Journal of the Korean Society of Coloproctology

Recently developed BMS TM (Zassi Bowel Mana

Dae-Ho Shon

Sang Hun Jung

Min-Chul Shim

Jae-Hwang Kim

Application of BMS™ Avoids a Defunctioning Colostomy in the Treatment of Fournier's Gangrene

BMS™ 在治疗Fournier坏疽中避免造口的应用

See Article on Page 100-107

Total mesorectal excision (TME) was proposed by Heald et al. [1] more than 20 years ago and it is defined as the complete excision of the visceral mesorectal tissue to the level of the levators. The local recurrence rate after rectal cancer surgery has decreased dramatically to below 10% thanks to this TME technique. Currently TME is the gold standard for treatment of rectal cancer. However, if the tumor is located in upper rectum, partial mesorectal excision (PME) down to 5 cm below tumor can be performed. In 1998, Lopez-Kostner et al. [2] from Cleveland clinic insisted that TME is not necessary in case of the upper rectal cancer. And in the same year, Zaheer et al. [3] from Mayo clinic stated that appropriate mesorectal excision during anterior resection when tumor is high in the rectum is likewise consistent with a low rate of local recurrence and good long-term survival. The term tumor-specific mesorectal excision (TSME) was noted first in this article. In the Europe, Maurer et al. [4] from Germany concluded that the rectal cancers of upper third are appropriately treated by PME to 5 cm below the tumor. TSME is defined as the precise perpendicular and circumferential excision of the mesorectum to the level of an appropriate distal resection margin by American Society of Colon and Rectal Surgeons.

Law and Chu et al. [5] from Queen Mary's Hospital in Hong Kong compared the patients with TME for mid and lower rectal cancer and PME for upper rectal cancer, where the rectum was transected 4 to 5 cm below the tumor. Due to longer operative times, higher anastomotic leak rates, a more technically demanding surgery and a higher incidence of stoma formation, the authors called for a more selective use of TME. The authors argue that oncologic outcome is not compromised with this approach based on similar cancer-specific survival patterns between TME and PME in this study. This conclusion was confirmed by meta-analysis. Mirnezami et al. [6] examined the long-term oncological impact of anastomotic leakage after rectal cancer surgery using meta-analysis methods. They found that anastomotic leakage has a negative impact on local recurrence after the rectal cancer surgery. A significant association between anastomotic leakage and reduced long-term cancer specific survival was also noted. Junginger and Hermanek [7] reviewed the literature concerning oncologic outcomes after the rectal surgery. The authors recommended PME, if the rectal cancer is located 12 to 16 cm from anal verge.

Oncologic outcomes after the rectal cancer surgery can be divided into the long-term survival and the local recurrence rate. Regarding rectal cancer, local recurrence rate is especially important compared to colon cancer. TSME itself and its quality is one of the most important factors to predict the local recurrence and even the long-term survival after rectal cancer surgery. Survival is mainly determined by the occurrence of distant metastasis, but TME seems to improve survival in patients without systemic disease. Therefore, the effort to improve the quality of TME is so crucial to improve oncologic outcomes after rectal cancer surgery. Preoperative concurrent chemoradiotherapy is another important factor to reduce the local failure. Pathologic results, such as distal margin, circumferential radial margin, T and N stage, lymphatic and vascular invasion, neural invasion, are also important factors to influence the oncologic results after TSME.

In conclusion, surgeon is one of the most important factors to predicting oncologic outcomes after TME. Individual surgeon should make an effort to improve surgical skill and pathologist can help him with the specimen audit. Nationwide audit program is needed to improve the oncologic results after TME in rectal cancer in South Korea. The other important factor is the preoperative radiotherapy. Preoperative radiotherapy with high quality TME can almost abolish the possibility of local recurrence.

Kil Yeon Lee

Journal of the Korean society of coloproctology

Factors Influencing Oncologic Outcomes after Tumor-specific Mesorectal Excision for Rectal Cancer

直肠癌肿瘤特异性直肠系膜切除术后肿瘤学结局的影响因素

A quick hemostatic effect, as well as sclerosing and shrinkage of hemorrhoids, can be attained when internal hemorrhoids are treated by using injection therapy with aluminum potassium sulfate and tannic acid (ALTA), the outcomes of treatment may be similar to those of a hemorrhoidectomy. However, if the type of hemorrhoid or the method of injection is not appropriate for ALTA treatment, complications peculiar to ALTA or recurrence may develop. Accordingly, sufficient understanding of the treatment mechanism of ALTA injection and repeated training for injection are required for effective use of the ALTA treatment. Keywords: Aluminum potassium sulfate and tannic acid; Hemorrhoid; Injection therapy

Seok Won Lim

Aluminum Potassium Sulfate and Tannic Acid Injection for Hemorrhoids

铝钾矾和鞣酸注射治疗痔疮

Purpose: Recently, laparoscopic surgery has been performed with increasing frequency in cases of various diseases, including colorectal cancer. However, in some cases, laparoscopic surgery should be converted to open procedures because of several factors. In this study, we tried to find the causes of and the risk factors for conversion to open procedures during colorectal cancer surgery. Methods: From June 2002 to May 2008, laparoscopic surgery in 324 patients who were diagnosed as having colorectal cancer was performed by two surgeons. Patients were divided into two groups, non-conversion and conversion groups. We investigated the differences in age, sex, presence of preoperative colonic obstruction, tumor invasion (pT stage), and so on between the two groups. Results: Of the 324 patients, 20 patients experienced an open conversion: 5 of 28 patients who had a colonic obstruction and 15 of 296 patients who had no obstruction (P=0.021). The causes of conversion during the surgery were tumor invasion, peritoneal adhesion, hemorrhage, and cancer perforation. There were 8 conversions out of 92 patients from June 2002 to May 2005 and 12 out of 232 from June 2005 to May 2008 (P=0.231). In regards to the degree of tumor invasion, 9 of 32 who were stage pT4 experienced a conversion to an open procedure (P<0.001). In multivariate analysis, the presence of a colonic obstruction and pT4 stage were meaningful risk factors for conversion to an open procedure. Conclusion: From this study, we can predict a higher rate of conversion to an open procedure in patients with locally advanced colon cancer, especially when a colonic obstruction is present. Therefore, a careful laparoscopic approach is needed in such patients.

Seung Hwan Lee

Soon Do Park

Sun Jin Park

Suk Hwan Lee

Risk Factors for Conversion in Laparoscopic Surgery for Colorectal Cancer

结直肠癌腹腔镜手术中转开腹的风险因素

Kim Yoon Seok

Lee Seung Hyun

Ahn Byung Kwon

Baek Sung Uhn

ERRATUM

勘误

Purpose The aim of this study was to analyze the oncologic outcomes and the risk factors for recurrence after a tumor-specific mesorectal excision (TSME) of resectable rectal cancer in a single institution. Methods A total of 782 patients who underwent a TSME for resectable rectal cancer between February 1995 and December 2005 were enrolled retrospectively. Oncologic outcomes included 5-year cancer-specific survival and its affecting factors, as well as risk factors for local and systemic recurrence. Results The 5-year cancer-specific survival rate was 77.53% with a mean follow-up period of 61 ± 31 months. The overall local and systemic recurrence rates were 9.2% and 21.1%, respectively. The risk factors for local recurrence were pN stage (P = 0.015), positive distal resection margin, and positive circumferential resection margin (P < 0.001). The risk factors for systemic recurrence were pN stage (P < 0.001) and preoperative carcinoembryonic antigen level (P = 0.005). The prognostic factors for cancer-specific survival were pT stage (P < 0.001), pN stage (P < 0.001), positive distal resection margin (P = 0.005), and positive circumferential resection margin (P = 0.016). Conclusion The oncologic outcomes in our institution after a TSME for patients with resectable rectal cancer were similar to those reported in other recent studies, and we established the risk factors that could be crucial for the planning of treatment and follow-up. Keywords: Rectal neoplasms; Colorectal cancer recurrence; Oncologic outcome; Tumor-specific mesorectal excision

Sam Hee Kim

Ki Beom Bae

Jung Min Kim

Jae Ho Shin

Min Sung An

Tae Geun Ha

Sung Mok Ryu

Kwang Hee Kim

Tae Hyeon Kim

Chang Soo Choi

Jin Yong Shin

Minkyung Oh

Seung Hun Baek

Kwan Hee Hong

Oncologic Outcomes and Risk Factors for Recurrence after Tumor-specific Mesorectal Excision of Rectal Cancer: 782 Cases

直肠癌肿瘤特异性直肠系膜切除术后的肿瘤学结局及复发风险因素：782例病例研究

This study was aimed to compare the results of a transanal repair with those of a transvaginal levatorplasty and to determine the long-term clinical outcomes according to the change in the depth of the rectocele after the procedure.Of 50 women who underwent a rectocele repair from March 2005 to February 2007, 26 women (group A) received a transanal repair, and 24 (group B) received a transvaginal repair with or without levatorplasty. At 12 months after the procedures, 45 (group A/B, 22/23 women) among the 50 women completed physiologic studies, including anal manometry and defecography, and clinical-outcome measurements. The variations of the clinical outcomes with changes in the depth of the rectocele were also evaluated in 42 women (group A/B, 20/22) at the median follow-up of 50 months.On the defecographic findings, the postoperative depth of the rectocele decreased significantly in both groups (group A vs. B, 1.91 ± 0.20 vs. 2.25 ± 0.46, P = 0.040). At 12 months after surgery, 17 women in each group (group A/B, 77/75%) reported improvement of their symptoms. However, only 11 and 13 women (group A/B, 55/59%) of groups A and B, respectively, maintained their improvement at the median follow-up of 50 months. Better results were reported in patients with a greater change in the depth of their rectocele (≥4 cm) after the procedure (P = 0.001)In both procedures, clinical outcomes might become progressively worse as the length of the follow-up is increased.

Choon Sik Chung

Sang Hwa Yu

Jeong Eun Lee

Dong Keun Lee

Comparison of Long-term Clinical Outcomes according to the Change in the Rectocele Depth between Transanal and Transvaginal Repairs for a Symptomatic Rectocele

有症状直肠膨出经肛门与经阴道修复后直肠膨出深度变化对长期临床结局的比较

Colouterine fistula is an extremely rare condition because the uterus is a thick, muscular organ. Here, we present a case of a colouterine fistula secondary to colonic diverticulitis. An 81-year-old woman was referred to the emergency department with abdominal pain and vaginal discharge. Computed tomography showed a myometrial abscess cavity in the uterus adherent to the thick sigmoid wall. Upon contrast injection via the cervical os for fistulography, we observed spillage of the contrast into the sigmoid colon via the uterine fundus. Inflammatory adhesion of the distal sigmoid colon to the posterior wall of the uterus was found during surgery. The colon was dissected off the uterus. Resection of the sigmoid colon, primary anastomosis, and repair of the fistula tract of the uterus were performed. The postoperative course was uneventful. This case represents an unusual type of diverticulitis complication and illustrates diagnostic procedures and surgical management for a colouterine fistula.

Pyong Wha Choi

Colouterine Fistula Caused by Diverticulitis of the Sigmoid Colon

乙状结肠憩室炎引起的子宫阴道瘘

Publication Information	Publisher: Korean Society of Coloproctology，Publishing cycle: ，Journal Type: journal，Open Access Journals: No
Basic data	Year of publication: 2009，Proportion of original research papers: ，Self Citation Rate:， Gold OA Rate:

Journal of the Korean Society of Coloproctology

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Application of BMS™ Avoids a Defunctioning Colostomy in the Treatment of Fournier's Gangrene

Factors Influencing Oncologic Outcomes after Tumor-specific Mesorectal Excision for Rectal Cancer

Aluminum Potassium Sulfate and Tannic Acid Injection for Hemorrhoids

Risk Factors for Conversion in Laparoscopic Surgery for Colorectal Cancer

ERRATUM

Factors Influencing Oncologic Outcomes after Tumor-specific Mesorectal Excision for Rectal Cancer

Aluminum Potassium Sulfate and Tannic Acid Injection for Hemorrhoids

Oncologic Outcomes and Risk Factors for Recurrence after Tumor-specific Mesorectal Excision of Rectal Cancer: 782 Cases

Comparison of Long-term Clinical Outcomes according to the Change in the Rectocele Depth between Transanal and Transvaginal Repairs for a Symptomatic Rectocele

Colouterine Fistula Caused by Diverticulitis of the Sigmoid Colon