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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

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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

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New anti-mesenteric delta-shaped stapled anastomosis: Technical report with short-term postoperative outcomes in patients with Crohn’s disease

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World Journal of Gastrointestinal Surgery 2024年第8期16卷 2592-2601页

作者： Jong Lyul Lee yong sik yoon Hyun Gu Lee Young Il Kim Min Hyun Kim Chan Wook Kim In Ja Park Seok-Byung Lim Chang sik Yu Division of Colon and Rectal Surgery Department of SurgeryUniversity of Ulsan College of MedicineAsan Medical CenterSeoul 05505South Korea Department of Surgery Gangdong Kyung Hee University HospitalSeoul 05278South Korea

BACKGROUND Medical treatment for Crohn’s disease(CD)has continuously improved,which has led to a decrease in surgical recurrence *** these advancements,25%of patients will undergo repeat intestinal *** of CD com-monly occurs on the mesentery side of the anastomosis *** To compare the new anti-mesenteric side-to-side delta-shaped stapled anasto-mosis(DSA)with the conventional stapled functional end-to-end anastomosis(CSA).METHODS This retrospective study included CD patients who underwent ileo-ileal or ileo-colic anastomosis between January 2020 and December *** DSA technique employed a stapler to maintain the concept of anti-mesentery side-to-side ana-stomosis by performing a 90°vertical closure of the open window compared with the CSA *** the corner where the open window is closed,the DSA avoids forming a pouch and creates an anastomosis resembling a delta shape within the intestinal *** compared demographics,preoperative condition,operative findings,and operative outcomes for the two *** The study included 175 patients,including 92 in the DSA group and 83 in the CSA *** two groups were similar in baseline characteristics,preoperative medical treatment,and operative findings except for the Montreal classification *** 30-days postoperative complication rate was signi-ficantly lower in the DSA group compared with the CSA group(16.3%vs 32.5%,P=0.009).Ileus incidence was significantly lower in the DSA group than in the CSA group(4.3%vs 14.5%,P=0.033),and the hospital stay was shorter in the DSA group than in the CSA group(5.67±1.53 days vs 7.39±3.68 days,P=0.001).CONCLUSION The DSA technique was feasible and showed comparable postoperative outcomes with lower short-term complic-ations compared with the CSA *** studies on CD recurrence and long-term complications are warranted.

关键词： Crohn’s disease Surgery Anastomosis Complication Recurrence

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Recent applications of chemosensitivity tests for colorectal cancer treatment

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World Journal of Gastroenterology 2014年第44期20卷 16398-16408页

作者： yong sik yoon Jin Cheon Kim Department of Surgery University of Ulsan College of Medicine Institute of Innovative Cancer Research and Asan Institute for Life Sciences Asan Medical Center

The evaluation of therapeutic efficacy is necessary to predict the outcome of patients with metastatic colorectal cancer(CRC). In these patients, there is a critical need for predictive chemosensitivity assays and biomarkers to optimize efficacy and minimize toxicity. The introduction of targeted agents has improved the progression-free survival and overall survival of patients with metastatic disease. However, approximately 50% of patients do not show a positive response to chemotherapy and the selection of patients likely to respond to a specific regimen remains challenging. Cell culturebased chemosensitivity tests use autologous viable tumor cells to evaluate susceptibility to specific agents in vitro and predict their direct effects. Adenosine triphosphate-based assays and methyl thiazolyl-diphenyltetrazolium bromide-based assays are used widely as sensitivity tests because of their short assay period, technical simplicity, and the requirement of small amount of specimen. Among protein- and gene-based chemosensitivity assays, assessment of KRAS mutation status predicts the response to epidermal growth factor receptor-targeted therapy in CRC patients. The validation of predictive and prognostic markers enables the selection of therapeutic regimens with optimal efficacy and minimal toxicity for each patient, which has been termed personalized treatment. This review summarizes currently available predictive and prognostic chemosensitivity tests for metastatic CRC.

关键词： Colorectal adenocarcinomas Colorectal cancer Chemotherapy In vitro assays Molecular targeted therapy Individualized therapy

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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

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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

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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

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Cumulative incidence and risk factors for pouch adenomas associated with familial adenomatous polyposis following restorative proctocolectomy

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World Journal of Gastroenterology 2022年第30期28卷 4152-4162页

作者： Hyo Seon Ryu Chang sik Yu Young Il Kim 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 MedicineAsan Medical CenterSeoul 05505South Korea

BACKGROUND The emergence of restorative total proctocolectomy has significantly reduced the lifetime colorectal cancer risk associated with familial adenomatous polyposis(FAP).However,adenomas may develop in the ileal pouch over time and may even progress to *** evaluated the cumulative incidence,time to development,and risk factors associated with ileal pouch *** To evaluate the cumulative incidence,time to development,and risk factors associated with pouch *** In this retrospective,observational study conducted at a tertiary center,95 patients with FAP who underwent restorative proctocolectomy at our center between 1989 and 2018 were consecutively *** mean follow-up period was 88 *** Pouch adenomas were found in 24(25.3%)patients,with a median time of 52 mo to their first *** adenomas were detected in most patients(95.9%).There were no high-grade dysplasia or *** the 24 patients with pouch adenomas,13 had all detected adenomas *** the 13 patients who underwent complete adenoma removal,four(38.5%)developed *** 11(45.8%)patients with numerous polyps within the pouch,seven(63.6%)exhibited progression of pouch *** cumulative risks of pouch adenoma development at 5,10,and 15 years after pouch surgery were 15.2%,29.6%,and 44.1%,*** colorectal polyposis(with more than 1000 polyps)was a significant risk factor for pouch adenoma development(hazard ratio,2.49;95% confidence interval:1.04-5.96;P=0.041).CONCLUSION Pouch adenomas occur at a fairly high rate in association with FAP after restorative proctocolectomy,and a high colorectal polyp count is associated with pouch adenoma development.

关键词： Adenomatous polyposis coli Familial adenomatous polyposis Adenoma Intestinal polyps Proctocolectomy,restorative Ileal pouch anal anastomosis

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Isolated vaginal metastasis from stage Ⅰ colon cancer: A case report

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World Journal of Clinical Cases 2020年第3期8卷 527-534页

作者： Soon Keun Kwon Chang sik Yu Shin-Wha Lee Jihun Kim Inho Song 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 MedicineAsan Medical CenterSeoul 05505South Korea Department of Obstetrics and Gynecology University of Ulsan College of MedicineAsan Medical CenterSeoul 05505South Korea Department of Pathology University of Ulsan College of MedicineAsan Medical CenterSeoul 05505South Korea

BACKGROUND Distant metastasis occasionally occurs in patients who have been diagnosed with colorectal cancer(CRC), but it occurs in a few patients with stage I CRC. The vagina as a metastasis site has also been reported, albeit rarely. Most reported cases of vaginal metastasis(VM) report their origin from advanced CRC. We encountered a patient who was diagnosed with isolated VM originating from stage I colon cancer(T2N0) and herein present the case of this *** SUMMARY A 63-year-old woman visited the outpatient clinic because of a positive result from a stool occult blood test. She underwent laparoscopic anterior resection and was pathologically diagnosed with stage I(T2N0) sigmoid colon cancer. Neither lymphovascular invasion nor perineural invasion was observed. Ten months following the surgery, isolated vaginal metastases were detected on gynecologic examination. The examination was performed due to vaginal spotting. A transvaginal wide excision was performed, and no other adjuvant treatment was provided after discussion with a multidisciplinary team and the ***, a new VM was discovered after 33 mo. An additional transvaginal excision was performed. To date, there has been no evidence of further disease progression. From the time of diagnosis of VM, the patient’s overall survival has been 54 *** VM can occur as a result of early-stage colorectal cancer. Surgeons should consider the possibility of VM following complaints of gynecologic symptoms following surgery.

关键词： Colorectal cancer Stage Ⅰ Vaginal metastasis Isolated metastasis Case report

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Cost-effective screening using a two-antibody panel for detecting mismatch repair deficiency in sporadic colorectal cancer

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World Journal of Clinical Cases 2021年第24期9卷 6999-7008页

作者： Jong Beom Kim Young Il Kim yong sik yoon Jihun Kim Seo Young Park Jong Lyul Lee Chan Wook Kim In Ja Park Seok-Byung Lim Chang sik Yu Jin Cheon Kim Division of Colon and Rectal Surgery University of Ulsan College of MedicineAsan Medical CenterSeoul 05505South Korea Department of Pathology 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 The microsatellite instability(MSI)test and immunohistochemistry(IHC)are widely used to screen DNA mismatch repair(MMR)deficiency in sporadic colorectal cancer(CRC).For IHC,a two-antibody panel of MLH1 and MSH2 or four-antibody panel of MLH1,MSH2,PMS2,and MSH6 are *** general,MSI is known as a more accurate screening test than *** To compare two-and four-antibody panels of IHC in terms of accuracy and cost benefit on the basis of MSI testing for detecting MMR *** We retrospectively analyzed patients with CRC who underwent curative surgery between 2015 and 2017 at a tertiary referral *** IHC with four antibodies and MSI tests were routinely *** sensitivity and specificity of a fourand two types of two-antibody panels(PMS2/MSH6 and MLH1/MSH2)were compared on the basis of MSI testing for detecting MMR *** High-frequency MSI was found in 5.5%(n=193)of the patients(n=3486).The sensitivities of the four-and two types of two-antibody panels were 97.4%,92.2%,and 87.6%,*** specificities of the three types of panels did not differ significantly(99.6%for the four-antibody and PMS2/MSH6 panels,99.7%for the MLH1/MSH2 panel).Based on Cohen's kappa statistic(κ),four-and twoantibody panels were in almost perfect agreement with the MSI test(κ>0.9).The costs of the MSI test and the four-and two-antibody panels of IHC were approximately$200,$160,and$80,*** Considering the cost of the four-antibody panel IHC compared to that of the twoantibody panel IHC,a two-antibody panel of PMS2/MSH6 might be the best choice in terms of balancing cost-effectiveness and accuracy.

关键词： Adenocarcinoma DNA mismatch repair Immunochemistry Monoclonal antibody Microsatellite instability Cost-effectiveness

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