Clinical outcomes of surgical management for recurrent rectal prolapse: a multicenter retrospective study

Purpose@#There are few reports on outcomes following surgical repair of recurrent rectal prolapse. The purpose of this study was to examine surgical outcomes for recurrent rectal prolapse. @*Methods@#We conducted a multicenter retrospective study of patients who underwent surgery for recurrent rectal prolapse. This study used data collected by the Korean Anorectal Physiology and Pelvic Floor Disorder Study Group. @*Results@#A total of 166 patients who underwent surgery for recurrent rectal prolapse were registered retrospectively between 2011 and 2016 in 8 referral hospitals. Among them, 153 patients were finally enrolled, excluding 13 patients who were not followed up postoperatively. Median follow-up duration was 40 months (range, 0.2–129.3 months). Methods of surgical repair for recurrent rectal prolapse included perineal approach (n = 96) and abdominal approach (n = 57). Postoperative complications occurred in 16 patients (10.5%). There was no significant difference in complication rate between perineal and abdominal approach groups. While patients who underwent the perineal approach were older and more fragile, patients who underwent the abdominal approach had longer operation time and admission days (P < 0.05). Overall, 29 patients (19.0%) showed re-recurrence after surgery. Among variables, none affected the re-recurrence. @*Conclusion@#For the recurrent rectal prolapse, the perineal approach is used for the old and fragile patients. The postoperative complications and re-recurrence rate between perineal and abdominal approach were not different significantly. No factor including surgical method affected re-recurrence for recurrent rectal prolapse.

Eosinophilic Gastrointestinal Disorder Presenting as Intractable Vomiting and Ascites in a Young Girl / 대한소아소화기영양학회지

Eosinophilic gastrointestinal disorder (EGID) is a rare disease in children that affects the bowel wall, with eosinophilic infiltration in the absence of any other causes for eosinophilia. The etiology remains unknown, but allergies and immunological imbalance are suspected triggers. We encountered a case of serosal EGID presenting as intractable vomiting and ascites in a 9-year-old girl, after influenza virus infection. Peripheral eosinophilia was not present. The diagnosis was confirmed by biopsy of the bowel wall through laparotomy and endoscopy, and controlled by 2 courses of steroid therapy due to recurring symptoms. Influenza virus infection was assumed to play a role in the onset of EGID through a Th2 response that stimulated eosinophilic infiltration in the GI tract. We therefore report this case along with a literature review.

The outcomes of intensified 5-fluorouracil plus leucovorin chemotherapy for preoperative chemoradiation in rectal cancers

PURPOSE: The clinical benefit of intensified neoadjuvant chemoradiotherapy (CRT) in rectal cancer has not been proved. We investigated clinical outcomes of intensified 5-fluorouracil plus leucovorin (5-FU/LV) chemotherapy.METHODS: We retrospectively analyzed 45 patients with locally advanced rectal adenocarcinoma who underwent neoadjuvant CRT between 2010 and 2015. Intensified group took additional 1 cycle of 5-FU/LV chemotherapy after radiation completion (resting period) before surgery, compared to conventional group.RESULTS: Eighteen patients were in conventional group and 27 were in intensified group. Median follow-up duration was 33.7 months (range, 7.8–75.6 months). Complete response rate was 11.4% (5/45). Twelve patients in conventional group and 16 patients in intensified group achieved downstaging (P=0.435). In aspect of toxicity, anemia and thrombocytopenia tended to be more frequent in intensified group without statistical difference. There was also no difference in survival between two groups.CONCLUSION: The intensified CRT with additional 1 cycle of 5-FU/LV in rectal cancer revealed no clinical benefit compared to conventional regimen. Considering that the adverse event was minimal and generally acceptable, further research with additional cycles of 5-FU/LV is needed to prove a real benefit of intensified CRT.

SIRT1 Expression Is Associated with Good Prognosis in Colorectal Cancer

BACKGROUND: Silent mating type information regulation 2 homolog 1 (SIRT1), an NAD+-dependent deacetylase, might act as a tumor promoter by inhibiting p53, but may also as a tumor suppressor by inhibiting several oncogenes such as beta-catenin and survivin. Deleted in breast cancer 1 (DBC1) is known as a negative regulator of SIRT1. METHODS: Immunohistochemical expressions of SIRT1, DBC1, beta-catenin, surviving, and p53 were evaluated using 2 mm tumor cores from 349 colorectal cancer patients for tissue microarray. RESULTS: Overexpression of SIRT1, DBC1, survivin, and p53 was seen in 235 (67%), 183 (52%), 193 (55%), and 190 (54%) patients, respectively. Altered expression of beta-catenin was identified in 246 (70%) patients. On univariate analysis, overexpression of SIRT1 (p=0.029) and altered expression of beta-catenin (p=0.008) were significantly associated with longer overall survival. Expression of SIRT1 was significantly related to DBC1 (p=0.001), beta-catenin (p=0.001), and survivin (p=0.002), but not with p53. On multivariate analysis, age, tumor stage, differentiation, and expression of SIRT1 were independent prognostic factors significantly associated with overall survival. CONCLUSIONS: SIRT1 overexpression is a good prognostic factor for colorectal cancer, and SIRT1 may interact with beta-catenin and survivin rather than p53.

A Comparative Study of Pancreaticoduodenectomy for Benign and Malignant Disease

PURPOSE: The mortality and morbidity rate after pancreaticoduodenectomy (PD) is still high, although the operative techniques and skills and the perioperative care has been improved. The incidence of PD for benign disease is 5~20%. The aim of this study is to determine the factors that differentiate between the benign group and the malignant group by comparing the clinical manifestations, and we studied the safety of performing PD for benign diseases by observing the early and late postoperative complications. METHODS: We retrospectively studied 124 patients who had been diagnosed with benign or malignant pancreatic diseases and who underwent PD between April 1995 and December 2005. We divided the patients into two groups, i.e., the benign group (20) and the malignant group (104), to compare their clinical characteristics and postoperative outcomes. Result: Chronic pancreatitis was the most common disease (35%) in the benign group and distal CBD cancer was the most common disease (40.4%) in the malignant group. Jaundice, weight loss, and elevation of CA 19-9 were more frequent in the malignant group than in the benign group (p<0.05). There were no statistical differences in the mortality rate (10.0% vs 6.7%), reoperation rate (5.0% vs 4.8%), hospital stays (27.1 days vs 24.0 days), early complications (30.0% vs 44.6%) and late complications (22.2% vs 26.4%) between the two groups. There were no mortality and newly developed malignancy during 33.4 months of follow-up period in benign group. CONCLUSION: On the preoperative evaluation, jaundice, weight loss, and elevation of CA 19-9 were more frequent in the malignant group. The postoperative early and late complications showed no difference between the two groups and complication rate was generally favorable. Thus, PD can be performed safely for benign diseases that cannot be treated in a conservative fashion and also for other clinically suspicious malignant diseases.

Prognostic Factors of Resected Stage IV Gastric Cancer Patients

PURPOSE: The prognosis of stage IV gastric cancer is poor with the 5-year survival rate still being about 10%. We investigated the prognostic factors of stage IV gastric cancer patients who underwent resection. MATERIALS AND METHODS: A retrospective study of 383 patients with stage IV gastric cancer who underwent surgery in our department between September 1983 to December 2000 was conducted. We classified the 383 patients into two groups: patients surviving 2 years or more (n=77) and those surviving less than 2 years (n=306). Clinicopathologic differences were analyzed between the two groups. We also performed univariate and multivariate analyses of various clinicopathologic factors concerning survival. RESULTS: Statistically significant clinicopathologic differences between the two groups were observed in regard to macroscopic type, distant metastasis, lymph node dissection, curability, and histology. Curability and histology were significant survival factors in 2-year survival. The 5-year survival rate was 5.4% in stage IV gastric cancer. Significant differences in survival among macroscopic type, distant metastasis, lymph node dissection, curability and histology were observed in the univariate analysis. In the Multivariate analysis, Curability, lymph node dissection, and histology were significantly beneficial factors for survival. CONCLUSION: Lymph node dissection, curability, and histology were independent prognostic factors in stage IV gastric cancer, and radical treatment is recommended to improve survival.

The Clinicopathologic Significance of a p63 Expression in Invasive Breast Cancer

PURPOSE: p63 is a recently described as p53 homologue. Despite their structural homologies, they have different activities. p63 is a specific myoepithelial cell marker in normal breast tissue and it is expressed in a minority of breast cancers. The aim of this study was to evaluate the prognostic significance of the p63 expression in breast cancer. METHODS: The expression of p63 in breast cancer was determined by performing immunohistochemistry on 350 patients who underwent mastectomy at the Department of Surgery at Korea University Medical Center between January 1992 and September 2004. A retrospective analysis was conducted using the medical records. A tissue microarray was constructed, and immunohistochemical analysis for p63 was performed according to the usual methods. RESULTS: Among 350 patients, 40 (11.4%) showed a p63 expression. There was a significant correlation between p63 and the histologic grade. There were significant correlations of p63 with p53 and HER2/neu, respectively. In the basal type of breast cancer, the p63 expression was significantly higher than in the luminal type of breast cancer. The 5 year disease free survival rates were 69% in the patients with a p63 expression and 76% in the patients without a p63 expression, but there was no statistical difference. CONCLUSION: The present results indicate that a p63 expression is associated with a high grade tumor, a p53 expression and a HER2/neu expression in breast cancer, which are the known poor prognostic factors of breast cancer. Immunohistochemical subtyping shows that the p63 expression is a useful predictor for the basal type of breast cancer. In addition, this study suggests that the p63 expression in the basal type of breast cancer is associated with a poor prognosis.