176 research outputs found
Clinical significance of tumor-infiltrating lymphocytes and neutrophil-to-lymphocyte ratio in patients with stage III colon cancer who underwent surgery followed by FOLFOX chemotherapy
Local tumor immune response and host immunity have been suggested as important prognosticators respectively in colorectal cancer. However, the utility of combination of these parameters remains inconclusive. The aim of this study was to investigate the combinational impact of local and host tumor immune response, as determined by tumor-infiltrating lymphocytes (TILs) and neutrophil-to-lymphocyte ratio (NLR), in patients with stage III colon cancer. Patients with stage III colon cancer homogeneously treated with surgery followed by FOLFOX chemotherapy between Jan 2007 and Aug 2013 were included retrospectively. Hematoxylin and eosin (H&E) stained tumor sections of local inflammatory infiltrate (TILs) were classified as 0-3 by the Klintrup-MΓ€kinen grading method. NLR was measured within 1 month of surgery. The association of NLR and TILs with survival, alone or combined, were measured using multivariate Cox proportional hazard regression analysis. Among 137 patients, 75 (54.7%) were identified as the high TIL group (TILs 2 and 3) and 97 (70.8%) as the low NLR group (NLRβ<β3). Of the patients with high TILs, 51 (68%) had a low NLR. In univariate analysis, operation time, complications, lymph node ratio (LNR), stage, TILs, and high TILs with low NLR were significantly associated with overall survival(OS). Multivariate Cox regression identified operation time, stage, and TILs as independent risk factors for OS. When high TILs with low NLR vs. others was entered into multivariate analysis, this also proved to be a significant predictor of OS (HR 4.1, 95% CI 1.1-14.2, Pβ=β0.025), with an increased C-index and lower AIC value compared to TILs. Measuring TILs using H&E stained sections could stratify the prognosis of stage III colon cancer. Considering host immunity, using the combination of TILs and NLR, allowed the prognosis to be stratified in more detail.ope
Robotic Surgery for Rectal Cancer and Cost-Effectiveness
Robotic surgery is considered as one of the advanced treatment modality of minimally invasive surgery for rectal cancer. Robotic rectal surgery has been performed for three decades and its application is gradually expanding along with technology development. It has several technical advantages which include magnified three-dimensional vision, better ergonomics, multiple articulated robotic instruments, and the opportunity to perform remote surgery. The technical benefits of robotic system can help to manipulate more meticulously during technical challenging procedures including total mesorectal excision in narrow pelvis, lateral pelvic node dissection, and intersphincteric resection. It is also reported that robotic rectal surgery have been shown more favorable postoperative functional outcomes. Despite its technical benefits, a majority of studies have been reported that there is rarely clinical or oncologic superiority of robotic surgery for rectal cancer compared to conventional laparoscopic surgery. In addition, robotic rectal surgery showed significantly higher costs than the standard method. Hence, the cost-effectiveness of robotic rectal surgery is still questionable. In order for robotic rectal surgery to further develop in the field of minimally invasive surgery, there should be an obvious cost-effective advantages over laparoscopic surgery, and it is crucial that large-scale prospective randomized trials are required. Positive competition of industries in correlation with technological development may gradually reduce the price of the robotic system, and it will be helpful to increase the cost-effectiveness of robotic rectal surgery.ope
Changes in Body Composition During Adjuvant FOLFOX Chemotherapy and Overall Survival in Non-Metastatic Colon Cancer
The impact of longitudinal anthropometric changes during adjuvant chemotherapy on long-term survival in non-metastatic colon cancer is unclear. Herein, we analyzed the prognostic significance of computed tomography (CT)-measured body composition changes in colon cancer patients who underwent surgery followed by adjuvant FOLFOX (folinic acid, 5-fluorouracil, oxaliplatin) chemotherapy. Data of 167 patients with stage III or high-risk stage II colon cancer were analyzed. Skeletal muscle index (SMI), skeletal muscle radiodensity (SMR), visceral fat index (VFI), subcutaneous fat index (SFI), and total fat index (TFI) changes during chemotherapy were calculated using preoperative and postchemotherapy CT image data. The Cox proportional hazard model was used to determine the correlation between changes in anthropometric values and overall survival (OS). The median changes (%) in SMI, SMR, VFI, SFI, and TFI over 210 days during chemotherapy were 8.7% (p < 0.001), 3.4% (p = 0.001), -19% (p < 0.001), -3.4% (p = 0.936), and -11.9% (p < 0.001), respectively. Cut-off values of changes in SMI (skeletal muscle index change, SMIC) and SMR (skeletal muscle radiodensity change, SMRC) were defined at -2% and -2 Hounsfield units (HU) respectively, whereas those of changes in VFI (visceral fat index change, VFIC), SFI (subcutaneous fat index change, SFIC), and TFI (total fat index change, TFIC) were based on values that provided the largest Ο2 on the Mantel-Cox test. Multivariable analysis revealed that low SMR measured on a postchemotherapy CT scan (hazard ratio, HR: 0.32, 95% confidence interval, CI: 0.15-0.70, p = 0.004) and visceral fat loss of at least 46.57% (HR: 0.31, 95% CI: 0.14-0.69, p = 0.004) were independent poor prognostic factors for OS. Severe visceral fat loss during FOLFOX chemotherapy and low skeletal muscle radiodensity measured on postchemotherapy CT scans are associated with poor OS in stage III and high-risk stage II colon cancer patients.ope
Clinical outcomes of complete cytoreduction with concurrent liver resection followed by hyperthermic intraperitoneal chemotherapy for synchronous peritoneal and liver metastatic colorectal cancer
BACKGROUND:
This study aimed to evaluate the clinical outcomes of concurrent liver resection with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in colorectal cancer patients with synchronous liver and peritoneal metastases.
METHODS:
Patients with colorectal liver and peritoneal metastasis who underwent complete cytoreduction and hyperthermic intraperitoneal chemotherapy with concurrent liver surgery between September 2014 and July 2018 were included. Perioperative outcomes, overall survival, and progression-free survival were analyzed retrospectively.
RESULTS:
In total, 22 patients were included. The median peritoneal cancer index was 13 (range, 0-26), and the median number of liver metastases was 3 (range, 1-13). The mean total operative time was 11.4 Β± 2.6βh. Minor postoperative complications (Clavien-Dindo grade I-II) were reported in 10 patients (45.5%), and major postoperative complications (grade III-V) were reported in five patients (22.7%), including one mortality patient. The median overall survival since diagnosis with metastasis was 27.4βmonths. The median overall survival since surgical intervention and the progression-free survival were 16.7βmonths and 7.1βmonths, respectively.
CONCLUSIONS:
This short-term follow-up study showed that, in an experienced center, combined resection with hyperthermic intraperitoneal chemotherapy for colorectal liver and peritoneal metastases was feasible and safe with acceptable oncologic outcomes.ope
Eosinophilic encephalomyelitis in horses caused by protostrongylid parasites
Four thoroughbred horses showing lameness, ataxia, circling, depression, recumbency, and seizures, were examined. The horses had gross, pale- to dark-red manifestations and foci in the central nervous system (CNS). Multifocal to coalescing eosinophilic necrotizing encephalomyelitis was observed histologically in the CNS along with intact or degenerated nematodes. Nematodes had polymyarian-coelomyarian musculature, a smooth thin cuticle, and intestines lined by multinucleated cells with microvilli. These traits suggested the nematodes belonged to the family Protostrongylidae, which includes Parelaphostrongylus tenuis. It was concluded that the horses were infected by nematodes, presumably Parelaphostrongylus tenuis, resulting in eosinophilic necrotizing encephalomyelitis.ope
Tailoring strategies for colorectal cancer screening and treatment based on age in colorectal cancer patients
ope
Shifting Treatment Strategies to Prevent Early Relapse of Locally Advanced Rectal Cancer After Preoperative Chemoradiotherapy
ope
Prediction of Metachronous Peritoneal Metastases After Radical Surgery for Colon Cancer: A Scoring System Obtained from an International Multicenter Cohort
Background: Since novel strategies for prevention and treatment of metachronous peritoneal metastases (mPM) are under study, it appears crucial to identify their risk factors. Our aim is to establish the incidence of mPM after surgery for colon cancer (CC) and to build a statistical model to predict the risk of recurrence.
Patients and methods: Retrospective analysis of consecutive pT3-4 CC operated at five referral centers (2014-2018). Patients who developed mPM were compared with patients who were PM-free at follow-up. A scoring system was built on the basis of a logistic regression model.
Results: Of the 1423 included patients, 74 (5.2%) developed mPM. Patients in the PM group presented higher preoperative carcinoembryonic antigen (CEA) [median (IQR): 4.5 (2.5-13.0) vs. 2.7 (1.5-5.9), P = 0.001] and CA 19-9 [median (IQR): 17.7 (12.0-37.0) vs. 10.8 (5.0-21.0), P = 0.001], advanced disease (pT4a 42.6% vs. 13.5%; pT4b 16.2% vs. 3.2%; P < 0.001), and negative pathological characteristics. Multivariate logistic regression identified CA 19-9, pT stage, pN stage, extent of lymphadenectomy, and lymphovascular invasion as significant predictors, and individual risk scores were calculated for each patient. The risk of recurrence increased remarkably with score values, and the model demonstrated a high negative predictive value (98.8%) and accuracy (83.9%) for scores below five.
Conclusions: Besides confirming incidence and risk factors for mPM, our study developed a useful clinical tool for prediction of mPM risk. After external validation, this scoring system may guide personalized decision-making for patients with locally advanced CC.ope
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κ³Ό μ°κ³νμ¬ μ립λλ νμ±μ μ§κ΅¬λ¨μκ³ν, λ μ νμΌλ‘ ꡬλΆλλ€. κ΅ν κ³νλ²μ κΈ°μ±μκ°μ§ μ μ¬νλ νμ§μ 건μΆνμ©μ±μ λ³κ²½ν μ μλ ν¨λ ₯μ λ³νμ μ§κ΅¬λ¨μκ³νμ λΆμ¬νκ³ μμ§ μλ€. λ°λΌμ νμ¬ λ³νμ μ§κ΅¬λ¨μκ³νμ μ§μ 곡λΆμ νμ§μ 건μΆνμ©μ±μ λ°μνμ¬ κ±΄μΆνκ°μ건μ κ·μ¨νλ λ° κ·ΈμΉκ³ μλ€. ννΈ λ³νμ μ§κ΅¬λ¨μκ³νμ κ²°μ κ³Ό λμκ³νμμ€μ¬μ
μ μνμ μ°κ³ν λ²μ μ₯μΉκ° λ§λ ¨λμ΄ μμ§ μμ λ³νμ μ§κ΅¬λ¨μκ³νμΌλ‘ λ―Έμ§ν λμκ³νμμ€μ΄ λλ μμ°λκ³ μλ€.
νμ±μ μ§κ΅¬λ¨μκ³νμ κ·Έ λ΄μ©λλ‘ λμνκ²½μ΄ μ‘°μ±λλ ν¨κ³Όλ₯Ό κ°μ§λ―λ‘ λ³νμ μ§κ΅¬λ¨μκ³νμ λΉνμ¬ μλμ μΌλ‘ κ°λ ₯ν λμΈμ ꡬμλ ₯μ κ°μ§ μ μλ€. κ·Έλ¬λ ννλ²μ νμ±μ μ§κ΅¬λ¨μκ³νꡬμμμ λμκ³νμμλ₯Ό λ³κ²½νκ³ μ νλ κ²½μ° κ±΄μΆλ², 곡κ°μ 보κ΄λ¦¬λ² λ±μ΄ μ νλ μ μ°¨μ μνλλ‘ νκ³ μλ€. μ΄ μ μ°¨μλ λμκ³νμ νλ¨μ΄ κ°μ
λ μ¬μ§κ° μλ€.
μ§κ΅¬λ¨μκ³νμ νμ§λ¨μμ κ·μ¨μ νκ³ ν μ§μ΄μ©κ·μ μ κΈ°λ°μμ€μ μ‘°νλ₯Ό λλͺ¨νλ λμκ³νμ΄λ€. λ°λΌμ νν λμκ³νμΌλ‘λ μ μΌνκ² νμ§, 건μΆνμ©μ±, κΈ°λ°μμ€ λ± λͺ¨λ λμκ³νμμμ κ΄ν μ¬νμ κ·μ¨ν μ μλ μ μ¬λ ₯μ κ°μ§κ³ μλ€. κ·Έλ¬λ κ΅ν κ³νλ²μ μ§κ΅¬λ¨μκ³νμ μ΄λ¬ν μ μ¬λ ₯μ μΆ©λΆν μ΄λ¦¬μ§ λͺ»νκ³ μλ€.μ 1 μ₯ μλ‘ 1
μ 1 μ μ°κ΅¬μ λͺ©μ 1
μ 2 μ μ°κ΅¬μ λ°©λ²κ³Ό λ²μ 3
μ 2 μ₯ λμκ³νμ μμμ μ ν 5
μ 1 μ λμκ³νμ μμ 5
β
. 건μΆνκ³Ό λμ곡ν λΆμΌμμ λμκ³νμ μμ 5
1. λμκ³ν κ°λ
μ 립μ νμμ± 5
2. λμκ³ν κ΄λ ¨ κ°λ
μ λ°λ¬ μ°ν 6
3. λμκ³ν λ°©λ²λ‘ 8
β
‘. λμκ³νμ λν λ²νμ ν΄μ 10
1. λμκ³νμ λν λ²νμ ν΄μμ νμμ± 10
2. λμκ³νμ λ²μ κ°λ
11
(1) νμ κ³νμΌλ‘μ λμκ³ν 11
(2) νμ κ³νκ³Ό κ³νμ¬λ 12
(3) νμ κ³νμ λΆλ₯ 12
κ°. μ’
ν©κ³νκ³Ό λΆλ¬Έλ³κ³ν 13
λ. μμκ³νκ³Ό νμκ³ν 13
λ€. ꡬμμ κ³νκ³Ό λΉκ΅¬μμ κ³ν 13
(4) λμκ³νκ³Ό μ¬μ°κΆ μ ν 14
3. λμκ³νμ λ²μ κΈ°λ₯ 15
4. λμκ³νμ λ²μ μ±μ§ 15
(1) λμκ³νμ μ²λΆμ± 15
(2) κ³ν보μ₯μ²κ΅¬κΆκ³Ό κ³νλ³κ²½μ²κ΅¬κΆ 16
μ 2 μ λμκ³νμ μ ν 19
β
. μ κ·Ήμ κ³νκ³Ό μκ·Ήμ κ³ν 19
β
‘. μ§κ΅¬λ¨μλ°©μκ³Ό λμλ¨μλ°©μ 19
β
’. λμκ·μ λ°©μκ³Ό λΆλ¦¬κ·μ λ°©μ 20
μ 3 μ κ΅ν κ³νλ²μ λμκ³νμ μ²΄κ³ 22
β
. μ°λ¦¬λλΌ λμκ³ν μ λμ λ³μ² 22
1. λμκ³ν μ λμ λμ
κ³Ό λ°λ¬ 22
2. κ΅ν κ³νλ²μ λμκ³ν μ λ 23
β
‘. λμκΈ°λ³Έκ³νκ³Ό λμκ³ν 24
1. νν κ΅ν κ³νλ²μ μ©μ΄μ μ΄ν΄ 24
2. λμκΈ°λ³Έκ³νκ³Ό λμκ³νμ κ΄κ³ 25
β
’. λμκ³νμ μ’
λ₯ 26
1. μμ€ 26
2. μ©λμ§μμ λμκ³ν 26
(1) μμ 26
(2) μ©λμ§κ΅¬Β·κ΅¬μμ 27
3. λμκ³νμμ€κ³ν 28
4. κ°λ°μ νμ λμκ³ν 28
5. μ§κ΅¬λ¨μκ³ν 29
μ 3 μ₯ μ§κ΅¬λ¨μκ³νμ κ°λ
κ³Ό μ립μ μ°¨ 30
μ 1 μ μμ€ 30
μ 2 μ μ§κ΅¬λ¨μκ³ν μ λ λμ
μ΄μ μ μ λ 31
β
. 건μΆλ²μ λμμ€κ³ μ λ 31
1. λμμ€κ³ μ λμ λμ
κ³Ό μμ 31
2. λμμ€κ³ μ λμ λ¬Έμ μ 32
3. λμμ€κ³ μ λμ κ°μ 33
β
‘. λμκ³νλ²μ μμΈκ³νꡬμ μ λ 34
1. μμΈκ³νꡬμ μ λμ λμ
κ³Ό μμ 34
2. μμΈκ³νꡬμ μ λμ λμμ€κ³ μ λμ λΉκ΅ 35
3. μμΈκ³νꡬμ μ λμ λ¬Έμ μ 36
μ 3 μ μ§κ΅¬λ¨μκ³νμ μμ 38
β
. μ§κ΅¬λ¨μκ³ν μ λμ λμ
38
β
‘. μ§κ΅¬λ¨μκ³νμ νΉμ§ 38
1. μ§κ΅¬λ¨μκ³νμ νμ 38
2. μ§κ΅¬λ¨μκ³νμ λμ μ§μ 39
(1) μ§κ΅¬λ¨μκ³νꡬμμ μμ 39
(2) κ΅ν κ³νλ²μ μ§κ΅¬λ¨μκ³νμ λμ μ§μ 40
3. μ§κ΅¬λ¨μκ³νμ λ²μ μ§μ 41
β
’. μ§κ΅¬λ¨μκ³νμ λ΄μ© 42
1. κ°κ΄ 42
2. ν μ§μ΄μ©κ·μ 43
3. κΈ°λ°μμ€μ μ§μ 44
μ 4 μ μ§κ΅¬λ¨μκ³νμ νΉμν μ립μ μ°¨ 45
β
. μ§κ΅¬λ¨μκ³νμ μ
μ 45
β
‘. μ§κ΅¬λ¨μκ³νμ κ²°μ 45
μ 5 μ μ§κ΅¬λ¨μκ³νκ³Ό λ€λ₯Έ λμκ³νμ κ΄κ³ 47
β
. μ©λμ§μμ λμκ³νκ³Όμ κ΄κ³ 47
β
‘. λμκ³νμμ€κ³νκ³Όμ κ΄κ³ 48
β
’. λμκ³νμ¬μ
κ³νκ³Όμ κ΄κ³ 49
1. λμκ³νμ¬μ
μ κ°λ
49
2. λμκ³νμ¬μ
κ³νμ μμ 49
(1) ν μ§μ΄μ©κ³νμ μμ 49
(2) λμκ³νμ¬μ
κ³νμ μ립 51
3. λμκ³νμ¬μ
κ³νκ³Ό μ§κ΅¬λ¨μκ³ν 51
μ 4 μ₯ μ§κ΅¬λ¨μκ³νμ μ νκ³Ό λ²μ ν¨κ³Ό 54
μ 1 μ μ§κ΅¬λ¨μκ³νμ μ ν 54
β
. μμ€ 54
β
‘. λ³νμ μ§κ΅¬λ¨μκ³ν 55
β
’. νμ±μ μ§κ΅¬λ¨μκ³ν 55
μ 2 μ μ§κ΅¬λ¨μκ³νκ³Ό νμ§ 57
β
. νμ§λ₯Ό ꡬννλ νμ§ 57
β
‘. νμ§μ κ°λ
57
β
’. νμ§μ λμκ³ν 58
1. λμκ³νμμ νμ§κ° κ°μ§λ μλ―Έ 58
2. νμ§μ λΆν κ³Ό λ³ν© 58
3. νμ§μ μ§κ΅¬λ¨μκ³ν 59
β
£. λ³νμ μ§κ΅¬λ¨μκ³νκ³Ό νμ§ 59
β
€. νμ±μ μ§κ΅¬λ¨μκ³νκ³Ό νμ§ 61
μ 3 μ μ§κ΅¬λ¨μκ³νκ³Ό 건μΆνμ©μ± 62
β
. 건μΆνμ©μ±μ μμ 62
β
‘. 건μΆνμ©μ±κ³Ό μ§λͺ©μΈ λ(ε) 62
1. μ§λͺ©μ μμ 62
2. λ(ε)μ νΉκΆμ μ§μ 63
β
’. 건μΆνμ©μ±μ λΆμ¬νλ λμκ³ν 64
1. λμκ³νμ¬μ
κ³ν 64
2. ν μ§μ νμ§ λ³κ²½ 64
(1) ν μ§νμ§λ³κ²½μ μμ 65
(2) ν μ§νμ§λ³κ²½μ νκ°μ건과 μ μ°¨ 65
β
£. λ³νμ μ§κ΅¬λ¨μκ³νκ³Ό 건μΆνμ©μ± 66
β
€. νμ±μ μ§κ΅¬λ¨μκ³νκ³Ό 건μΆνμ©μ± 67
μ 4 μ μ§κ΅¬λ¨μκ³νκ³Ό 건μΆνκ°μ건 68
β
. λμκ³νμ μν 건μΆνκ°μ건 68
β
‘. μ§κ΅¬λ¨μκ³νμ 건μΆνκ°μ건 κ·μ¨ λ°©μ 69
μ 5 μ μ§κ΅¬λ¨μκ³νκ³Ό κΈ°λ°μμ€ 71
β
. κΈ°λ°μμ€ μΌλ° 71
1. κΈ°λ°μμ€μ μμ 71
2. λμκ³νμμ€μ μ€μΉ μ μ°¨ 71
(1) λμκ³νμμ€μ κ²°μ 71
(2) λμκ³νμμ€μ¬μ
μ μν 72
β
‘. λμκ³νμμ€κ³Ό μ¬μ°κΆ μ ν 73
1. λμκ³νμμ€μ κ²°μ κ³Ό 건μΆνμ μ ν 73
2. μ€μκ³νμ μΈκ°μ μμ©κΆ 73
3. μ₯κΈ°λ―Έμ§ν λμκ³νμμ€ 74
β
’. κΈ°λ°μμ€μ λ°°μΉμ κ·λͺ¨λ₯Ό μ νλ μ§κ΅¬λ¨μκ³ν 76
β
£. λ³νμ μ§κ΅¬λ¨μκ³νκ³Ό κΈ°λ°μμ€ 76
β
€. νμ±μ μ§κ΅¬λ¨μκ³νκ³Ό κΈ°λ°μμ€ 77
μ 5 μ₯ νν μ§κ΅¬λ¨μκ³νμ νκ³ 78
μ 1 μ νν μ§κ΅¬λ¨μκ³νμ λ¬Έμ μ 78
β
. μμ€ 78
β
‘. μ±κ²©μ΄ λ€λ₯Έ λ μ§κ΅¬λ¨μκ³ν 78
β
’. νμ§κ³νμ λΆμ¬ 79
β
£. 건μΆνμ©μ± κ·μ μ λΆμ¬ 80
β
€. μ₯κΈ°λ―Έμ§ν λμκ³νμμ€μ μμ° 81
μ 2 μ μ§κ΅¬λ¨μκ³νμ κΈ°λ₯ 82
β
. μ§κ΅¬λ¨μκ³νκ³Ό λ
μΌμ B-plan 82
β
‘. μ§κ΅¬λ¨μκ³νμ νΉμμ± 82
μ 6 μ₯ κ²°λ‘ 84
μ°Έκ³ λ¬Έν 86
Abstract 89Maste
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