High-risk stage II colon cancer after curative resection.

OBJECTIVES: This study was designed to clarify which attributes of stage II colon cancer are associated with tumor recurrence and survival after curative resection, and the effects of adjuvant chemotherapy (ACT). METHODS: We retrospectively reviewed outcomes and clinicopathological characteristics of 1476 patients with stage II colon cancer who underwent curative resection. RESULTS: Of 1476 patients, 204 (13.8%) developed recurrence. Macroscopic type, serum CA19-9 levels, venous invasion, emergency operation, and postoperative ileus were independently associated with overall recurrence. Carbohydrate antigen (CA)19-9 levels, the number of dissected lymph nodes (LN), sex, age, ACT, emergency operation, venous invasion, and macroscopic type were independently associated with poor prognosis. Prognosis was significantly better in patients who received ACT than in those who did not. Among patients with extensive venous invasion, those with fewer than 13 dissected LNs, male patients, and patients >50 years old, the prognosis was significantly better in patients who received ACT than in those who did not. CONCLUSIONS: ACT for stage II colon cancer is recommended to improve the prognosis of patients with extensive venous invasion, patients with fewer than 13 dissected LNs, patients >50 years old, and male patients, particularly patients with more than two of these risk factors.

Assessment of on-pump beating coronary artery bypass surgery performed after introduction of off-pump approach.

OBJECTIVE: To clarify the position of on-pump beating coronary artery bypass (CAB) and to define preoperative indicators of intentional conversion to the procedure in the era of advancement of off-pump CAB (OPCAB), we assessed on-pump beating CAB performed after the introduction of OPCAB. SUBJECTS AND METHODS: We assessed 130 patients who underwent single CAB [117 (90%) with OPCAB and 13 (10%) with on-pump beating CAB] between August 1999 (when OPCAB was selected as the first-line surgical procedure) and December 2004. RESULTS: No significant differences were seen between the groups in the number of coronary lesions or the prevalence of left main trunk (LMT) lesion. Reduced left cardiac function, cardiac dilatation, and mitral regurgitation (MR) were more remarkable in the on-pump beating CAB group. Preoperative ischemic condition was generally unstable in the both groups. A conversion to on-pump beating CAB occurred at anastomosis for the left anterior descending (LAD) branch in 61% and for the left circumflex (LCX) branch in 15%. LAD patients had more severe left cardiac dysfunction and cardiac dilatation than LCX patients. CONCLUSION: To perform safe and reliable CAB surgery, cardiovascular surgeons should define preoperative indicators of difficult OPCAB and convert OPCAB to on-pump beating CAB intentionally without hesitation when unstable hemodynamics is detected.