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Long-term outcome of stem cell transplantation with and without anti-tumor necrotic factor therapy in perianal fistula with Crohn’s disease

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World Journal of Stem Cells 2024年第3期16卷 257-266页

作者： Min Young Park yong sik yoon Jae Ha Park Jong Lyul Lee Chang sik Yu Division of Colon and Rectal Surgery Department of SurgeryYonsei University College of MedicineSeoul 03722South Korea Division of Colon and Rectal Surgery Department of SurgeryUniversity of Ulsan College of MedicineAsan Medical CenterSeoul 05505South Korea

BACKGROUND Stem cell transplantation is a promising therapeutic option for curing perianal fistula in Crohn’s disease(CD).Anti-tumor necrotic factor(TNF)therapy combined with drainage procedure is effective as ***,previous studies are limited to proving whether the combination treatment of biologics and stem cell transplantation improves the effect of fistula *** This study aimed to evaluate the long-term outcomes of stem cell transplantation and compare Crohn’s perianal fistula(CPF)closure rates after stem cell transplantation with and without anti-TNF therapy,and to identify the factors affecting CPF closure and *** The patients with CD who underwent stem cell transplantation for treating perianal fistula in our institution between Jun 2014 and December 2022 were *** data were compared according to anti-TNF therapy and CPF *** A total of 65 patients were *** median age of females was 26 years(range:21-31)and that of males was 29(44.6%).The mean follow-up duration was 65.88±32.65 months,and complete closure was observed in 50(76.9%)*** closure rates were similar after stem cell transplantation with and without anti-TNF therapy(66.7%vs 81.6%at 3 year,P=0.098).The patients with fistula closure had short fistulous tract and infrequent proctitis and anorectal stricture(P=0.027,0.002,and 0.008,respectively).Clinical factors such as complexity,number of fistulas,presence of concurrent abscess,and medication were not significant for *** cumulative 1-,2-,and 3-year closure rates were 66.2%,73.8%,and 75.4%,*** Anti-TNF therapy does not increase CPF closure rates in patients with stem cell ***,both refractory and non-refractory CPF have similar closure rates after additional anti-TNF *** tract length,proctitis,and anal stricture are risk factors for non-closure in patients with CPF after stem cell transplantation.

关键词： Crohn’s disease Anus Fistula Stem cell transplantation Tumor necrosis factor-alpha inhibitors Infliximab

Clinicopathological features of familial adenomatous polyposis in Korean patients

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World Journal of Gastroenterology 2016年第17期22卷 4380-4388页

作者： Sung Min Jung yong sik yoon Seok-Byeong Lim Chang sik Yu Jin Cheon Kim Division of Colon and Rectal Surgery Department of Surgery University of Ulsan College of Medicine Seoul 05505 South Korea Asan Medical Center Seoul 05505 South Korea

AIM: To identify prognostic factors and to correlate APC mutations with clinical features, including extracolic manifestations. METHODS: One hundred thirty-five patients who underwent surgical procedures for familial adenomatous polyposis(FAP) were included. FAP was diagnosed when the number of adenomatous polyps was > 100. Data related to patient, extracoloic manifestations, cancer characteristics, operative procedure, follow up and surveillance were collected. APC mutation testing was performed in the 30 most recent patients. DNA was extracted from peripheral blood and polymerase chain reaction products using 31 primer pairs on APC gene were sequenced. A retrospective study was performed to investigate a causal relationship between prognosis and feature of ***: The mean age of the 51 patients with colorectal cancer(CRC) was older than that of those without CRC(30.5 vs 36.9, P = 0.002). Older individuals were more likely to have colon cancer at the time of FAP diagnosis [odds ratio, 4.75(95%CI: 1.71-13.89) and 5.91(1.76-22.12) for 40-49 years and age > 50 vs age < 30). The number of confirmed deaths was 13 and the median age at death was 40 years(range, 27 to 85 years). Ten of the deaths(76.9%) were from CRC. Another cause of two cases of death were desmoid tumors(15.4%). Development of cancer on remnant rectal or ileal mucosa after surgery was not observed. The APC mutation testing revealed 23 pathogenic mutations and one likely pathogenic mutation, among which were four novel mutations. The correlation between mutational status and clinical manifestations was investigated. Mutations that could prodict poor prognosis were at codon 1309 which located on mutation cluster region, codon 1465 and codon ***: Identification of APC mutations should aid in the diagnosis and counseling of family members in terms of early diagnosis and management of FAP.

关键词： Adenomatous polyposis coli Colorectal neoplasms APC gene Prognosis Survival

Surgical outcomes of Korean ulcerative colitis patients with and without colitis-associated cancer

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World Journal of Gastroenterology 2015年第12期21卷 3547-3553页

作者： yong sik yoon yong Beom Cho Kyu Joo Park Seung Hyuk Baik Sang Nam yoon Seung-Bum Ryoo Kil Yeon Lee Hungdai Kim Ryung-Ah Lee Chang sik Yu Department of Colon and Rectal Surgery University of Ulsan College of Medicine and Asan Medical Center epartment of Surgery Samsung Medical Center Sungkyunkwan University School of Medicine Department of Surgery Seoul National University College of Medicine Department of Surgery Yonsei University College of Medicine Severance Hospital Department of Surgery Kangnam Sacred Heart Hospital Hallym University College of Medicine Department of Surgery Kyung Hee University School of Medicine Department of Surgery Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine Department of Surgery Ewha Womans University School of Medicine

AIM: To determine the clinicopathologic characteristics of surgically treated ulcerative colitis(UC) patients, and to compare the characteristics of UC patients with colitis-associated cancer(CAC) to those without CAC. METHODS: Clinical data on UC patients who underwent abdominal surgery from 1980 to 2013 were collected from 11 medical institutions. Data were analyzed to compare the clinical features of patients with CAC and those of patients without ***: Among 415 UC patients, 383(92.2%) underwent total proctocolectomy, and of these, 342(89%) were subjected to ileal pouch-anal anastomosis. CAC was found in 47 patients(11.3%). Adenocarcinoma was found in 45 patients, and the others had either neuroendocrine carcinoma or lymphoma. Comparing the UC patients with and without CAC, the UC patients with CAC were characteristically older at the time of diagnosis, had longer disease duration, underwent frequent laparoscopic surgery, and were infrequently given preoperative steroid therapy(P < 0.001-0.035). During the 37 mo mean follow-up period, the 3-yearoverall survival rate was 82.2%.CONCLUSION: Most Korean UC patients experience early disease exacerbation or complications. Approximately 10% of UC patients had CAC, and UC patients with CAC had a later diagnosis, a longer disease duration, and less steroid treatment than UC patients without CAC.

关键词： Ulcerative colitis Colorectal neoplasms Colorectal

Short-term and long-term outcomes of laparoscopic vs open ileocolic resection in patients with Crohn's disease: Propensityscore matching analysis

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World Journal of Gastroenterology 2021年第41期27卷 7159-7172页

作者： Shin Jeong Pak Young Il Kim yong sik yoon Jong Lyul Lee Jung Bok Lee Chang sik Yu Department of Colon and Rectal Surgery University of Ulsan College of MedicineAsan Medical CenterSeoul 05505South Korea Department of Clinical Epidemiology and Biostatistics University of Ulsan College of MedicineAsan Medical CenterSeoul 05505South Korea

BACKGROUND Laparoscopic ileocolic resection(LICR)is the preferred surgical approach for primary ileocolic Crohn’s disease(CD)because it has greater recovery benefits than open ICR(OICR).AIM To compare short-and long-term outcomes in patients who underwent LICR and *** Patients who underwent ICR for primary CD from 2006 to 2017 at a single tertiary center specializing in CD were *** who underwent LICR and OICR were subjected to propensity-score matching *** were propensityscore matched 1:1 by factors potentially associated with 30-d perioperative *** included demographic characteristics and disease-and treatment-related *** were compared using univariate and multivariate ***-term surgical recurrence-free survival(SRFS)in the two groups was determined by the Kaplan-Meier method and compared by the log-rank *** During the study period,348 patients underwent ICR,211 by the open approach and 137 ***-score matching yielded 102 pairs of *** rate of postoperative complication was significantly lower(14%versus 32%,P=0.003),postoperative hospital stay significantly shorter(8 d versus 13 d,P=0.003),and postoperative pain on day 7 significantly lower(1.4 versus 2.3,P<0.001)in propensity-score matched patients who underwent LICR than in those who underwent *** analysis showed that postoperative complications were significantly associated with preoperative treatment with biologics[odds ratio(OR):3.14,P=0.01]and an open approach to surgery(OR:2.86,P=0.005).The 5-and 10-year SRFS rates in the matched pairs were 92.9%and 83.3%,respectively,with SRFS rates not differing significantly between the OICR and LICR *** performance of additional procedures was an independent risk factor for surgical recurrence[hazard ratio(HR):3.28,P=0.02].CONCLUSION LICR yielded better short-term outcomes and postoperative recovery than OICR,with no differences in long-ter

关键词： Crohn’s disease Laparoscopic Surgery Postoperative complications Recurrence Propensity score Retrospective study

Short- and long-term outcomes of surgical treatment in patients with intestinal Behcet’s disease

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World Journal of Gastrointestinal Surgery 2024年第2期16卷 429-437页

BACKGROUND Behcet’s disease(BD),a chronic vasculitic disorder affecting multiple organs,is characterized by recurrent oral and genital ulcers,arthritis,vasculitis,and intes-tinal *** intestinal involvement of BD is common in East Asia,the efficacy and long-term outcomes of surgical treatment of intestinal BD still remain to be *** To evaluate the postoperative clinical course of intestinal BD and determine factors associated with its *** Data from patients who underwent surgical treatment for intestinal BD between January 2010 and August 2021 were retrospectively ***’demo-graphics,clinical features,postoperative course,complications,and follow-up data were *** We analyzed 39 surgeries in 31 *** mean patient age was 45.1 years,and the mean interval between the diagnosis of intestinal BD and surgical treatment was 4.9 years(range 1.0-8.0 years).The most common indication for surgery was medical intractability(n=16,41.0%),followed by fistula or abscess(n=11,28.2%).Laparoscopic approaches were used in 19 patients(48.7%),and 5 patients(12.8%)underwent emergency *** most common surgical procedure was ileocecal resection(n=18,46.2%),followed by right colectomy(n=11,28.2%).A diverting stoma was created in only one patient(2.6%).During a mean follow-up period of 45(range 8-72)months,eight cases(20.5%)of recurrence in five patients required *** interval between operations was 12.1 months(range 6.3-17.8 mo).Four patients(10.3%)experienced recurrence within 1 year postoperatively,and all eight recurrences occurred within 2 years of the initial *** reoperation rates at 1 and 3 years were 10.3%and 20.5%,respectively.A redo ileocolic anastomosis was performed in all recurrent *** multivariate Cox regression analysis,emergency surgery[hazard ratio(HR)9.357,95%confidence interval(CI):1.608-54.453,P=0.013]and elevated C-reactive protein(CRP)levels(HR 1.154,95%CI:1.002–1.328,

关键词： Behcet syndrome Intestinal General surgery Recurrence Risk factors

Impression of prognosis regarding pathologic stage after preoperative chemoradiotherapy in rectal cancer

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World Journal of Gastroenterology 2015年第2期21卷 563-570页

作者： Kyungyeon Hwang In Ja Park Chang sik Yu Seok-Byung Lim Jong Lyul Lee yong sik yoon Chan Wook Kim Jin Cheon Kim Department of Colon and Rectal Surgery University of Ulsan College of Medicine and Asan Medical CenterSeoul 138-736South Korea

AIM: To ascertain pathologic stage as a prognostic indicator for rectal cancer patients receiving preoperative chemoradiotherapy(PCRT).METHODS: Patients with mid- and low rectal carcinoma(magnetic resonance imaging- based clinical stage Ⅱ or Ⅲ) between 2000 and 2009 and treated with curative radical resection were identified. Patients were divided into two groups: PCRT and No-PCRT. Recurrence-free survival(RFS) was examined according to pathologic stage and addition of adjuvant ***: Overall, 894 patients were identified. Of these, 500 patients received PCRT. Adjuvant chemotherapy was delivered to 81.5% of the No-PCRT and 94.8% of the PCRT patients. Adjuvant radiotherapy was given to 29.4% of the patients in the No PCRT group. The 5-year RFS for the No-PCRT group was 92.6% for StageⅠ, 83.3% for Stage Ⅱ, and 72.9% for Stage Ⅲ. The 5-year RFS for the PCRT group was 95.2% for yp Stage 0, 91.7% for yp StageⅠ, 73.9% for yp Stage Ⅱ, and 50.7% for yp Stage Ⅲ.CONCLUSION: Pathologic stage can predict prognosis in PCRT patients. Five-year RFS is significantly lower among PCRT patients than No-PCRT patients in pathologic stage Ⅱ and Ⅲ. These results should be taken into account when considering adjuvant treatment for patients treated with PCRT.

关键词： Preoperative Chemoradiotherapy Rectal cancer Patho

Ratio of metastatic lymph nodes is more important for rectal cancer patients treated with preoperative chemoradiotherapy

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World Journal of Gastroenterology 2015年第11期21卷 3274-3281页

作者： In Ja Park Chang sik Yu Seok-Byung Lim yong sik yoon Chan Wook Kim Tae Won Kim Jong Hoon Kim Jin Cheon Kim Department of colon and rectal Surgery University of Ulsan College of Medicine and Asan Medical Center Department of Medical Oncology University of Ulsan College of Medicine and Asan Medical Center Department of Radiation Oncology University of Ulsan College of Medicine and Asan Medical Center

AIM:To evaluate the predictive value of the lymph node(LN) ratio(LNR,number of metastatic LNs/ examined LNs) for recurrence in patients with rectal cancer and to compare its applicability according to preoperative chemoradiotherapy(PCRT).METHODS:From 2000 to 2009,967 patients with metastatic LNs after curative resection for locally advanced rectal cancer were *** were categorized according to PCRT(PCRT vs No PCRT).The cut-off LNR was determined based on the p N1 vs p N2 when the recommended number of LNs was *** 5-year recurrence-free survival(RFS) rates using the Kaplan-Meier method were compared according to p/yp N stage and the LNR in each ***:Among patients with the same p/yp N stage,the 5-year RFS rate differed according to the *** addition,the 5-year RFS rate was significantly different between p N and LNR groups in patients with No *** PCRT group,however,only LNR was associated with *** multivariate analysis,both p N and LNR were significant independent prognostic factors for 5-year RFS in the No PCRT *** the PCRT group,only LNR category was found to be associated with RFS(HR = 2.36,95%CI:1.31-3.84,and P = 0.001).CONCLUSION:The LNR is an important prognostic predictor of RFS in rectal cancer patients especially treated with *** p N categories could not discriminate between prognostic groups of RFS after PCRT.

关键词： Rectal cancer Preoperative chemoradiotherapy Lymph

Postoperative changes of manometry after restorative proctocolectomy in Korean ulcerative colitis patients

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World Journal of Gastroenterology 2017年第31期23卷 5780-5786页

作者： se heon oh yong sik yoon jong lyul lee chan wook kim in ja park seok-byung lim chang sik yu jin cheon kim department of surgery division of colon and rectal surgery university of ulsan college of medicine asan medical center

To investigate the changes of postoperative anal sphincter function and bowel frequency in Korean patients with ulcerative colitis (UC). METHODSA total of 127 patients with UC who underwent restorative proctocolectomy (RPC) during 20 years were retrospectively analyzed. The parameters of anal manometry and bowel frequency were compared according to the 6-mo intervals until 24 mo postoperatively. Manometry was used to measure the maximal squeezing pressure (MSP) and maximal resting pressure (MRP). RESULTSMSP decreased after surgery until 6 mo (157 to 142 mmHg); thereafter, it improved and was recovered to and maintained at the preoperative value at 12 mo postoperatively (142-170 mmHg, P < 0.001). Although the decreased MRP (65 to 56 mmHg) improved after 18 mo (62 mmHg), it did not completely recover to the preoperative value. The decreased rectal capacity after surgery (90 to 82 mL) gradually increased up to 150 mL at 24 mo. Although bowel frequency showed significant gradual decreases at each interval, it was stabilized after 12 mo postoperatively (6.5 times/d). CONCLUSIONPostoperative changes of manometry and bowel frequency after restorative proctocolectomy in Korean patients with UC were not different from those in Western patients with UC.

关键词： Ulcerative colitis Surgery Treatment outcome Manometry Bowel frequency Restorative proctocolectomy

Intestinal endometriosis:Diagnostic ambiguities and surgical outcomes

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World Journal of Clinical Cases 2019年第4期7卷 441-451页

作者： Jun Woo Bong Chang sik Yu Jong Lyul Lee Chan Wook Kim yong sik yoon In Ja Park Seok-Byung Lim Jin Cheon Kim Division of Colon and Rectal Surgery Department of SurgeryUniversity of Ulsan College of Medicine and Asan Medical Center

BACKGROUND Endometriosis is a common disease for women of reproductive age. However,when it involves intestines, it is difficult to diagnose preoperatively because its symptoms overlap with other diseases and the results of evaluations can be unspecific. Thus it is important to know the clinical characteristics of intestinal endometriosis and how to exactly *** To analyze patients in whom intestinal endometriosis was diagnosed after surgical treatments, and to evaluate the clinical characteristics of preoperatively misdiagnosed *** We retrospectively reviewed the pathologic reports of 30 patients diagnosed as having intestinal endometriosis based on surgical specimens between January2000 and December 2017. We reviewed their clinical characteristics and surgical *** Twenty-three(76.6%) patients showed symptoms associated with endometriosis,with dysmenorrhea being the most common(n = 9, 30.0%). Thirteen patients(43.3%) had a history of pelvic surgeries. Ten patients(33.3%) had a history of treatment for endometriosis. Only 4 patients(13.3%) had a diagnosis of endometriosis based on endoscopic biopsy findings. According to preoperative evaluations, 13 patients(43.3%) had an initial diagnosis of pelvic endometriosis and 17 patients(56.6%) were misdiagnosed as having other diseases. The most common misdiagnosis was submucosal tumor in the large intestine(n = 8, 26.7%),followed by malignancies of the colon/rectum(n = 3, 10.0%) and ovary(n = 3,10.0%). According to the Clavien-Dindo classification, 5 complications were grade I or II and 2 complications were grade IIIa. The median follow-up period was 26.9(0.6-132.1) mo, and only 1 patient had a recurrence of *** Intestinal endometriosis is difficult to diagnose preoperatively because it mimics various intestinal diseases. Thus, if women of reproductive age have ambiguous symptoms and signs with nonspecific radiologic and/or endoscopic findings,intestinal endometriosis sho

关键词： Endometriosis Intestinal endometriosis Diagnosis Surgery Treatment