Comparison of Three Surgical Techniques in Pilonidal Sinus Surgery.

Our study aims to compare the surgical outcome of Limberg transposition flap, Karydakis flap, and primary closure after excision to treat sacrococcygeal pilonidal sinus disease. A total of 634 patients with pilonidal sinus who underwent surgery were evaluated retrospectively from January 2014 to January 2016. The patients were divided into three groups. Limberg transposition flap (LTF) was performed in 131 patients (group 1), Karydakis flap (KF) was performed in 232 patients (group 2) and primary closure (PC) after excision was performed in 271 patients (group 3). Patient demographics, operative and postoperative outcomes were recorded and analyzed retrospectively. The mean age (p=0.98), sex ratio (p=0.74) and removed sinus volume (p=0.67) were not statistically different between groups. Mean operative time was 54.3 ± 6.4 min for group 1, 46.8 ± 10.5 min for group 2, and 26.9 ± 5.8 min for group 3 respectively (p=0.01). When the length of hospital stay was compared, there was a significant difference in favor of primary closure (p=0.01). Regarding early surgical complication, Karydakis flap technique was superior to other groups (p<0.001). The recurrent rate was higher in the primary closure group (p<0.001). In our study, the primary closure method regarding the duration of surgery and hospitalization; Karydakis method regarding postoperative complications (seroma, hematoma, wound dissociation, infection, recurrence) were superior to the other two methods.

Comparison of emergency surgeries for obstructed colonic cancer with elective surgeries: A retrospective study.

OBJECTIVE: Colon cancer patients presented with obstruction were known to have worse postoperative morbidity and mortality rates, but conflicting data has been reported in recent years. We aimed to investigate postoperative complication rates, and short and long-term oncological outcomes in patients with colon cancer treated with either emergency surgery due to obstruction or elective surgery. METHODS: Two hundred fifty two patients were analyzed. Patients presented with obstruction and underwent an emergency surgery, and patients operated under elective circumstances were compared according to their demographic variables, tumor characteristics, and short and long term treatment outcomes. RESULTS: Distribution of age, gender and comorbidities were similar between both the groups. Need for an end colostomy was significantly higher in obstructed patients (22.7% vs 1.6%, respectively). Obstructed patients were tending to be at an advanced stage. Postoperative morbidity and mortality, and prognosis of colon cancer patients presented with obstruction is worse than patients operated under elective circumstances. CONCLUSIONS: Colon cancer patients presented with obstruction constitutes more than one quarter of all patients. These patients have significantly higher morbidity and mortality rates. Obstructed colon cancer usually appears at advanced stage. Primary resection and anastomosis is safe in most of the cases.

Global Effects of SARS-CoV-2 Era on Kidney Transplantation Activities: Analysis of WHO Data.

BACKGROUND: Uncertainty raises questions in kidney transplant during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic regarding the recipient, the donor, and health care professionals. The pandemic not only has disrupted kidney transplanted patients but also has influenced transplant systems, donation chains, and timely and safe transplant surgeries. In the present study, we aimed to explore the global effects of the SARS-CoV-2 pandemic on kidney transplant. METHODS: We collected transplantation statistics and SARS-CoV-2 pandemic data from the World Health Organization website on June 15, 2021. Spearman correlation analysis was applied to assess the strength of a monotonic relationship among quantitative variables. We also demonstrated the clinical characteristics of our kidney recipients with SARS-CoV-2 infection. RESULTS: Comparison of the mean of global kidney transplantation statistics between 2010 and 2019 with 2020 statistics showed a significant decrease in kidney transplant from living donors (P < .001). From the beginning of the pandemic to June 15, 2021, 1 of the 43 kidney transplant patients we treated in our clinic died of SARS-CoV-2 infection after discharge. Two of the patients we transplanted and saw in follow-up before the pandemic died of SARS-CoV-2 infection. CONCLUSION: While the overall kidney transplant numbers have increased in the year to date, kidney transplants decreased drastically at the onset of the pandemic.

Management of endocrine surgical disorders during COVID-19 pandemic: expert opinion for non-surgical options.

PURPOSE: The COVID-19 pandemic brought unprecedented conditions for overall health care systems by restricting resources for non-COVID-19 patients. As the burden of the disease escalates, routine elective surgeries are being cancelled. The aim of this paper was to provide a guideline for management of endocrine surgical disorders during a pandemic. METHODS: We used Delphi method with a nine-scale Likert scale on two rounds of voting involving 64 experienced eminent surgeons and endocrinologists who had the necessary experience to provide insight on endocrine disorder management. All voting was done by email using a standard questionnaire. RESULTS: Overall, 37 recommendations were voted on. In two rounds, all recommendations reached an agreement and were either endorsed or rejected. Endorsed statements include dietary change in primary hyperparathyroidism, Cinacalcet treatment in secondary hyperparathyroidism, alpha-blocker administration for pheochromocytoma, methimazole ± ß-blocker combination for Graves' disease, and follow-up for fine-needle aspiration results of thyroid nodules indicated as Bethesda 3-4 cytological results and papillary microcarcinoma. CONCLUSION: This survey summarizes expert opinion for the management of endocrine surgical conditions during unprecedented times when access to surgical treatment is severely disrupted. The statements are not applicable in circumstances in which surgical treatment is possible.

A Comparative Analysis of Once-daily and Twice-daily Formulation of Tacrolimus in De Novo Kidney Transplant Recipients.

OBJECTIVES: We aimed to compare the once-daily and twice-daily formulation of tacrolimus concerning the efficiency and effects on graft function in de novo kidney transplant patients. METHODS: Twenty once-daily (TAC-OD) and twenty twice-daily (TAC-BID) tacrolimus administrated de novo kidney recipients who had received initial immunosuppressive therapy according to protocols at our institution (0.2 mg/kg of tacrolimus combined with 1000 milligrams of steroid taper plus 720 mg of mycophenolate and with 2.5mg/kg anti-thymocyte globulin) assessed concerning demographics, drug doses and blood concentration, and graft function. RESULTS: The mean tacrolimus blood concentration measurements were higher in the TAC-OD group in the first sixty days after transplantation, and the TAC-OD group showed more blood concentration overshoots/fluctuations in the first 30 days of the treatment. The initial drug dose was significantly higher in the TAC-OD group than the TAC-BID group (p=0.04). There was no meaningful difference among groups according to graft function (creatinine measurements) (p>0.05). CONCLUSION: Between de novo kidney recipients, the new TAC-OD formulation presents a similar short-term efficacy profile as TAC-BID. However, a higher daily dosage of TAC-OD is needed to achieve similar blood concentrations in the early postoperative period.

A comparison of dexmedetomidine versus midazolam for sedation, pain and hemodynamic control, during colonoscopy under conscious sedation.

OBJECTIVE: The intent of our study was to compare the effects of dexmedetomidine versus midazolam on perioperative hemodynamics, sedation, pain, satisfaction and recovery scores during colonoscopy. MATERIAL AND METHODS: A total of 60 ASA I-II patients, between 20 and 80 years of age were included in the study. Patients were randomly assigned to two groups. Midazolam 0.05 mg kg(-1) and fentanyl citrate 1 microg kg(-1) were administered intravenously to cases in Group I (n = 30). An initial loading dose of 1 microg kg(-1) dexmedetomidine was administered intravenously in 10 min to cases in Group II (n = 30) before the procedure and as a continuous infusion dose of 0.5 microg kg(-1) h(-1) just before the procedure started. Also 1 microg kg(-1) fentanyl citrate was administered intravenously immediately before the procedure. Peripheral oxygen saturation (S(pO2)), mean arterial pressure (MAP), heart rate (HR), Ramsay Sedation Scale (RSS), Numeric Rating Scale (NRS) scores and colonoscopist satisfaction scores of the cases were recorded. RESULTS: Although statistically significant values were not detected between the two groups with regard to mean arterial pressure, in Group I heart rates were higher and S(pO2) scores were lower in a statistically significant manner. When the groups were compared with regard to RSS, the RSS scores of Group I at the 10th and 15th minutes were significantly lower than Group II. There was no statistically significant difference between the two groups when compared with regard to NRS scores. Satisfaction scores were significantly lower in Group II. CONCLUSION: Dexmedetomidine provides more efficient hemodynamic stability, higher Ramsay sedation scale scores, higher satisfaction scores and lower NRS scores in colonoscopies. According to our results we believe that dexmedetomidine can be used safely as a sedoanalgesic agent in colonoscopies.

The Positive Effects of a Calorie-Restricting High-Protein Diet Combined with Intragastric Botulinum Toxin Type A Application Among Morbidly Obese Patients: A Prospective, Observational Analysis of Eighty-Seven Grade 2 Obese Patients.

PURPOSE: Many studies evaluating the effect of intragastric botulinum toxin type A injection (IG-BTxA) for the treatment of obesity have been published. However, none of these studies combined this procedure with a calorie-restricting high-protein diet. Herein, we aimed to evaluate the effects of IG-BTxA application combined with a calorie-restricting high-protein diet. MATERIALS AND METHODS: This prospective cohort study is conducted with eighty-seven grade 2 obese patients treated between January 2019 and August 2019. Group 1: IG-BTxA + refused to consult the dietitian; group 2: IG-BTxA + get calorie-restricting high-protein diet; group 3: only get a calorie-restricting high-protein diet. Loss of weight, treatment adaptation (visual analog scale score), the status and changes of comorbid conditions, and changes in eating behaviors (Self-Regulation of Eating Behaviour Questionnaire score) were assessed. RESULTS: Loss of weight, treatment adaptation, and positive behavioral change in eating preferences were significantly higher in group 2 (p = 0.01; p = 0.001; p < 0.01, respectively). Additionally, the decrease in medication requirement for diabetes and hypertension was higher in group 2 (p < 0.05). CONCLUSION: IG-BTxA application before calorie-restricting high-protein diet facilitates adaptation to the new diet style and helps to lose weight faster in grade 2 obese patients. Also, more positive results were achieved in terms of controlling comorbid diseases.

Castleman's disease presenting with mechanical intestinal obstruction: A rare case.

Castleman's disease (CD) is a lymphoproliferative disorder and the occurrence of CD in the small bowel is rare. In this study, we present one case of CD causing mechanical intestinal obstruction due to involvement of terminal ileum. A 50-year-old man was admitted to the hospital with signs and symptoms of mechanical intestinal obstruction without history previous surgery. After examination and obtaining abdominal computed tomography, diagnosis of mechanical intestinal obstruction was reached and emergency surgery was performed with a median incision. On abdominal exploration a tumor like mass that also held distal small intestine mesentery, and ileocecal valve causing complet intestinal obstruction was observed. Ileocecal resection and ileocolonic anastomosis were performed. CD is a rare entity and should be kept in mind during the differential diagnosis of mechanical intestinal obstruction provided that wall thickening in terminal ileum mimicking mass, and accompanying enlargement mesenteric lymph nodes observed during preoperative investigations or intraoperative exploration.

An analysis of general surgery theses set up between years 1998-2018 in Turkey: Evidence levels and publication rates of 1996 theses.

OBJECTIVES: Setting up and advocating a thesis is mandatory at the end of the residency training program to become a specialist in general surgery according to the regulations on medical specialization in Turkey. Writing a thesis helps the resident to learn to ask structured questions, assembling the most accurate study design, managing the study process, collecting the results and building a conclusion with medical implications. In this descriptive study, we aimed to investigate the publication rates of the theses written in the field of general surgery and to assess the properties of the published theses. MATERIAL AND METHODS: We performed an online search on September 1, 2018, about the theses of general surgery residents on the website of National Thesis data center of Academic Educational Board in Turkey including theses of medical residents in university-affiliated hospitals and analyzed theses accomplished between 1998-2018. The publication status of the theses was assessed by the entry of author name, the title of the theses and keywords of the theses by using the search engines of PubMed, Google Scholar and Turkish Academic Network and Information Center Turkish Database (ULAKBIM). Data were presented in a descriptive form as absolute numbers and percentages. RESULTS: Between 1998-2018, 1996 theses were completed. 393 (20.5%) of these were published in a journal, and 288 (14.4%) were published in a journal indexed in SCI/SCIE. According to research methodologies, 79.2% of the experimental studies were published in SCI/SCIE indexed journals. CONCLUSION: Publication rates of the theses in the field of general surgery are low as they are in other specialties of medicine. This descriptive study might give an idea about the low scientific publication rates of general surgery theses. Further studies are needed to understand the underlying factors, which are responsible for this scant scientific performance.

Comparison of New Era's Education Platforms, YouTube® and WebSurg®, in Sleeve Gastrectomy.

INTRODUCTION: The Internet is a widely used resource for obtaining medical information. However, the quality of information on online platforms is still debated. Our goal in this quality-controlled WebSurg® and YouTube®-based study was to compare these two online video platforms in terms of the accuracy and quality of information about sleeve gastrectomy videos. METHODS: Most viewed (popular) videos returned by YouTube® search engine in response to the keyword "sleeve gastrectomy" were included in the study. The educational accuracy and quality of the videos were evaluated according to known scoring systems. A novel scoring system measured technical quality. The ten most viewed (popular) videos in WebSurg® in response to the keyword "sleeve gastrectomy" were compared with ten YouTube® videos with the highest educational/technical scores. RESULTS: Scoring systems measuring the educational accuracy and quality of WebSurg® videos were significantly higher than ten YouTube® videos which have the most top technical scores (p < 0.05), and no significant difference was found in the assessment of ten YouTube® videos that have the highest technical ratings compared with WebSurg® videos (p 0.481). CONCLUSIONS: WebSurg® videos, which were passed through a reviewing process and were mostly prepared by academicians, remained below the expected quality. The main limitation of WebSurg® and YouTube® is the lack of information on preoperative and postoperative processes.

Comparison of the effects of two different marine-derived omega-3 fatty acid sources, krill oil, and fish oil, on the healing of primary colonic anastomoses after colectomy applied Wistar albino rat model.

BACKGROUND: Oils from marine organisms have a different fatty acid composition. Fish oil (FO) has a high content of eicosapentaenoic and docosahexaenoic acids esterified to triacylglycerols; while in krill oil (KO), fatty acids are primarily esterified to phospholipids. This study aimed to compare the efficacy of two different, marine-derived omega-3 fatty acid sources in the wound healing of colon anastomoses rat model. METHODS: For the study, we used 42 male Wistar albino rats. The rats were divided into six groups with seven rats in each group-CO3: left colonic anastomosis (control group), sacrificed on the third day; KO3: left colonic anastomosis + oral KO, sacrificed on the third day; FO3: left colonic anastomosis + oral FO, sacrificed on the third day; CO7: left colonic anastomosis (control group), sacrificed on the seventh day; KO7: left colonic anastomosis + oral KO, sacrificed on the seventh day; FO7: left colonic anastomosis + oral FO, sacrificed on the seventh day. Peritoneal adhesions, anastomotic bursting pressures, hydroxyproline levels, and histological examination of the anastomotic tissue were evaluated. RESULTS: On day 7, bursting pressure and hydroxyproline measurements of the KO group was significantly higher than the FO group (p=0.012; p=0.002, respectively). Also, on day 7, a statistically significant difference was observed between the groups according to inflammatory cell infiltration, fibroblast activity, neoangiogenesis, and collagen deposition in favor of the KO group (p=0.023; p=0.028; p=0.016; p=0.012, respectively). CONCLUSION: Both KO and FO supplementation in patients before colorectal surgery may reduce some risk of anastomotic leakage; and KO might be a better alternative and excellent omega-3 source.

Retrospective Analysis of the first 100 Kidney Transplants at the Istanbul Okan University, Health Application and Research Center.

OBJECTIVES: The renal transplant program of Istanbul Okan University Hospital started in August 2017. Five cadaveric and 95 living donor kidney transplants have been performed for over 16 months. In this study, we aimed to share our experiences regarding kidney transplantation. METHODS: In this study, a retrospective analysis of 100 patients who underwent kidney transplantation at the Istanbul Okan University over 16 months, the Health Application and Research Center was carried out. Patients' demographics, creatinine levels of donors and recipients, co-morbid conditions, postoperative complications, features of arterial anastomosis and arterial variations observed on computed tomography angiography of donor-patient were assessed. RESULTS: Mean age of donor patients was 44.05±13.76 (18-71) years. All living donors had computed tomography angiography for assessment of the vascular structure of both kidneys. Accessory right kidney artery was the most dominant vascular variation (16.5%). The primary cause of chronic renal disease was diabetes mellitus (36.4%) and hypertension (15.6%). Mean warm and cold ischemia time was 1.82±0.44 (1-3) and 40.25±6.12 (31-57) minutes, respectively. The most observed postoperative complication was stenosis of ureter anastomosis (4.1%). End-to-end arterial anastomosis between renal and internal iliac arteries was the most preferred anastomosis (57.2%). CONCLUSION: Increasing kidney transplantation, which is the most appropriate treatment in terms of cost-effectiveness, will be beneficial for patient health and economy of the country.

The Positive Effects of the Human Amniotic Membrane on the Healing of Staple Line After Sleeve Gastrectomy Applied Long-Evans Rat Model.

BACKGROUND: The staple line leakage is a dangerous complication of sleeve gastrectomy. Various strategies have been tried to reduce the leakage risk. The amniotic membrane (AmM) is the inner layer of the placental membranes and has anti-inflammatory, anti-fibrosis, and anti-scarring effects, and it also has lower immune characteristics which are another essential characteristic of AmM concerning its utility for grafting. In this study, we aimed to investigate the impact of AmM on the staple line healing process of sleeve gastrectomy model in rats. MATERIALS AND METHODS: We used twenty-eight Long-Evans rats in this study. Sleeve gastrectomy was performed with tristapler. Fourteen rats served as controls, AmM was applied staple line of the other fourteen. Fourteen animals were sacrificed (seven from the AmM applied group and the other seven from the control group) on the third postoperative day. And, the other fourteen animals were sacrificed (seven from the AmM applied group and seven from the control group) on the seventh postoperative day. The tissue around the staple line was evaluated microscopically and macroscopically, bursting pressures and hydroxyproline levels were also measured. RESULTS: The bursting pressure and hydroxyproline measurements of the AmM applied group was significantly higher on the seventh postoperative day (p = 0.015, p = 0.012) Fibroblast activity and neoangiogenesis of the AmM applied group was also significantly higher on the seventh postoperative day (p = 0.004, p = 0.002). CONCLUSION: This study showed that covering of staple line of sleeve gastrectomy model in rats significantly provided higher bursting pressures and increased hydroxyproline levels, fibroblast activity, and neoangiogenesis which may potentially lead a better staple line healing. We think further investigations are needed on this issue.

Pulmonary echinococcosis mimicking multiple lung metastasis of breast cancer: the role of fluoro-deoxy-glucose positron emission tomography.

BACKGROUND: Echinococcosis is still a serious problem particularly in endemic areas such as South and Central America, Mediterranean countries, and Russia. Furthermore, hydatid cysts of the lung are often indistinguishable from a variety of other pulmonary lesions such as lung tumors CASE PRESENTATION: We herein present a 56 year old woman with breast cancer who presented with bilateral pulmonary nodules due to echinococcosis granulosis that mimicked metastatic breast cancer to the lung. CONCLUSION: During the evaluation of the malignancies which could metastasize to the lung, it must be kept in mind that the appearance of bilateral multiple pulmonary masses can also be the sign of a pulmonary echinococcosis especially in endemic areas. FDG-PET with its known high negative predictive value in characterizing indeterminate pulmonary nodules >1 cm is very helpful to characterize this kind of lesions.

Regional Clinical and Biochemical Differences among Patients with Primary Hyperparathyroidism.

BACKGROUND: Environmental habitat may play a role in clinical disparities of primary hyperparathyroidism (pHPT) patients. AIMS: To compare preoperative clinical symptoms and associated conditions and surgical findings in patients with pHPT, living in different geographical regions from the Black Sea, Mediterranean and Anatolia regions. STUDY DESIGN: Retrospective, clinical-based multi-centric study of 694 patients with pHPT. METHODS: Patients from 23 centers and 8 different geographical regions were included. Data related to baseline demographics, clinical, pathologic and treatment characteristics of 8 regions were collected and included age, gender, residential data, symptoms, history of fracture, existence of brown tumor, serum total Ca and p levels, serum parathormone (PTH) levels, serum 25-OH vitamin D levels, bone mineral density, size of the resected abnormal parathyroid gland(s), histology, as well as the presence of ectopia, presence of dual adenoma, and multiple endocrine neoplasia (MEN)- or familial-related disease. RESULTS: The median age was 54. Asymptomatic patient rate was 25%. The median PTH level was 232 pg/mL and serum total Ca was 11.4 mg/dL. Eighty-seven percent of patients had an adenoma and 90% of these had a single adenoma. Hyperplasia was detected in 79 patients and cancer in 9 patients. The median adenoma size was 16 mm. Significant parameters differing between regions were preoperative symptoms, serum Ca and p levels, and adenoma size. All patients from South-East Anatolia were symptomatic, while the lowest p values were reported from East Anatolia and the largest adenoma size, as well as highest Ca levels, were from Bulgaria. CONCLUSION: Habitat conditions vary between geographical regions. This affects the clinicopathological features of patients with pHPT.

The effect of early warm plastic bag application on postoperative pain after hemorrhoidectomy: a prospective randomized controlled trial.

Hemorrhoidectomy is used for the surgical treatment of high-grade hemorrhoids. The most prominent complaint after hemorrhoidectomy is pain. Postoperative pain management is still a big problem after surgery in patients with hemorrhoidectomy. The aim of the study was to assess the effect of early application of warm bag on postoperative pain after hemorrhoidectomy. All patients were randomly divided into warm plastic bag and control groups by using sealed envelopes, which were prepared preoperatively. After standard spinal anesthesia, all patients underwent standard Milligan-Morgan hemorrhoidectomy using Ligasure™. Although the study group received the warm bag application, the control group did not receive such a treatment. Two separate visual analog scale (VAS) measurements were performed for postoperative pain assessments on postoperative days, one during the resting state and the other one during the straining phase after the onset of peristaltic bowel movement. Postoperative VAS scores were significantly lower among the warm plastic bag group as compared with the control group on Days 1 and 3 for the resting state and on Day 3 for defecation. Additionally, a significant difference existed between the two groups in terms of the need for additional anesthesia. Local thermal application appears to be a safe and effective method for pain relief after hemorrhoidectomy.

The role of d-lactate in differential diagnosis of acute appendicitis.

INTRODUCTION: Early diagnosis of acute appendicitis, known as the most frequent cause of acute surgical abdominal pathologies, dramatically decreases the related complications. D-lactate, produced by intestinal bacteria as a fermentation product, may be useful in diagnosing acute abdominal pathologies. The aim of this study was to investigate whether the presence of d-lactate would be a significant indicator in the early diagnosis of acute appendicitis. METHODS: Eighty consecutive patients were prospectively included in this study. The patients were divided into four groups: acute appendicitis (group 1), perforated acute appendicitis (group 2), nonspecific abdominal pain (group 3), and acute abdomen other than acute appendicitis (group 4). For the control group, blood samples were taken in the same manner from 20 healthy subjects. RESULTS: There was no significant difference in blood d-lactate levels between the simple acute appendicitis and acute perforated appendicitis groups (p > .05). The blood d-lactate levels in groups 1 and 2 were significantly higher than those in groups 3 and 4, and the control group (p < .001). The reliability of d-lactate was determined as 97% sensitivity, 93% specificity, 90% positive predictive and 95% negative predictive values, and 95% accuracy. CONCLUSIONS: Based on findings in this study, blood d-lactate level may be a valuable diagnostic marker for the diagnosis of acute appendicitis.

The effects of LigaSure on the laparoscopic management of acute appendicitis: "LigaSure assisted laparoscopic appendectomy".

A very important step in laparoscopic appendectomy is dissection of the appendiceal mesenteric pedicle. The aim of this study was to investigate the effect of LigaSure in laparoscopic appendectomy. Between August 2007 and June 2008, a total of 32 patients were included in the study. Patients were randomized into 2 groups. The first group's dissection of the mesoappendix was performed with LigaSure (5 to 10 mm), whereas the second group's with endodissector and endoclip. The surgical time, postoperative complications, additional analgesics use and hospital stay were compared. There were no significant differences in complication rates, use of analgesics and hospital stay between the groups. The operation time (49.06+/-14.73 min vs. 59.69+/-12.54 min, P=0.036) was significantly lower in the LigaSure group. This study demonstrates that dissection of the mesoappendix with LigaSure reduces the operation time and could be used safely. However, more experiences are needed to attain reliable scientific results.

Persistent high postoperative carcinoembryonic antigen in colorectal cancer patients--is it important?

INTRODUCTION: Evaluation of pre- and postoperative serum CEA levels together has seldom been assessed for the prognosis of colorectal cancer (CRC). OBJECTIVE: To concurrently evaluate pre- and postoperative CEA as factors of relapse and survival. METHODS: The study consisted of 114 patients who had undergone surgery from February 2002 to June 2006 for CRC. All patients were classified into four groups according to their pre- and postoperative CEA levels. Data obtained for clinicopathologic parameters, lymph node metastasis, stage, recurrence, and CEA levels were analyzed to determine their association with survival. Multivariate analysis by the Cox proportional hazard regression model was performed to identify the independent prognostic factors associated with survival. RESULTS: Postoperative serum CEA levels remained high in Group 3 (n = 32). Nineteen patients (59.3%) demonstrated a detectable cause for persistent high CEA levels, while the reasons for those in the other thirteen patients (40.6%) remained obscure. Abnormal preoperative CEA levels significantly correlated with the depth of tumor invasion, lymph node metastasis, TNM stage, and recurrence (p < 0.05). Abnormal postoperative CEA levels were significantly related to the depth of tumor invasion, TNM stage, and postoperative relapse (p<0.05). Patients in Group 3 demonstrated the worst survival rate. Abnormal postoperative CEA levels, lymph node metastasis, and location of the tumor were independent prognostic factors for survival. CONCLUSION: The survival of patients with high postoperative CEA levels due to unknown reasons may be extended if they are exhaustively tested with sensitive diagnostic methods and treated at an early stage.