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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

Optimal postoperative surveillance strategies for stage III colorectal cancer

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World Journal of Gastrointestinal Surgery 2021年第9期13卷 1012-1024页

作者： Min Young Park In Ja Park Hyo Seon Ryu Jay Jung Minsung Kim seok-byung lim Chang Sik Yu Jin Cheon Kim Colon and Rectal Surgery Asan Medical CenterSeoul 05505South Korea Colon and Rectal Surgery Asan Medical Center and University of Ulsan College of MedicineSeoul 05505South Korea

BACKGROUND Optimal surveillance strategies for stage III colorectal cancer(CRC)are lacking,and intensive surveillance has not conferred a significant survival *** To examine the association between surveillance intensity and recurrence and survival rates in patients with stage III *** Data from patients with pathologic stage III CRC who underwent radical surgery between January 2005 and December 2012 at Asan Medical Center,Seoul,Korea were retrospectively *** consisted of abdominopelvic computed tomography(CT)every 6 mo and chest CT annually during the 5 year follow-up period,resulting in an average of three imaging studies per *** who underwent more than the average number of imaging studies annually were categorized as high intensity(HI),and those with less than the average were categorized as low intensity(LI).RESULTS Among 1888 patients,864(45.8%)were in HI ***,sex,and location were not different between *** group had more advanced T and N stage(P=0.002,0.010,each).Perineural invasion(PNI)was more identified in the HI group(21.4%vs 30.3%,P<0.001).The mean overall survival(OS)and recurrence-free interval(RFI)was longer in the LI group(P<0.001,each).Multivariate analysis indicated that surveillance intensity[odds ratio(OR)=1.999;95%confidence interval(CI):1.680–2.377;P<0.001],pathologic T stage(OR=1.596;95%CI:1.197–2.127;P=0.001),PNI(OR=1.431;95%CI:1.192–1.719;P<0.001),and circumferential resection margin(OR=1.565;95%CI:1.083–2.262;P=0.017)in rectal cancer were significantly associated with *** mean post-recurrence survival(PRS)was longer in patients who received curative resection(P<0.001).Curative resection rate of recurrence was not different between HI(29.3%)and LI(23.8%)groups(P=0.160).PRS did not differ according to surveillance intensity(P=0.802).CONCLUSION Frequent surveillance with CT scan do not improve OS in stage III CRC *** need to evaluate role of other surveillance method rather tha

关键词： Colorectal cancer Surveillance intensity Survival Recurrence

Colonic J-pouch anal anastomosis after ultralow anterior resection with upper sphincter excision for low-lying rectal cancer

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World Journal of Gastroenterology 2005年第17期11卷 2570-2573页

作者： Jae-Gahb Park Min Ro Lee seok-byung lim Chang Won Hong Sang Nam Yoon Sung-Bum Kang Seung Chul Heo Seung-Yong Jeong Kyu Joo Park Department of Surgery Seoul National University College of Medicine 28 Yongon-dongChongno-guSeoul 110-744Korea Cancer Research Institute and Cancer Research CenterSeoul National University28 Yongon-dongChongno-guSeoul 110-744Korea Research Institute and HospitalNational Cancer Center809 Madu-dongIlsan-guGoyangGyeonggi 411-764Korea Department of Surgery Seoul National University College of Medicine 28 Yongon-dongChongno-guSeoul 110-744Korea Research Institute and Hospital National Cancer Center 809 Madu-dongIlsan-guGoyangGyeonggi 411-764Korea

AIM:There is some evidence of functional superiority of colonic J-pouch over straight coloanal anastomosis (CM) in ultralow anterior resection (ULAR) or intersphincteric resection. On the assumption that colonic J-pouch anal anastomosis is superior to straight CM in ULAR with upper sphincter excision (USE: excision of the upper part of the internal sphincter) for low-lying rectal cancer, we compare functional outcome of colonic J-pouch vsthe straight CM. METHODS: Fifty patients of one hundred and thirty-three rectal cancer patients in whom lower margin of the tumors were located between 3 and 5 cm from the anal verge received ULAR including USE from September 1998 to January 2002. Patients were randomized for reconstruction using either a straight (n = 26) or a colonic J-pouch anastomosis (n = 24) with a temporary diverting-loop ileostomy. All patients were followed-up prospectively by a standardized questionnaire [Fecal Inco-ntinence Severity Index (FISI) scores and Fecal Incontinence Quality of Life (FIQL) scales]. RESULTS: We found that, compared to straight anastomosis patients, the frequency of defecation was significantly lower in J-pouch anastomosis patients for 10 mo after ileostomy takedown. The FISI scores and FIQL scales were significantly better in J-pouch patients than in straight patients at both 3 and 12 mo after ileostomy takedown. Furthermore, we found that FISI scores highly correlated with FIQL scales. CONCLUSION: This study indicates that colonic J-pouch anal anastomosis decreases the severity of fecal incontinence and improves the quality of life for 10 mo after ileostomy takedown in patients undergoing ULAR with USE for low-lying rectal cancer.

关键词： Upper sphincter excision Ultralow anterior resection Coloanal anastomosis Rectal cancer

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

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

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

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