Radical Reresection for T2 Gallbladder Cancer Patients Diagnosed following Laparoscopic Cholecystectomy

PURPOSE: Despite advances in imaging techniques, laparoscopic cholecystectomy (LC) gives many advantages to some patients with suspected gallbladder cancer. The aim of this study was to investigate clinicopathological features and to analyze the risk factors of recurrence after radical reresection for T2 gallbladder cancer patients diagnosed following LC. METHODS: From January 2002 to December 2009, the data of 21 consecutive patients for radical reresection for T2 gallbladder cancer were reviewed, retrospectively. The significance of the variables for recurrence was examined by the Kaplan-Meier method and log-rank test followed by multivariate analyses using Cox's proportional hazard model. RESULTS: Of the 21 patients studied, 11 were men and 10 were women. Lymph node metastasis was present in 7 patients (33.4%). The 5-year survival rate and disease-free survival rate in those patients were 75.3% and 67.9%, respectively. In the univariate analysis, the male gender (P=0.0047), poorly differentiated tumor (P=0.0169), presence of lymph node metastasis (P=0.0012), presence of lymphovascular invasion (P=0.0259) and presence of perineural invasion (P=0.0096) were significant factors related to recurrence after radical reresection. In the multivariate analysis, the presence of lymph node metastasis was an independently significant factor (5-year disease free survival rate, 20.9% vs. 83.8% in the absence of lymph node metastasis; P=0.015). CONCLUSION: For patients with T2 gallbladder carcinoma diagnosed following LC, radical reresection is highly recommended and the presence of lymph node metastasis is an unfavorable prognostic factor that calls for additional treatment after radical surgery.

Is the Yersinia enterocolitica Possible Infectious Agent in Acute Appendicitis?

PURPOSE: With increasing frequency, Yersinia enterocolitica is being recognized as an important bacterial cause of acute gastrointestinal infection with abdominal pain. In addition, the association of Y. enterocolitica infections with acute appendicitis has been suggested. This study was undertaken to ascertain whether Y. enterocolitica is a possible infectious agent in acute appendicitis. METHODS: Between December 2007 and April 2008, 162 patients who underwent appendectomy for presumed appendicitis, enrolled in this prospective study. After surgical excision of appendix, a portion of each specimen was cultured for Y. enterocolitica with highly selective media (Cefsulodin-Irgasan-Novobiocin agar). RESULTS: Pathologically, 150 of the patients had appendicitis and 12 patients had normal appendices. Only one of the 150 patients (0.7%) with appendicitis was found to be culture positive for Y. enterocolitica, while it was not detected from normal appendices. CONCLUSION: The authors were unable to implicate Y. enterocolitica as a major pathogen in acute appendicitis within the Seoul area. However, we thought there to be more need for investigation for association of Y. enterocolitica with acute appendicitis over a broader area and season.

A Case of Adenocarcinoma in Ileocecal Valve Mimicking Inflammatory Bowel Disease / 대한소화기내시경학회지

Adenocarcinoma of the ileocecal valve is rare. It's clinical manifestations are non-specific such as intestinal intussusception, obstruction and right lower abdominal discomfort according to type of cancer. Particularly infiltrative type carcinoma of the ileocecal valve may be easily misdiagnosed as inflammatory bowel disease by radiological imagings and clinical symptoms. We experienced one case of adenocarcinoma of the ileocecal valve mimiking inflammatory bowel disease in radiological features. Colonoscopic findings also could not differentiate malignancy with chronic inflammatory condition. We report a case of adenocarcinoma of the ileocecal valve, which endoscopic findings mimic chronic inflammatory disease, with a review of literature.