A. Sakr, Jong Min Lee, H. Alawfi, M. Alessa, N. Kim
Desmoid tumors (fibromatosis), are rare locally aggressive tumors with less liability of metastasis. They have a high rate of recurrence even after complete excision. In patients with familial adenomatous polyposis (FAP; Gardner syndrome), desmoid tumors tend to be more aggressive and may result in vital organs destruction and can be fatal. They account for around 0.03% of all neoplasms. The incidence is 2–4 million population per year [1]. The age of presentation is between 15 and 60 with more females’ predilection [2]. Desmoid tumor occurs more frequently in FAP patients than other population with the majority of tumors being intra-abdomiOriginal Article Korean Journal of Clinical Oncology 2019;15:86-92 https://doi.org/10.14216/kjco.19016 pISSN 1738-8082 ∙ eISSN 2288-4084
{"title":"Postoperative developed intra-abdominal desmoid tumor after surgical resection of gastrointestinal malignancy: A review of 10 cases","authors":"A. Sakr, Jong Min Lee, H. Alawfi, M. Alessa, N. Kim","doi":"10.14216/kjco.19016","DOIUrl":"https://doi.org/10.14216/kjco.19016","url":null,"abstract":"Desmoid tumors (fibromatosis), are rare locally aggressive tumors with less liability of metastasis. They have a high rate of recurrence even after complete excision. In patients with familial adenomatous polyposis (FAP; Gardner syndrome), desmoid tumors tend to be more aggressive and may result in vital organs destruction and can be fatal. They account for around 0.03% of all neoplasms. The incidence is 2–4 million population per year [1]. The age of presentation is between 15 and 60 with more females’ predilection [2]. Desmoid tumor occurs more frequently in FAP patients than other population with the majority of tumors being intra-abdomiOriginal Article Korean Journal of Clinical Oncology 2019;15:86-92 https://doi.org/10.14216/kjco.19016 pISSN 1738-8082 ∙ eISSN 2288-4084","PeriodicalId":74045,"journal":{"name":"Korean journal of clinical oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87927502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
47 Periampullary tumors include neoplastic lesions of the pancreatic head, the ampulla of Vater, the duodenum, and the distal common bile duct. Although of different origins, these neoplasms are treated the same, with pancreaticoduodenectomy. Early and accurate diagnosis is extremely important to both the overall survival and the quality of life of patients with periampullary malignant tumors [1]. Unfortunately, until now, there has been no ideal imaging modality for the diagnosis of periampullary lesions. Since it is difficult to use biopsies to confirm the diagnosis because of the anatomical location of the tumors, many noninvasive tests, such as ultrasound, computed tomography (CT), and magnetic resonance imaging, have become important in diagnosing periampullary tumors. Even though there are some diagnostic inaccuracies in these noninvasive tests, invasive procedures, such as endoscopic retrograde cholangiopancreatography or endoscopic ultrasound, also carry risks of complications, such as bleeding, perforation, and the spreading of tumors [2]. Several studies have reported the clinical utility of carbohydrate antigen 19-9 (CA19-9) levels and positron emission tomography-CT (PET/CT) in the diagnosis and management of periampullary tumors [3,4]. Serum CA19-9 is an extensively studied and validated biomarker of pancreatic cancer that has also been used for the diagnosis and surveillance of periampullary tumors. It has well-known roles in predicting prognosis, overall survival, response to chemotherapy, and postoperative recurrence [3,5-7]. 18F-fluorodeoxyglucose PET/CT (FDG-PET/CT) is a metabolic imaging system based on glucose uptake capacity [3,6-8]. The accumulation of FDG reflects the rate of carbohydrate metabolism, which is an index of the metabolic activity of the cells. Carbohydrate metabolism is more active in malignant cells, resulting in a significant accumulation of FDG [6]. This examination has been well investigated in the field of esophageal, rectal, and some other cancers for detecting residual, viable cancer after anticancer treatment [5]. The maximum standardized uptake value (SUVmax marker of tumor glucose metabolism detected by [18F]) is a FDGPET/CT value. The SUVmax reflects tumor aggressiveness and is an independent prognostic factor in pancreatic cancer. The evaluation of SUVmax offers an advanced method of detecting small solid lesions, based on the focal uptake of FDG-labeled glucose in malignant tumor cell populations [3,7]. The authors aimed to determine the preoperative predictive value of the FDG-PET and CA19-9 diagnostic tools for periampullary tumors [9]. They found that elevated CA19-9 levels and the SUVmax of PET/CT were associated with malignancy in periampullary tumors. And thus, normal CA19-9 and no uptake of FDGPET were correlated with benign lesions. However, there were some limitations to this study due to the small numbers of benign lesions (n = 17) and the heterogenicity of the periampullary tumors, in w
{"title":"The importance of 18F-fluorodeoxyglucose positron emission tomography and carbohydrate antigen 19-9 in patients with periampullary tumors","authors":"H. Jung","doi":"10.14216/kjco.19009","DOIUrl":"https://doi.org/10.14216/kjco.19009","url":null,"abstract":"47 Periampullary tumors include neoplastic lesions of the pancreatic head, the ampulla of Vater, the duodenum, and the distal common bile duct. Although of different origins, these neoplasms are treated the same, with pancreaticoduodenectomy. Early and accurate diagnosis is extremely important to both the overall survival and the quality of life of patients with periampullary malignant tumors [1]. Unfortunately, until now, there has been no ideal imaging modality for the diagnosis of periampullary lesions. Since it is difficult to use biopsies to confirm the diagnosis because of the anatomical location of the tumors, many noninvasive tests, such as ultrasound, computed tomography (CT), and magnetic resonance imaging, have become important in diagnosing periampullary tumors. Even though there are some diagnostic inaccuracies in these noninvasive tests, invasive procedures, such as endoscopic retrograde cholangiopancreatography or endoscopic ultrasound, also carry risks of complications, such as bleeding, perforation, and the spreading of tumors [2]. Several studies have reported the clinical utility of carbohydrate antigen 19-9 (CA19-9) levels and positron emission tomography-CT (PET/CT) in the diagnosis and management of periampullary tumors [3,4]. Serum CA19-9 is an extensively studied and validated biomarker of pancreatic cancer that has also been used for the diagnosis and surveillance of periampullary tumors. It has well-known roles in predicting prognosis, overall survival, response to chemotherapy, and postoperative recurrence [3,5-7]. 18F-fluorodeoxyglucose PET/CT (FDG-PET/CT) is a metabolic imaging system based on glucose uptake capacity [3,6-8]. The accumulation of FDG reflects the rate of carbohydrate metabolism, which is an index of the metabolic activity of the cells. Carbohydrate metabolism is more active in malignant cells, resulting in a significant accumulation of FDG [6]. This examination has been well investigated in the field of esophageal, rectal, and some other cancers for detecting residual, viable cancer after anticancer treatment [5]. The maximum standardized uptake value (SUVmax marker of tumor glucose metabolism detected by [18F]) is a FDGPET/CT value. The SUVmax reflects tumor aggressiveness and is an independent prognostic factor in pancreatic cancer. The evaluation of SUVmax offers an advanced method of detecting small solid lesions, based on the focal uptake of FDG-labeled glucose in malignant tumor cell populations [3,7]. The authors aimed to determine the preoperative predictive value of the FDG-PET and CA19-9 diagnostic tools for periampullary tumors [9]. They found that elevated CA19-9 levels and the SUVmax of PET/CT were associated with malignancy in periampullary tumors. And thus, normal CA19-9 and no uptake of FDGPET were correlated with benign lesions. However, there were some limitations to this study due to the small numbers of benign lesions (n = 17) and the heterogenicity of the periampullary tumors, in w","PeriodicalId":74045,"journal":{"name":"Korean journal of clinical oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84838359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ah Jung Seo, J. Shin, Y. Park, J. Huh, Y. Cho, H. Kim, S. Yun, W. Lee
laparoscopic is widely in the of colorectal 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.
{"title":"Mucinous carcinoma is a predictive factor for the risk of open conversion from laparoscopic colectomy in colorectal cancer","authors":"Ah Jung Seo, J. Shin, Y. Park, J. Huh, Y. Cho, H. Kim, S. Yun, W. Lee","doi":"10.14216/kjco.19014","DOIUrl":"https://doi.org/10.14216/kjco.19014","url":null,"abstract":"laparoscopic is widely in the of colorectal 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.","PeriodicalId":74045,"journal":{"name":"Korean journal of clinical oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84390989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Seo, Sung E. Oh, J. An, M. Choi, T. Sohn, J. Bae, Sung Kim, J. Lee
As long-term oncological safety has been confirmed over time, laparoscopic or robotic gastrectomy has become a standard option in treatment of early gastric cancer (EGC) [1,2]. EGC is defined as a malignancy invading the mucosa and submucosal layer, regardless of lymph node metastasis [3]. Because of the shallow depth of the tumor, it is difficult to determine the exact location of the lesion by simply touching the serosa with surgical instruments during total laparoscopic or robot surgery [4]. Therefore, it is important to use an adequate tumor localization method to ensure adequate proximal resection lines during intracorporeal anastomosis. For total laparoscopic or robotic surgery, there are several methods for localization of the tumor [5-7], such as endoscopic tattooing, intraoperative endoscopy, or ultrasonography. However, the blurring effect of tattoo ink or need for additional equipment and endoscopists for intraoperative endoscopy have made the preopOriginal Article Korean Journal of Clinical Oncology 2019;15:49-55 https://doi.org/10.14216/kjco.19010 pISSN 1738-8082 ∙ eISSN 2288-4084
{"title":"Are intraoperative abdominal radiographs necessary for identification of clips during totally laparoscopic or robotic gastrectomy?","authors":"J. Seo, Sung E. Oh, J. An, M. Choi, T. Sohn, J. Bae, Sung Kim, J. Lee","doi":"10.14216/kjco.19010","DOIUrl":"https://doi.org/10.14216/kjco.19010","url":null,"abstract":"As long-term oncological safety has been confirmed over time, laparoscopic or robotic gastrectomy has become a standard option in treatment of early gastric cancer (EGC) [1,2]. EGC is defined as a malignancy invading the mucosa and submucosal layer, regardless of lymph node metastasis [3]. Because of the shallow depth of the tumor, it is difficult to determine the exact location of the lesion by simply touching the serosa with surgical instruments during total laparoscopic or robot surgery [4]. Therefore, it is important to use an adequate tumor localization method to ensure adequate proximal resection lines during intracorporeal anastomosis. For total laparoscopic or robotic surgery, there are several methods for localization of the tumor [5-7], such as endoscopic tattooing, intraoperative endoscopy, or ultrasonography. However, the blurring effect of tattoo ink or need for additional equipment and endoscopists for intraoperative endoscopy have made the preopOriginal Article Korean Journal of Clinical Oncology 2019;15:49-55 https://doi.org/10.14216/kjco.19010 pISSN 1738-8082 ∙ eISSN 2288-4084","PeriodicalId":74045,"journal":{"name":"Korean journal of clinical oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75042101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Periampullary tumors can arise from structures near the ampulla of Vater, pancreas, common bile duct, or duodenum, and the prognosis varies with the origin [1]. These neoplasms are usually treated by pylorus-preserving pancreatoduodenectomy or Whipple procedure. Pancreas cancer is one of most aggressive malignancies and cancers involving the pancreas are the fifth most common cause of cancer deaths in Korea [2]. Early diagnosis and differentiation of malignant from benign periampullary neoplasm is essential for decisions on performing surgical resection. The initial work up for a patient with periampullary masses includes computed tomography (CT), magnetic resonance imaging (MRI), endoscopic ultrasound (EUS), endoscopic ultrasound-guided fine needle aspiration (EUS-FNA), and magnetic resonance cholangiopancreatography (MRCP) [3]. FNA is important in the diagnosis of cystic lesions of the pancreas, but EUS-FNA of pancreatic tumors is dif cult to perform because of the retroperitoneal location [4,5]. Invasive procedures like endoscopic retrograde cholangiopancreatography (ERCP) or EUS-FNA have diagnostic accuracy, but are associated with procedure-related complications [6]. FDG-PET/ Original Article Korean Journal of Clinical Oncology 2019;15:56-60 https://doi.org/10.14216/kjco.19011 pISSN 1738-8082 ∙ eISSN 2288-4084
{"title":"Clinical usefulness of fluorodeoxyglucose-positron emission tomography/computed tomography and carbohydrate antigen 19-9 in patients with periampullary tumors","authors":"Jeong Kim, M. Shin, N. Choi","doi":"10.14216/kjco.19011","DOIUrl":"https://doi.org/10.14216/kjco.19011","url":null,"abstract":"Periampullary tumors can arise from structures near the ampulla of Vater, pancreas, common bile duct, or duodenum, and the prognosis varies with the origin [1]. These neoplasms are usually treated by pylorus-preserving pancreatoduodenectomy or Whipple procedure. Pancreas cancer is one of most aggressive malignancies and cancers involving the pancreas are the fifth most common cause of cancer deaths in Korea [2]. Early diagnosis and differentiation of malignant from benign periampullary neoplasm is essential for decisions on performing surgical resection. The initial work up for a patient with periampullary masses includes computed tomography (CT), magnetic resonance imaging (MRI), endoscopic ultrasound (EUS), endoscopic ultrasound-guided fine needle aspiration (EUS-FNA), and magnetic resonance cholangiopancreatography (MRCP) [3]. FNA is important in the diagnosis of cystic lesions of the pancreas, but EUS-FNA of pancreatic tumors is dif cult to perform because of the retroperitoneal location [4,5]. Invasive procedures like endoscopic retrograde cholangiopancreatography (ERCP) or EUS-FNA have diagnostic accuracy, but are associated with procedure-related complications [6]. FDG-PET/ Original Article Korean Journal of Clinical Oncology 2019;15:56-60 https://doi.org/10.14216/kjco.19011 pISSN 1738-8082 ∙ eISSN 2288-4084","PeriodicalId":74045,"journal":{"name":"Korean journal of clinical oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76054186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Stomach cancer is the second most common cause of cancer related death worldwide. The liver is the major site of metastases in 9%–40% of cases, though the metastatic pattern in most cases is diffuse, involving both the peritoneum and distant lymph nodes [1-4]. In contrast to the well-described guidelines for hepatic resection of colorectal cancer and neuroendocrine liver metastases, surgical resection of stomach cancer liver metastases (SCLMs) is only considered in a select few patients. Treatment for SCLM is mainly based on the physician’s experience because of the limited clinical benefit of hepatic resection. In general, surgical resection is not commonly performed in patients with hepatic metastases from gastric cancers, because of poor long-term outcomes. However, recent studies suggest that hepatic resection for SCLM showed improved outcomes in select patients, with a 5-year survival ranging from 23% to 42% [3-6]. Yet, the effectiveness of liver resection in the treatment of SCLM is still controversial. The aim of this paper was to review the outcomes of select patients with SCLM after hepatic resection at a single center.
{"title":"Hepatic resection for isolated stomach cancer liver metastases: A single-center experience","authors":"Hyunyou Kim, H. Seo","doi":"10.14216/kjco.19013","DOIUrl":"https://doi.org/10.14216/kjco.19013","url":null,"abstract":"Stomach cancer is the second most common cause of cancer related death worldwide. The liver is the major site of metastases in 9%–40% of cases, though the metastatic pattern in most cases is diffuse, involving both the peritoneum and distant lymph nodes [1-4]. In contrast to the well-described guidelines for hepatic resection of colorectal cancer and neuroendocrine liver metastases, surgical resection of stomach cancer liver metastases (SCLMs) is only considered in a select few patients. Treatment for SCLM is mainly based on the physician’s experience because of the limited clinical benefit of hepatic resection. In general, surgical resection is not commonly performed in patients with hepatic metastases from gastric cancers, because of poor long-term outcomes. However, recent studies suggest that hepatic resection for SCLM showed improved outcomes in select patients, with a 5-year survival ranging from 23% to 42% [3-6]. Yet, the effectiveness of liver resection in the treatment of SCLM is still controversial. The aim of this paper was to review the outcomes of select patients with SCLM after hepatic resection at a single center.","PeriodicalId":74045,"journal":{"name":"Korean journal of clinical oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78160515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Y. Woo, Youngkyoung You, Jaehyun Han, Hojoong Choi, Y. Kim, B. Kwak, T. Hong, Donggoo Kim
Purpose: We have summarized the experience of our institution related to what treatment has been performed in patients with pancreatic fistula and their outcome. Methods: Seventy-eight pancreatico-enteric anastomosis failure (PEAF) patients of 403 pancreaticoduodenectomy (PD) were included for this retrospective study. PEAF was defined by the presence of rich amylase (over 10,000 IU/L) in drainage fluid at postoperative day 5 to 7 and radiographic demonstration of the anastomotic breakdown and associated local fluid collection. The management was analyzed by observation group (O group), intervention (I group) and surgery group (S group). Results: Preoperative clinical status of the PEAF group and non-PEAF group was similar. Bile duct cancer was the highest risk subgroup of the PEAF (P=0.001) and the pancreatic adenocarcinoma showed the least risk for the PEAF (P<0.001). Among the 78 PEAF patients, 50 were managed as a conservative treatment, 15 patients were received radiologic intervention and 13 patients performed rescue surgery. Among these three subgroups, there was no statistical significance in the patient’s demographics, clinical status, surgical factors and disease nature. However, mortality was significantly higher in the S group (P<0.001). The mortality cases were developed one and six patients in O and S group, respectively. Surgical procedures in S group were completion total pancreatectomy with or without splenectomy (n=12) and pancreatectomy preserving spleen in four (28.6%). Pancreaticogastrostomy repair and Roux-en-Y pancreaticojejunostomy reconstruction were performed each case, respectively. Conclusion: Proper drainage catheter indwelling during the PD or postoperative radiological intervention can effectively manage the PEAF without surgical interventional treatment.
{"title":"Single institute experience of pancreatico-enteric anastomosis failure after pancreaticoduodenectomy","authors":"Y. Woo, Youngkyoung You, Jaehyun Han, Hojoong Choi, Y. Kim, B. Kwak, T. Hong, Donggoo Kim","doi":"10.14216/KJCO.19005","DOIUrl":"https://doi.org/10.14216/KJCO.19005","url":null,"abstract":"Purpose: We have summarized the experience of our institution related to what treatment has been performed in patients with pancreatic fistula and their outcome. Methods: Seventy-eight pancreatico-enteric anastomosis failure (PEAF) patients of 403 pancreaticoduodenectomy (PD) were included for this retrospective study. PEAF was defined by the presence of rich amylase (over 10,000 IU/L) in drainage fluid at postoperative day 5 to 7 and radiographic demonstration of the anastomotic breakdown and associated local fluid collection. The management was analyzed by observation group (O group), intervention (I group) and surgery group (S group). Results: Preoperative clinical status of the PEAF group and non-PEAF group was similar. Bile duct cancer was the highest risk subgroup of the PEAF (P=0.001) and the pancreatic adenocarcinoma showed the least risk for the PEAF (P<0.001). Among the 78 PEAF patients, 50 were managed as a conservative treatment, 15 patients were received radiologic intervention and 13 patients performed rescue surgery. Among these three subgroups, there was no statistical significance in the patient’s demographics, clinical status, surgical factors and disease nature. However, mortality was significantly higher in the S group (P<0.001). The mortality cases were developed one and six patients in O and S group, respectively. Surgical procedures in S group were completion total pancreatectomy with or without splenectomy (n=12) and pancreatectomy preserving spleen in four (28.6%). Pancreaticogastrostomy repair and Roux-en-Y pancreaticojejunostomy reconstruction were performed each case, respectively. Conclusion: Proper drainage catheter indwelling during the PD or postoperative radiological intervention can effectively manage the PEAF without surgical interventional treatment.","PeriodicalId":74045,"journal":{"name":"Korean journal of clinical oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85243926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jaram Lee, Seung-Seop Yeom, Soo-Young Lee, C. Kim, Hyeong-Rok Kim, Y. J. Kim
Purpose: The bowel frequency of patients who had undergone rectal resection might be difficult to distinguish from the diarrhea of Clostridium difficile infection (CDI). The change of bowel movement following rectal surgery has been a challenge for the diagnosis of CDI and scarce studies discussed this diagnostic difficulty. Methods: a total of 8,327 patients in a single colorectal was evaluated for CDI, and their medical records were ret rospectively reviewed. Bowel frequency and treatment outcomes were compared between the rectal resection group (RG) and colectomy group (CG). Diagnostic time was defined as the time interval between first diarrhea (more than three times a day) and pathologic confirmation date of CDI. Results: CDI incidence was 2.3% (17/752) vs. 0.41% (31/7,575) between RG and CG (P<0.001). RG had frequent bowel movements than CG (RG: 13.56±6.16/day vs. CG: 8.39±6.23/day; P=0.010), but the interval between the time of symptom and the time of CDI diagnosis was longer in the RG than in CG (RG: 1.38±3.34 days vs. CG: 0.39±1.16 days). A total of three mortalities has been occurred (RG: 2 vs. CG: 1), and the reasons were delayed diagnosis and omitted treatment. Conclusion: Patients experienced significant bowel frequency after rectal surgery than after colectomy, and the delayed diagnosis was associated with mortality. Active surveillance for CDI should be performed for the patients who underwent rectal surgery to prevent morbidity and mortality from delayed diagnosis of CDI, but sophisticated guideline also should be evaluated to reduce over-examinations.
目的:直肠切除术患者的肠频率可能难以与艰难梭菌感染(CDI)腹泻区分。直肠手术后肠道运动的变化一直是CDI诊断的一个挑战，很少有研究讨论这一诊断困难。方法:对单个结直肠共8327例患者进行CDI评估，并对其病历进行回顾性分析。比较直肠切除术组(RG)和结肠切除术组(CG)的肠频率和治疗结果。诊断时间定义为首次腹泻(每日3次以上)与CDI病理确诊日期之间的时间间隔。结果:RG组和CG组CDI发生率分别为2.3%(17/752)和0.41%(31/ 7575)，差异有统计学意义(P<0.001)。RG比CG排便次数多(RG: 13.56±6.16/d vs. CG: 8.39±6.23/d);P=0.010)，但RG组症状出现时间与CDI诊断时间间隔较CG组长(RG: 1.38±3.34 d vs CG: 0.39±1.16 d)。共发生3例死亡(RG: 2 vs. CG: 1)，原因是延误诊断和遗漏治疗。结论:直肠手术后患者排便频率明显高于结肠切除术后患者，延迟诊断与死亡率相关。对于接受直肠手术的患者，应积极监测CDI，以防止延迟诊断CDI的发病率和死亡率，但也应评估复杂的指南，以减少过度检查。
{"title":"The diagnostic delay and treatment outcome of Clostridium difficile infection in the patients who underwent rectal surgery","authors":"Jaram Lee, Seung-Seop Yeom, Soo-Young Lee, C. Kim, Hyeong-Rok Kim, Y. J. Kim","doi":"10.14216/KJCO.19007","DOIUrl":"https://doi.org/10.14216/KJCO.19007","url":null,"abstract":"Purpose: The bowel frequency of patients who had undergone rectal resection might be difficult to distinguish from the diarrhea of Clostridium difficile infection (CDI). The change of bowel movement following rectal surgery has been a challenge for the diagnosis of CDI and scarce studies discussed this diagnostic difficulty. Methods: a total of 8,327 patients in a single colorectal was evaluated for CDI, and their medical records were ret rospectively reviewed. Bowel frequency and treatment outcomes were compared between the rectal resection group (RG) and colectomy group (CG). Diagnostic time was defined as the time interval between first diarrhea (more than three times a day) and pathologic confirmation date of CDI. Results: CDI incidence was 2.3% (17/752) vs. 0.41% (31/7,575) between RG and CG (P<0.001). RG had frequent bowel movements than CG (RG: 13.56±6.16/day vs. CG: 8.39±6.23/day; P=0.010), but the interval between the time of symptom and the time of CDI diagnosis was longer in the RG than in CG (RG: 1.38±3.34 days vs. CG: 0.39±1.16 days). A total of three mortalities has been occurred (RG: 2 vs. CG: 1), and the reasons were delayed diagnosis and omitted treatment. Conclusion: Patients experienced significant bowel frequency after rectal surgery than after colectomy, and the delayed diagnosis was associated with mortality. Active surveillance for CDI should be performed for the patients who underwent rectal surgery to prevent morbidity and mortality from delayed diagnosis of CDI, but sophisticated guideline also should be evaluated to reduce over-examinations.","PeriodicalId":74045,"journal":{"name":"Korean journal of clinical oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79287517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Do-Hoon Kim, Y. Kim, Joon-Hyop Lee, Y. Chung, S. Choi, J. Kang, H. Park, Y. Chun
The treatment methods for breast cancer are evolving rapidly. New therapies such as radiation therapy, chemotherapy, and endocrine therapy, have been developed with the improvements in science and technology, and now molecular genetic methods have been developed to greatly affect the treatment and prognosis of breast cancer. As of October 2017, there were 69 drugs approved by the Food and Drug Administration for breast cancer treatment [1]. In a situation where technology in various fields is developed [2], the guidelines for the diagnosis and treatment of breast cancer and the development of treatment plans are improving at an accelerating rate [3]. Therefore, it is necessary to choose a treatment that suits the individual characteristics of a patient, but there are too many factors for a physician to synthesize and determine the knowledge in all fields. Clinical decision-support systems can be a great solution to Original Article Korean Journal of Clinical Oncology 2019;15:3-6 https://doi.org/10.14216/kjco.19002 pISSN 1738-8082 ∙ eISSN 2288-4084
{"title":"A comparative study of Watson for Oncology and tumor boards in breast cancer treatment","authors":"Do-Hoon Kim, Y. Kim, Joon-Hyop Lee, Y. Chung, S. Choi, J. Kang, H. Park, Y. Chun","doi":"10.14216/KJCO.19002","DOIUrl":"https://doi.org/10.14216/KJCO.19002","url":null,"abstract":"The treatment methods for breast cancer are evolving rapidly. New therapies such as radiation therapy, chemotherapy, and endocrine therapy, have been developed with the improvements in science and technology, and now molecular genetic methods have been developed to greatly affect the treatment and prognosis of breast cancer. As of October 2017, there were 69 drugs approved by the Food and Drug Administration for breast cancer treatment [1]. In a situation where technology in various fields is developed [2], the guidelines for the diagnosis and treatment of breast cancer and the development of treatment plans are improving at an accelerating rate [3]. Therefore, it is necessary to choose a treatment that suits the individual characteristics of a patient, but there are too many factors for a physician to synthesize and determine the knowledge in all fields. Clinical decision-support systems can be a great solution to Original Article Korean Journal of Clinical Oncology 2019;15:3-6 https://doi.org/10.14216/kjco.19002 pISSN 1738-8082 ∙ eISSN 2288-4084","PeriodicalId":74045,"journal":{"name":"Korean journal of clinical oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81195666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Association between bioelectrical impedance analysis and platelet-to-lymphocyte ratio in colorectal cancer","authors":"J. Kim","doi":"10.14216/KJCO.19001","DOIUrl":"https://doi.org/10.14216/KJCO.19001","url":null,"abstract":"","PeriodicalId":74045,"journal":{"name":"Korean journal of clinical oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74312179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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