bowel obstruction (AOR, 2.348), clinical T4 stage (AOR, 2.201), and serum carcinoembryonic antigen level >5 ng/mL (AOR, 2.289) were significantly associated with open conversion. Moreover, mucinous carcinoma was a significantly more frequent histopathologic type than adenocarcinoma (10.0% vs. 3.2%, P<0.001) in the open conversion group with an AOR of 2.549 (confidence interval, 1.259–5.159; P=0.009). Conclusion: The present study presented a novel finding, i.e. mucinous carcinoma as the histopathologic type could be an independent predictive factor for conversion from laparoscopic colectomy to open surgery. Identifying patients with mucinous carcinoma will help stratify the risk of open conversion preoperatively.
Risk Factors of Anastomotic Leakage and Long-Term Survival After Colorectal Surgery
Park, Jong Seob,Huh, Jung Wook,Park, Yoon Ah,Cho, Yong Beom,Yun, Seong Hyeon,Kim, Hee Cheol,Lee, Woo Yong Wolters Kluwer Health 2016 Medicine Vol.95 No.8
<P><B>Abstract</B></P><P>Anastomotic leakage (AL) is one of the most serious complications of colorectal surgery. It can affect long-term oncologic outcomes, but the impact on long-term survival remains uncertain. The aim of this study is to evaluate the operative characteristics of leakage and no leakage groups and to analyze long-term oncologic outcomes.</P><P>We prospectively enrolled 10,477 patients from 2000 to 2011 and retrospectively reviewed the data.</P><P>Male sex (odds ratio [OR], 3.90; <I>P</I> < 0.001), intraoperative transfusion (OR, 2.31; <I>P</I> = 0.042), and operative time (OR, 1.73; <I>P</I> = 0.032) were independent risk factors of AL in the colon. In the rectum, male sex (OR, 2.37; <I>P</I> < 0.001), neoadjuvant chemoradiotherapy (OR, 2.26; <I>P</I> < 0.001), and regional lymph node metastasis (OR, 1.43; <I>P</I> = 0.012) were independent risk factors of AL, and diverting stoma (OR, 0.24; <I>P</I> < 0.001) was associated with a deceased risk of AL. AL in the rectum without a diverting stoma was associated with disease-free survival (DFS, OR, 1.47; <I>P</I> = 0.037). Colonic leakage was not associated with 5-year DFS (leakage group vs nonleakage group, 72.4% vs 80.9%, <I>P</I> = 0.084); however, in patients undergoing rectal resection, there was a significant difference in 5-year DFS (67.0% vs 76.6%, <I>P</I> = 0.005, respectively).</P><P>AL in the rectum is associated with worse long-term DFS and overall survival. A diverting stoma was shown to protect against this effect and was associated with long-term survival in rectal surgery. Therefore, creating a diverting stoma should be considered in high-risk patients undergoing rectal surgery.</P>