Bong-Hyeon Kye | Catholic University of Korea (original) (raw)
Papers by Bong-Hyeon Kye
BMC Gastroenterology
Background Prevention and early detection of colorectal cancer (CRC) is a global priority, with m... more Background Prevention and early detection of colorectal cancer (CRC) is a global priority, with many countries conducting population-based CRC screening programs. Although colonoscopy is the most accurate diagnostic method for early CRC detection, adherence remains low because of its invasiveness and the need for extensive bowel preparation. Non-invasive fecal occult blood tests or fecal immunochemical tests are available; however, their sensitivity is relatively low. Syndecan-2 (SDC2) is a stool-based DNA methylation marker used for early detection of CRC. Using the EarlyTect™-Colon Cancer test, the sensitivity and specificity of SDC2 methylation in stool DNA for detecting CRC were previously demonstrated to be greater than 90%. Therefore, a larger trial to validate its use for CRC screening in asymptomatic populations is now required. Methods All participants will collect their stool (at least 20 g) before undergoing screening colonoscopy. The samples will be sent to a central lab...
World Journal of Gastrointestinal Oncology
We evaluated the prognostic impact of vascular invasion (VI) compared with nodal (N) stage and de... more We evaluated the prognostic impact of vascular invasion (VI) compared with nodal (N) stage and developed a new staging system including VI in colon cancer. Patients who underwent curative resection with stage II-III colon cancer were assigned to VI and non-VI groups; the latter was subclassified as N0, N1, and N2; a new TNVM staging was devised by adding the V-stage. Among the 2243 study participants, the VI group independently showed worse oncological outcomes than the N1 group (disease-free survival (DFS), hazard-ratio (HR) 1.704, 1.267–2.291; overall survival (OS), HR 2.301, 1.582–3.348). The 5-year DFS in the VI group was 63.4% [N1b (74.6%), p = 0.003; N2a (69.7%), p = 0.126; and N2b (56.8%), p = 0.276], and the 5-year OS was 76.6% [N1b (84.9%), p = 0.004; N2a (83.0%), p = 0.047; and N2b (76.1%), p = 0.906]. Thus, we considered VI as N2a in TNVM staging; 78 patients (3.5%) underwent upstaging. The 5-year OS rates of stage IIB and IIC increased from 88.6% and 65.9% in TNM staging...
Trauma and Emergency Care
Scientific Reports
A bridge to surgery (BTS) after a colonic stent for obstructive colon cancer has not been accepte... more A bridge to surgery (BTS) after a colonic stent for obstructive colon cancer has not been accepted as a standard treatment strategy. Also, there is no consensus regarding the optimal time interval for BTS. We aimed to identify the optimal timing for BTS after stent placement to decrease the oncologic risk. We retrospectively collected data of 174 patients who underwent BTS after stent placement for stage II or III obstructive colon cancer from five hospitals. We divided the patients into three groups based on the time interval for BTS after stent placement: within 7 days (Group 1), from 8 to 14 days (Group 2), and after 14 days (Group 3). The primary outcome was to compare the oncologic outcomes including overall survival (OS), disease-free survival (DFS), and recurrence rate (RR) among the three groups. Groups 1, 2, and 3 involved 75, 56, and 43 patients, respectively. Postoperative morbidity rates were 17.3%, 10.8%, and 9.3% in Groups 1, 2, and 3, respectively (P = 0.337). RRs wer...
Annals of Surgical Treatment and Research
Purpose: Colonoscopy is an effective method of screening for colorectal cancer (CRC), and it can ... more Purpose: Colonoscopy is an effective method of screening for colorectal cancer (CRC), and it can prevent CRC by detection and removal of precancerous lesions. The most important considerations when performing colonoscopy screening are the safety and satisfaction of the patient and the diagnostic accuracy. Accordingly, the Korean Society of Coloproctology (KSCP) herein proposes an optimal level of standard performance to be used in endoscopy units and by individual colonoscopists for screening colonoscopy. These guidelines establish specific criteria for assessment of safety and quality in screening colonoscopy. Methods: The Colonoscopy Committee of the KSCP commissioned this Position Statement. Expert gastrointestinal surgeons representing the KSCP reviewed the published evidence to identify acceptable quality indicators and indicators that lacked sufficient evidence. Results: The KSCP recommends an optimal standard list for quality control of screening colonoscopy in the following 6 categories: training and competency of the colonoscopist, procedural quality, facilities and equipment, performance indicators and auditable outcomes, disinfection of equipment, and sedation and recovery of the patient. Conclusion: The KSCP recommends that endoscopy units performing CRC screening evaluate 6 key performance measures during daily practice.
BMC Cancer
Background The introduction of complete mesocolic excision (CME) with central vascular ligation (... more Background The introduction of complete mesocolic excision (CME) with central vascular ligation (CVL) for right-sided colon cancer has improved the oncologic outcomes. Recently, we have introduced a modified CME (mCME) procedure that keeps the same principles as the originally described CME but with a more tailored approach. Some retrospective studies have reported the favourable oncologic outcomes of laparoscopic mCME for right-sided colon cancer; however, no prospective multicentre study has yet been conducted. Methods This study is a multi-institutional, prospective, single-arm study evaluating the oncologic outcomes of laparoscopic mCME for adenocarcinoma arising from the right side of the colon. A total of 250 patients will be recruited from five tertiary referral centres in South Korea. The primary outcome of this study is 3-year disease-free survival. Secondary outcome measures include 3-year overall survival, incidence of surgical complications, completeness of mCME, and dis...
Annals of Coloproctology
Purpose: Many studies have shown that the enhanced recovery after surgery (ERAS) protocols improv... more Purpose: Many studies have shown that the enhanced recovery after surgery (ERAS) protocols improve postoperative surgical outcomes. The purpose of this study was to observe the effects on postoperative inflammatory markers and to explore the effects of a high degree of compliance and the use of epidural anesthesia on inflammation and surgical outcomes.Methods: Four hundred patients underwent colorectal cancer surgery at 2 hospitals during 2 different periods, namely, from January 2006 to December 2009 and from January 2017 to July 2017. Data related to the patient’s clinicopathological features, inflammatory markers, percentage of compliance with elements of the ERAS protocol, and use of epidural anesthesia were collected from a prospectively maintained database.Results: The complication rate and the length of hospital stay (LOS) were less in the ERAS group than in the conventional group (P = 0.005 and P ≤ 0.001, respectively). The postoperative white blood cell count and the durati...
Surgical Metabolism and Nutrition
Purpose: Patients with cancers arising from the gastrointestinal tract can suffer from nutritiona... more Purpose: Patients with cancers arising from the gastrointestinal tract can suffer from nutritional inadequacies caused by various factors. This study investigated the risk of malnutrition after curative surgery in patients with gastric cancer (GC) or colorectal cancer (CRC) using various preoperative and postoperative nutritional screening tools. Materials and Methods: In the authors' hospital, 407 patients (206 patients with GC and 201 patients with CRC) underwent surgery between July 2011 and June 2012. The patients from the two groups were matched using the propensity score and then analyzed the nutritional data from 170 patients (85 patients in each group), retrospectively. Results: In both groups, the postoperative nutritional status was impaired significantly compared to the preoperative status. The postoperative risk of undernutrition in CRC patients was significantly lower than that of the GC patients according to the Malnutrition Universal Screening Tool (P=0.007). At the time of hospital discharge after surgery, the incidence of a lower serum albumin level (P=0.002) and more than 5% weight loss (P=0.013) were higher in the GC group than in the CRC group. A comparison of the postoperative nutritional status among the types of surgery in each group, total gastrectomy in the GC group (P=0.015) and proctectomy with diverting stoma in the CRC group (P=0.06), were related to more than 5% weight loss. Conclusion: Gastrointestinal cancer surgery might increase the patients' postoperative risk of malnutrition, particularly in GC surgery. Therefore, consecutive assessments of the nutritional status and appropriate nutritional support are necessary after surgery for GC and CRC.
Scientific Reports
Sphincter-saving surgery (SSS) is the gold standard for rectal cancer surgery but results in a wi... more Sphincter-saving surgery (SSS) is the gold standard for rectal cancer surgery but results in a wide spectrum of bowel dysfunction. This study investigated the impact of colonic dysmotility on the incontinent form of bowel dysfunction. Bowel function of patients who received SSS with loop ileostomy for treating rectal cancer was reviewed retrospectively from June 2013 two August 2015 at a single hospital. Immediately after closure of a diverting stoma, patients were tested for the colonic transit time (CTT) using radiopaque markers. Bowel dysfunction at 6 and 12 months after SSS was measured as the severity of fecal incontinence according to the Cleveland Clinic Incontinence Score (CCIS) and the use of an anti-diarrheal drug. A short CTT for the left colonic segment was significantly associated with the high CCIS and use of an antidiarrheal agent at 6 months after sphincter preservation. However, the CTT didn’t correlate with the CCIS at 12 months after SSS. Rather, age and surgical ...
Annals of Robotic and Innovative Surgery
Since the establishment of KAROS, discussions about the education and management of robotic surge... more Since the establishment of KAROS, discussions about the education and management of robotic surgery have begun in earnest. In May 2014, as a project task of Korean Society of Surgeons, a "Introduction of a credentialing system for robotic surgery in Korea" proposed by the KAROS was approved. Then, in September 2014, the Preparatory Committee for credentialing system for robotic surgery was established with the approval of the Korean
European Journal of Surgical Oncology
BMJ Open
IntroductionSurgical site infection (SSI) after abdominal surgery remains a significant cause of ... more IntroductionSurgical site infection (SSI) after abdominal surgery remains a significant cause of morbidity and is associated with an increased socioeconomic burden and a reduced quality of life. Circular wound protectors have been expected to reduce the risk of SSI, but previous studies reported conflicting results on their protective effects. The purpose of this study was to evaluate the efficacy of circular wound protectors in reducing SSI in open abdominal surgery.Methods and analysisThe circular pOlyethylen drape in preVEntion of suRgical site infection (COVER) trial investigates whether the application of a dual-ring circular plastic wound protector reduces the rate of SSI in patients undergoing elective or emergent open abdominal surgery related to the gastrointestinal tract, regardless of the type of wound classified by the Centers for Disease Control. The COVER trial is a multicentre, randomised controlled clinical trial with two parallel arms—one using a dual-ring wound pro...
Annals of Coloproctology
The oncological outcomes of laparoscopic rectal cancer surgery were evaluated in the recent multi... more The oncological outcomes of laparoscopic rectal cancer surgery were evaluated in the recent multicenter randomized clinical trials (RCTs). The MRC-CLASSIC, COLOR II, and COREAN trials found no differences in local recurrence or disease-free survival rate between laparoscopic and open surgery. However, the non-inferiority of laparoscopic surgery with respect to open surgery for rectal cancer was not established on statistical analysis in the ACOSOG Z6051 and the ALaCaRT trials. Quality of total mesorectal excision (TME) is one of the most important prognostic factors. Incomplete TME had unfavorable oncologic outcomes compared to the complete TME. Although the TME quality can be clearly identified on pathologic evaluation, there is controversy regarding the acceptable range of oncologically safe TME for laparoscopic surgery. It is not certain whether near-complete TME has an unfavorable oncologic impact and whether laparoscopic surgery with near-complete TME is an oncological threat. Therefore, the surgical community will be interested in the long-term outcomes and the meta-analysis of the ongoing large-scale RCTs. The laparoscopic rectal cancer surgery has been steadily increasing with its oncologic safety having been reported consistently in various multicenter RCTs. To improve the surgical quality, colorectal surgeons should choose the most appropriate surgical technique, including laparoscopic surgery.
Annals of Surgical Treatment and Research
The optimal treatment for synchronous liver metastasis (LM) from colorectal cancer (CRC) depends ... more The optimal treatment for synchronous liver metastasis (LM) from colorectal cancer (CRC) depends on various factors. The present study was intended to investigate the oncologic outcome according to the time of resection of metastatic lesions. Methods: Data from patients who underwent treatment with curative intent for primary CRC and synchronous LM between 2004 and 2009 from 9 university hospitals in Korea were collected retrospectively. One hundred forty-three patients underwent simultaneous resection for primary CRC and synchronous LM (simultaneous surgery group), and 65 patients were treated by 2-stage operation (staged surgery group). Results: The mean follow-up length was 41.2 ± 24.6 months. In the extent of resection for hepatic metastasis, major hepatectomy was more frequently performed in staged surgery group (33.8% vs. 8.4%, P < 0.001). The rate of severe complications of Clavien-Dindo classification grade III or more was not significantly different between the 2 groups. The 3-year overall survival (OS) rate was 85.0% in staged surgery group and 69.4% in simultaneous surgery group (P = 0.013), and the 3-year recurrence-free survival (RFS) rate was 46.4% in staged surgery group and 30.2% in simultaneous surgery group (P = 0.143). In subgroup analysis based on the location of primary CRC, the benefit of staged surgery for OS and RFS was clearly shown in rectal cancer (P = 0.021 and P = 0.015). Conclusion: Based on our results, staged surgery with or without neoadjuvant chemotherapy should be considered for resectable synchronous LM from CRC, especially in rectal cancer, as a safe and fairly promising option.
Scientific Reports
Advancement of the surgical modality and perioperative care are the two main dimensions for the m... more Advancement of the surgical modality and perioperative care are the two main dimensions for the modern improvement of surgical outcome. The purpose of this study was to compare the effectiveness of the two by using the data from the single-port laparoscopic surgery and the early recovery after surgery (ERAS) program. Patients who underwent elective surgery for primary adenocarcinoma of the colon were divided into three groups and compared: ERAS (multi-port laparoscopic surgery with ERAS perioperative care), Conventional-SILS (single-port surgery with conventional perioperative care), or Conventional-Multi (multi-port laparoscopic surgery with conventional perioperative care). Ninetyone, 83, and 96 patients were registered, respectively. There were no differences among the three groups in baseline characteristics except pathological stage and operation site in colon. Although the ERAS group started a soft diet earlier and had earlier discharge, there were no differences in intra-and post-operative morbidity rate, readmission rate, or reoperation rate. The ERAS perioperative care was a significant factor for reducing length of hospital stay in the multivariate analysis, while single-port surgery was not. In modern laparoscopic colon cancer treatment, a systemic approach such as the ERAS program appears to be more effective than a technical approach for significantly improving short-term surgical outcomes. Short-and long-term outcomes of colorectal cancer surgery are improving due to a number of advancements, including minimally invasive surgery, the principle of total mesorectal excision/complete mesocolic excision, a multidisciplinary team approach, and the development of chemotherapy in the modern era. The ERAS (Early Recovery After Surgery) program is also known to improve postoperative outcomes following colorectal surgery. ERAS aims to quickly restore patients to preoperative condition after surgery through various efforts such as minimizing fasting time in the perioperative period, encouraging exercise, and intensive control of pain 1. ERAS is known to reduce postoperative complications, hasten recovery, and reduce the length of hospital stay 2,3. Another approach, single-port laparoscopic surgery, is reported to not only have a cosmetic effect, but also decrease intraoperative blood loss and postoperative length of hospital stay by enhancing recovery of bowel movements due to further shortening of the incision length compared to conventional multi-port laparoscopic surgery 4. Both methods can improve short-term performance in colon cancer surgery, but one is a systemic approach requiring cooperation from experts in different fields, and the other is a technical approach, dependent on the ability of the surgeon. Neither has been sufficiently validated with clinical data in Korea. Currently, multi-port laparoscopic surgery with conventional perioperative care is the main surgical treatment for colon cancer in
Journal of Laparoendoscopic & Advanced Surgical Techniques
Objectives: Over the last century, unthinkable goals have been achieved in health care and medica... more Objectives: Over the last century, unthinkable goals have been achieved in health care and medical sciences, leading to longer life expectancy. Although cancer affects all ages, it disproportionately targets older individuals. Thus, surgical oncologists are confronted with increasing numbers of older patients presenting with multiple chronic conditions. We intended to investigate the safety of oncologic resection in older patients with colorectal cancer (CRC) based on perioperative outcomes. Materials and Methods: We retrospectively collected and analyzed data from older patients (>85 years) who underwent curative resection for stage II or III CRC between January 2007 and August 2017 at four hospitals (St. Vincent's Hospital, Incheon St. Mary's Hospital, Seoul St. Mary's Hospital, and Yeouido St. Mary's Hospital). Results: A total of 140 patients were enrolled in this study. The mean age was 87.1, the mean stay in the intensive care unit after surgery was 1.6 ± 3.8 days, and the mean postoperative hospital stay was 10.5 ± 3.8 days, D3 lymph node dissection was performed in 67.0% of patients, and D2 lymph node dissection was performed in 33.0%. Postoperative complications occurred in 38 patients (27.9%). In the univariate analysis, the risk factors for postoperative complications were the omission of mechanical bowel preparation (P = .039) and open surgery (P = .031). Conclusions: Oncologic resection in selected older patients with CRC might be a relatively safe treatment option. In particular, a laparoscopic approach might be a safer surgical method than open surgery in older patients with CRC.
International Journal of Colorectal Disease
PurposeSphincter-saving surgery is widely accepted operative modality to treat rectal cancer. It ... more PurposeSphincter-saving surgery is widely accepted operative modality to treat rectal cancer. It often requires temporary diverting stoma to avoid the complications of anastomotic failure. This study investigates the cumulative failure rate in sphincter preservation for rectal cancer and the risk factors associated with the permanent stoma.MethodsA retrospective study on 358 patients diagnosed with primary rectal cancer from 2009 to 2013 was conducted at a single institute. Three hundred and thirty-one out of 358 patients with rectal cancer located within 12 cm from the anal verge, who underwent sphincter-preserving surgery, were included in this study. The cumulative rate for permanent stoma was calculated. Univariate and multivariate analysis were performed, comparing the patients with stoma to the ones without.ResultsTemporary diverting stoma was created in 223 (82%) patients. After median follow-up of 42 months, 18 patients (6.6%) persistently used temporary stoma or required re-creation of stoma. Univariate analysis revealed that BMI, tumor location below 4 cm from the anal verge, coloanal anastomosis, anastomotic leakage, and local recurrence were significantly associated with persistent use or re-formation of stoma. Multivariate analysis showed that anastomotic leakage (OR 50.3; 95% CI, 10.1–250.1; p < 0.0001) and local recurrence (OR 11.3; 95% CI, 1.61–78.5; p = 0.015) were the independent risk factors.ConclusionPatients with anastomotic leakage and local recurrence are at high risk for permanent stoma. Not only should patients be fully informed of possible failure in sphincter preservation preoperatively, but also patient-oriented decision should be made on patient-tailored surgical plan.
BMC Gastroenterology
Background Prevention and early detection of colorectal cancer (CRC) is a global priority, with m... more Background Prevention and early detection of colorectal cancer (CRC) is a global priority, with many countries conducting population-based CRC screening programs. Although colonoscopy is the most accurate diagnostic method for early CRC detection, adherence remains low because of its invasiveness and the need for extensive bowel preparation. Non-invasive fecal occult blood tests or fecal immunochemical tests are available; however, their sensitivity is relatively low. Syndecan-2 (SDC2) is a stool-based DNA methylation marker used for early detection of CRC. Using the EarlyTect™-Colon Cancer test, the sensitivity and specificity of SDC2 methylation in stool DNA for detecting CRC were previously demonstrated to be greater than 90%. Therefore, a larger trial to validate its use for CRC screening in asymptomatic populations is now required. Methods All participants will collect their stool (at least 20 g) before undergoing screening colonoscopy. The samples will be sent to a central lab...
World Journal of Gastrointestinal Oncology
We evaluated the prognostic impact of vascular invasion (VI) compared with nodal (N) stage and de... more We evaluated the prognostic impact of vascular invasion (VI) compared with nodal (N) stage and developed a new staging system including VI in colon cancer. Patients who underwent curative resection with stage II-III colon cancer were assigned to VI and non-VI groups; the latter was subclassified as N0, N1, and N2; a new TNVM staging was devised by adding the V-stage. Among the 2243 study participants, the VI group independently showed worse oncological outcomes than the N1 group (disease-free survival (DFS), hazard-ratio (HR) 1.704, 1.267–2.291; overall survival (OS), HR 2.301, 1.582–3.348). The 5-year DFS in the VI group was 63.4% [N1b (74.6%), p = 0.003; N2a (69.7%), p = 0.126; and N2b (56.8%), p = 0.276], and the 5-year OS was 76.6% [N1b (84.9%), p = 0.004; N2a (83.0%), p = 0.047; and N2b (76.1%), p = 0.906]. Thus, we considered VI as N2a in TNVM staging; 78 patients (3.5%) underwent upstaging. The 5-year OS rates of stage IIB and IIC increased from 88.6% and 65.9% in TNM staging...
Trauma and Emergency Care
Scientific Reports
A bridge to surgery (BTS) after a colonic stent for obstructive colon cancer has not been accepte... more A bridge to surgery (BTS) after a colonic stent for obstructive colon cancer has not been accepted as a standard treatment strategy. Also, there is no consensus regarding the optimal time interval for BTS. We aimed to identify the optimal timing for BTS after stent placement to decrease the oncologic risk. We retrospectively collected data of 174 patients who underwent BTS after stent placement for stage II or III obstructive colon cancer from five hospitals. We divided the patients into three groups based on the time interval for BTS after stent placement: within 7 days (Group 1), from 8 to 14 days (Group 2), and after 14 days (Group 3). The primary outcome was to compare the oncologic outcomes including overall survival (OS), disease-free survival (DFS), and recurrence rate (RR) among the three groups. Groups 1, 2, and 3 involved 75, 56, and 43 patients, respectively. Postoperative morbidity rates were 17.3%, 10.8%, and 9.3% in Groups 1, 2, and 3, respectively (P = 0.337). RRs wer...
Annals of Surgical Treatment and Research
Purpose: Colonoscopy is an effective method of screening for colorectal cancer (CRC), and it can ... more Purpose: Colonoscopy is an effective method of screening for colorectal cancer (CRC), and it can prevent CRC by detection and removal of precancerous lesions. The most important considerations when performing colonoscopy screening are the safety and satisfaction of the patient and the diagnostic accuracy. Accordingly, the Korean Society of Coloproctology (KSCP) herein proposes an optimal level of standard performance to be used in endoscopy units and by individual colonoscopists for screening colonoscopy. These guidelines establish specific criteria for assessment of safety and quality in screening colonoscopy. Methods: The Colonoscopy Committee of the KSCP commissioned this Position Statement. Expert gastrointestinal surgeons representing the KSCP reviewed the published evidence to identify acceptable quality indicators and indicators that lacked sufficient evidence. Results: The KSCP recommends an optimal standard list for quality control of screening colonoscopy in the following 6 categories: training and competency of the colonoscopist, procedural quality, facilities and equipment, performance indicators and auditable outcomes, disinfection of equipment, and sedation and recovery of the patient. Conclusion: The KSCP recommends that endoscopy units performing CRC screening evaluate 6 key performance measures during daily practice.
BMC Cancer
Background The introduction of complete mesocolic excision (CME) with central vascular ligation (... more Background The introduction of complete mesocolic excision (CME) with central vascular ligation (CVL) for right-sided colon cancer has improved the oncologic outcomes. Recently, we have introduced a modified CME (mCME) procedure that keeps the same principles as the originally described CME but with a more tailored approach. Some retrospective studies have reported the favourable oncologic outcomes of laparoscopic mCME for right-sided colon cancer; however, no prospective multicentre study has yet been conducted. Methods This study is a multi-institutional, prospective, single-arm study evaluating the oncologic outcomes of laparoscopic mCME for adenocarcinoma arising from the right side of the colon. A total of 250 patients will be recruited from five tertiary referral centres in South Korea. The primary outcome of this study is 3-year disease-free survival. Secondary outcome measures include 3-year overall survival, incidence of surgical complications, completeness of mCME, and dis...
Annals of Coloproctology
Purpose: Many studies have shown that the enhanced recovery after surgery (ERAS) protocols improv... more Purpose: Many studies have shown that the enhanced recovery after surgery (ERAS) protocols improve postoperative surgical outcomes. The purpose of this study was to observe the effects on postoperative inflammatory markers and to explore the effects of a high degree of compliance and the use of epidural anesthesia on inflammation and surgical outcomes.Methods: Four hundred patients underwent colorectal cancer surgery at 2 hospitals during 2 different periods, namely, from January 2006 to December 2009 and from January 2017 to July 2017. Data related to the patient’s clinicopathological features, inflammatory markers, percentage of compliance with elements of the ERAS protocol, and use of epidural anesthesia were collected from a prospectively maintained database.Results: The complication rate and the length of hospital stay (LOS) were less in the ERAS group than in the conventional group (P = 0.005 and P ≤ 0.001, respectively). The postoperative white blood cell count and the durati...
Surgical Metabolism and Nutrition
Purpose: Patients with cancers arising from the gastrointestinal tract can suffer from nutritiona... more Purpose: Patients with cancers arising from the gastrointestinal tract can suffer from nutritional inadequacies caused by various factors. This study investigated the risk of malnutrition after curative surgery in patients with gastric cancer (GC) or colorectal cancer (CRC) using various preoperative and postoperative nutritional screening tools. Materials and Methods: In the authors' hospital, 407 patients (206 patients with GC and 201 patients with CRC) underwent surgery between July 2011 and June 2012. The patients from the two groups were matched using the propensity score and then analyzed the nutritional data from 170 patients (85 patients in each group), retrospectively. Results: In both groups, the postoperative nutritional status was impaired significantly compared to the preoperative status. The postoperative risk of undernutrition in CRC patients was significantly lower than that of the GC patients according to the Malnutrition Universal Screening Tool (P=0.007). At the time of hospital discharge after surgery, the incidence of a lower serum albumin level (P=0.002) and more than 5% weight loss (P=0.013) were higher in the GC group than in the CRC group. A comparison of the postoperative nutritional status among the types of surgery in each group, total gastrectomy in the GC group (P=0.015) and proctectomy with diverting stoma in the CRC group (P=0.06), were related to more than 5% weight loss. Conclusion: Gastrointestinal cancer surgery might increase the patients' postoperative risk of malnutrition, particularly in GC surgery. Therefore, consecutive assessments of the nutritional status and appropriate nutritional support are necessary after surgery for GC and CRC.
Scientific Reports
Sphincter-saving surgery (SSS) is the gold standard for rectal cancer surgery but results in a wi... more Sphincter-saving surgery (SSS) is the gold standard for rectal cancer surgery but results in a wide spectrum of bowel dysfunction. This study investigated the impact of colonic dysmotility on the incontinent form of bowel dysfunction. Bowel function of patients who received SSS with loop ileostomy for treating rectal cancer was reviewed retrospectively from June 2013 two August 2015 at a single hospital. Immediately after closure of a diverting stoma, patients were tested for the colonic transit time (CTT) using radiopaque markers. Bowel dysfunction at 6 and 12 months after SSS was measured as the severity of fecal incontinence according to the Cleveland Clinic Incontinence Score (CCIS) and the use of an anti-diarrheal drug. A short CTT for the left colonic segment was significantly associated with the high CCIS and use of an antidiarrheal agent at 6 months after sphincter preservation. However, the CTT didn’t correlate with the CCIS at 12 months after SSS. Rather, age and surgical ...
Annals of Robotic and Innovative Surgery
Since the establishment of KAROS, discussions about the education and management of robotic surge... more Since the establishment of KAROS, discussions about the education and management of robotic surgery have begun in earnest. In May 2014, as a project task of Korean Society of Surgeons, a "Introduction of a credentialing system for robotic surgery in Korea" proposed by the KAROS was approved. Then, in September 2014, the Preparatory Committee for credentialing system for robotic surgery was established with the approval of the Korean
European Journal of Surgical Oncology
BMJ Open
IntroductionSurgical site infection (SSI) after abdominal surgery remains a significant cause of ... more IntroductionSurgical site infection (SSI) after abdominal surgery remains a significant cause of morbidity and is associated with an increased socioeconomic burden and a reduced quality of life. Circular wound protectors have been expected to reduce the risk of SSI, but previous studies reported conflicting results on their protective effects. The purpose of this study was to evaluate the efficacy of circular wound protectors in reducing SSI in open abdominal surgery.Methods and analysisThe circular pOlyethylen drape in preVEntion of suRgical site infection (COVER) trial investigates whether the application of a dual-ring circular plastic wound protector reduces the rate of SSI in patients undergoing elective or emergent open abdominal surgery related to the gastrointestinal tract, regardless of the type of wound classified by the Centers for Disease Control. The COVER trial is a multicentre, randomised controlled clinical trial with two parallel arms—one using a dual-ring wound pro...
Annals of Coloproctology
The oncological outcomes of laparoscopic rectal cancer surgery were evaluated in the recent multi... more The oncological outcomes of laparoscopic rectal cancer surgery were evaluated in the recent multicenter randomized clinical trials (RCTs). The MRC-CLASSIC, COLOR II, and COREAN trials found no differences in local recurrence or disease-free survival rate between laparoscopic and open surgery. However, the non-inferiority of laparoscopic surgery with respect to open surgery for rectal cancer was not established on statistical analysis in the ACOSOG Z6051 and the ALaCaRT trials. Quality of total mesorectal excision (TME) is one of the most important prognostic factors. Incomplete TME had unfavorable oncologic outcomes compared to the complete TME. Although the TME quality can be clearly identified on pathologic evaluation, there is controversy regarding the acceptable range of oncologically safe TME for laparoscopic surgery. It is not certain whether near-complete TME has an unfavorable oncologic impact and whether laparoscopic surgery with near-complete TME is an oncological threat. Therefore, the surgical community will be interested in the long-term outcomes and the meta-analysis of the ongoing large-scale RCTs. The laparoscopic rectal cancer surgery has been steadily increasing with its oncologic safety having been reported consistently in various multicenter RCTs. To improve the surgical quality, colorectal surgeons should choose the most appropriate surgical technique, including laparoscopic surgery.
Annals of Surgical Treatment and Research
The optimal treatment for synchronous liver metastasis (LM) from colorectal cancer (CRC) depends ... more The optimal treatment for synchronous liver metastasis (LM) from colorectal cancer (CRC) depends on various factors. The present study was intended to investigate the oncologic outcome according to the time of resection of metastatic lesions. Methods: Data from patients who underwent treatment with curative intent for primary CRC and synchronous LM between 2004 and 2009 from 9 university hospitals in Korea were collected retrospectively. One hundred forty-three patients underwent simultaneous resection for primary CRC and synchronous LM (simultaneous surgery group), and 65 patients were treated by 2-stage operation (staged surgery group). Results: The mean follow-up length was 41.2 ± 24.6 months. In the extent of resection for hepatic metastasis, major hepatectomy was more frequently performed in staged surgery group (33.8% vs. 8.4%, P < 0.001). The rate of severe complications of Clavien-Dindo classification grade III or more was not significantly different between the 2 groups. The 3-year overall survival (OS) rate was 85.0% in staged surgery group and 69.4% in simultaneous surgery group (P = 0.013), and the 3-year recurrence-free survival (RFS) rate was 46.4% in staged surgery group and 30.2% in simultaneous surgery group (P = 0.143). In subgroup analysis based on the location of primary CRC, the benefit of staged surgery for OS and RFS was clearly shown in rectal cancer (P = 0.021 and P = 0.015). Conclusion: Based on our results, staged surgery with or without neoadjuvant chemotherapy should be considered for resectable synchronous LM from CRC, especially in rectal cancer, as a safe and fairly promising option.
Scientific Reports
Advancement of the surgical modality and perioperative care are the two main dimensions for the m... more Advancement of the surgical modality and perioperative care are the two main dimensions for the modern improvement of surgical outcome. The purpose of this study was to compare the effectiveness of the two by using the data from the single-port laparoscopic surgery and the early recovery after surgery (ERAS) program. Patients who underwent elective surgery for primary adenocarcinoma of the colon were divided into three groups and compared: ERAS (multi-port laparoscopic surgery with ERAS perioperative care), Conventional-SILS (single-port surgery with conventional perioperative care), or Conventional-Multi (multi-port laparoscopic surgery with conventional perioperative care). Ninetyone, 83, and 96 patients were registered, respectively. There were no differences among the three groups in baseline characteristics except pathological stage and operation site in colon. Although the ERAS group started a soft diet earlier and had earlier discharge, there were no differences in intra-and post-operative morbidity rate, readmission rate, or reoperation rate. The ERAS perioperative care was a significant factor for reducing length of hospital stay in the multivariate analysis, while single-port surgery was not. In modern laparoscopic colon cancer treatment, a systemic approach such as the ERAS program appears to be more effective than a technical approach for significantly improving short-term surgical outcomes. Short-and long-term outcomes of colorectal cancer surgery are improving due to a number of advancements, including minimally invasive surgery, the principle of total mesorectal excision/complete mesocolic excision, a multidisciplinary team approach, and the development of chemotherapy in the modern era. The ERAS (Early Recovery After Surgery) program is also known to improve postoperative outcomes following colorectal surgery. ERAS aims to quickly restore patients to preoperative condition after surgery through various efforts such as minimizing fasting time in the perioperative period, encouraging exercise, and intensive control of pain 1. ERAS is known to reduce postoperative complications, hasten recovery, and reduce the length of hospital stay 2,3. Another approach, single-port laparoscopic surgery, is reported to not only have a cosmetic effect, but also decrease intraoperative blood loss and postoperative length of hospital stay by enhancing recovery of bowel movements due to further shortening of the incision length compared to conventional multi-port laparoscopic surgery 4. Both methods can improve short-term performance in colon cancer surgery, but one is a systemic approach requiring cooperation from experts in different fields, and the other is a technical approach, dependent on the ability of the surgeon. Neither has been sufficiently validated with clinical data in Korea. Currently, multi-port laparoscopic surgery with conventional perioperative care is the main surgical treatment for colon cancer in
Journal of Laparoendoscopic & Advanced Surgical Techniques
Objectives: Over the last century, unthinkable goals have been achieved in health care and medica... more Objectives: Over the last century, unthinkable goals have been achieved in health care and medical sciences, leading to longer life expectancy. Although cancer affects all ages, it disproportionately targets older individuals. Thus, surgical oncologists are confronted with increasing numbers of older patients presenting with multiple chronic conditions. We intended to investigate the safety of oncologic resection in older patients with colorectal cancer (CRC) based on perioperative outcomes. Materials and Methods: We retrospectively collected and analyzed data from older patients (>85 years) who underwent curative resection for stage II or III CRC between January 2007 and August 2017 at four hospitals (St. Vincent's Hospital, Incheon St. Mary's Hospital, Seoul St. Mary's Hospital, and Yeouido St. Mary's Hospital). Results: A total of 140 patients were enrolled in this study. The mean age was 87.1, the mean stay in the intensive care unit after surgery was 1.6 ± 3.8 days, and the mean postoperative hospital stay was 10.5 ± 3.8 days, D3 lymph node dissection was performed in 67.0% of patients, and D2 lymph node dissection was performed in 33.0%. Postoperative complications occurred in 38 patients (27.9%). In the univariate analysis, the risk factors for postoperative complications were the omission of mechanical bowel preparation (P = .039) and open surgery (P = .031). Conclusions: Oncologic resection in selected older patients with CRC might be a relatively safe treatment option. In particular, a laparoscopic approach might be a safer surgical method than open surgery in older patients with CRC.
International Journal of Colorectal Disease
PurposeSphincter-saving surgery is widely accepted operative modality to treat rectal cancer. It ... more PurposeSphincter-saving surgery is widely accepted operative modality to treat rectal cancer. It often requires temporary diverting stoma to avoid the complications of anastomotic failure. This study investigates the cumulative failure rate in sphincter preservation for rectal cancer and the risk factors associated with the permanent stoma.MethodsA retrospective study on 358 patients diagnosed with primary rectal cancer from 2009 to 2013 was conducted at a single institute. Three hundred and thirty-one out of 358 patients with rectal cancer located within 12 cm from the anal verge, who underwent sphincter-preserving surgery, were included in this study. The cumulative rate for permanent stoma was calculated. Univariate and multivariate analysis were performed, comparing the patients with stoma to the ones without.ResultsTemporary diverting stoma was created in 223 (82%) patients. After median follow-up of 42 months, 18 patients (6.6%) persistently used temporary stoma or required re-creation of stoma. Univariate analysis revealed that BMI, tumor location below 4 cm from the anal verge, coloanal anastomosis, anastomotic leakage, and local recurrence were significantly associated with persistent use or re-formation of stoma. Multivariate analysis showed that anastomotic leakage (OR 50.3; 95% CI, 10.1–250.1; p < 0.0001) and local recurrence (OR 11.3; 95% CI, 1.61–78.5; p = 0.015) were the independent risk factors.ConclusionPatients with anastomotic leakage and local recurrence are at high risk for permanent stoma. Not only should patients be fully informed of possible failure in sphincter preservation preoperatively, but also patient-oriented decision should be made on patient-tailored surgical plan.