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백옥주,김영배,오승엽,서광욱 대한대장항문학회 2009 Annals of Coloproctolgy Vol.25 No.5
Purpose: This study was designed to review the clinical characteristics of gastrointestinal stromal tumors (GISTs) of the colon and rectum and to evaluate their immunohistochemical and pathologic features based on the current National Institutes of Health criteria. Methods: Patient and disease characteristics, pathologic features, surgical or endoscopic management, and clinical outcomes of 11 patients with GISTs diagnosed and primarily treated at our institution between March 1995 and February 2009 were evaluated. Results: Colorectal GISTs accounted for 4.4% of all GISTs. The primary location was the rectum (8 cases). Four patients had high-risk GISTs, 4 patients had low-risk GISTs, and 3 patients had very low-risk GISTs. All tumors were c-kit positive. Four patients underwent a radical resection, whereas 7 patients underwent an endoscopic resection (n=3) or a transanal excision (n=4). Two high-risk patients without adjuvant Imatinib mesylate therapy developed metastases, but the other highrisk patients with adjuvant Imatinib mesylate therapy didn’t. Conclusion: Colorectal GISTs occurred predominantly in the rectum. Because GISTs do not metastasize through the lymphatics, small GISTs that are amenable to local excision or endoscopic resection can be treated by either of these techniques as long as negative microscopic margins are obtained around the primary tumor. Patients with high-risk GISTs should be considered for the use of Imatinib mesylate as adjuvant therapy. Purpose: This study was designed to review the clinical characteristics of gastrointestinal stromal tumors (GISTs) of the colon and rectum and to evaluate their immunohistochemical and pathologic features based on the current National Institutes of Health criteria. Methods: Patient and disease characteristics, pathologic features, surgical or endoscopic management, and clinical outcomes of 11 patients with GISTs diagnosed and primarily treated at our institution between March 1995 and February 2009 were evaluated. Results: Colorectal GISTs accounted for 4.4% of all GISTs. The primary location was the rectum (8 cases). Four patients had high-risk GISTs, 4 patients had low-risk GISTs, and 3 patients had very low-risk GISTs. All tumors were c-kit positive. Four patients underwent a radical resection, whereas 7 patients underwent an endoscopic resection (n=3) or a transanal excision (n=4). Two high-risk patients without adjuvant Imatinib mesylate therapy developed metastases, but the other highrisk patients with adjuvant Imatinib mesylate therapy didn’t. Conclusion: Colorectal GISTs occurred predominantly in the rectum. Because GISTs do not metastasize through the lymphatics, small GISTs that are amenable to local excision or endoscopic resection can be treated by either of these techniques as long as negative microscopic margins are obtained around the primary tumor. Patients with high-risk GISTs should be considered for the use of Imatinib mesylate as adjuvant therapy.
백옥주,오승엽,서광욱 대한대장항문학회 2009 Annals of Coloproctolgy Vol.25 No.1
Purpose: The detection of synchronous and metachronous colon cancer is important for the surgical treatment. The aim of this study is to review the clinicopathological characteristics of multiple colon cancers. Methods: A retrospective analysis was performed with 43 patients with multiple colon cancers who underwent surgical treatment from June 1996 to May 2008. Patients with familial adenomatous polyposis and cancer from inflammatory bowel disease were excluded. Results: There were 43 cases of multiple colon cancers. Synchronous colon cancers were present in 30 patients and metachronous colon cancers were present in 18 patients. The mean age was 61.33±11.44, and the male-to-female ratio was 23:20. The index cancer and the second cancers in synchronous colon cancers, as well as the first colon cancer in metachronous colon cancers showed, significantly more distal tumor locations. However, the second cancers in metachronous colon cancers showed no significant differences in tumor location. As for stage, a more advanced stage was noted in the index cancer than in the second cancers in synchronous cancer. However, an early stage was noted for the first colon cancer in metachronous cancers. Seventeen patients with synchronous cancer and 14 patients with metachronous colon cancer underwent a total or a subtotal colectomy. Conclusion: Detection of synchronous colon cancer was important for deciding the extent of surgical resection. Patients with colon cancer should be considered for frequent colonoscopy follow-up for early detection of metachronous colon cancer. Purpose: The detection of synchronous and metachronous colon cancer is important for the surgical treatment. The aim of this study is to review the clinicopathological characteristics of multiple colon cancers. Methods: A retrospective analysis was performed with 43 patients with multiple colon cancers who underwent surgical treatment from June 1996 to May 2008. Patients with familial adenomatous polyposis and cancer from inflammatory bowel disease were excluded. Results: There were 43 cases of multiple colon cancers. Synchronous colon cancers were present in 30 patients and metachronous colon cancers were present in 18 patients. The mean age was 61.33±11.44, and the male-to-female ratio was 23:20. The index cancer and the second cancers in synchronous colon cancers, as well as the first colon cancer in metachronous colon cancers showed, significantly more distal tumor locations. However, the second cancers in metachronous colon cancers showed no significant differences in tumor location. As for stage, a more advanced stage was noted in the index cancer than in the second cancers in synchronous cancer. However, an early stage was noted for the first colon cancer in metachronous cancers. Seventeen patients with synchronous cancer and 14 patients with metachronous colon cancer underwent a total or a subtotal colectomy. Conclusion: Detection of synchronous colon cancer was important for deciding the extent of surgical resection. Patients with colon cancer should be considered for frequent colonoscopy follow-up for early detection of metachronous colon cancer.
백옥주,오승엽,김영배,서광욱 대한대장항문학회 2010 Annals of Coloproctolgy Vol.26 No.2
Purpose: Microsatellite instability-high (MSI-H) colorectal cancer (CRC) displays a well-described distinct phenotype, but the true biological significance of MSI-low (L) is still uncertain. To clarify the significance of this MSI-L, we studied the differences between patients with CRC with MSI-H, MSI-L, and microsatellite stability (MSS). Methods: A total of 723 consecutive patients (429 males and 294 females) who had undergone resections between September 2002 and August 2007 were studied. We analyzed the clinicopathological features, the MSI statuses, and the prognoses of the 723 CRC patients. Results: MSI-H was observed in 54 (7.5%), MSI-L in 27 (3.7%), and MSS in 642 (88.8%) of the 723 colorectal cancer patients. MSI-L and MSS CRC share similar clinicopathological features. A univariate analysis showed no significant differences in overall survival between MSI-L, MSS, and MSI-H. In the multivariate Cox regression analysis, MSI-L was significantly (P=0.036) associated with poorer prognosis compared with MSS tumors, after adjustment for factors previous shown to be associated with the survival based on potentially relevant variables. Conclusion: In conclusion, the current study showed no difference in the clinicopathological features of MSI-L versus MSS CRCs. However, in the multivariate analysis, patients with MSI-L CRCs had significantly poorer overall survival. Finally, these findings support the existence of MSI-L CRCs as a distinct category. Thus, further studies are required to explore possible reasons for the adverse prognosis associated with MSI-L cancers.