Persistent High Postoperative Carcinoembryonic Antigen in Colorectal Cancer Patients- Is it Important?

INTRODUCTION: Evaluation of pre- and postoperative serum CEA levels together has seldom been assessed for the prognosis of colorectal cancer (CRC). OBJECTIVE: To concurrently evaluate pre- and postoperative CEA as factors of relapse and survival. METHODS: The study consisted of 114 patients who had undergone surgery from February 2002 to June 2006 for CRC. All patients were classified into four groups according to their pre- and postoperative CEA levels. Data obtained for clinicopathologic parameters, lymph node metastasis, stage, recurrence, and CEA levels were analyzed to determine their association with survival. Multivariate analysis by the Cox proportional hazard regression model was performed to identify the independent prognostic factors associated with survival. RESULTS: Postoperative serum CEA levels remained high in Group 3 (n = 32). Nineteen patients (59.3%) demonstrated a detectable cause for persistent high CEA levels, while the reasons for those in the other thirteen patients (40.6%) remained obscure. Abnormal preoperative CEA levels significantly correlated with the depth of tumor invasion, lymph node metastasis, TNM stage, and recurrence (p < 0.05). Abnormal postoperative CEA levels were significantly related to the depth of tumor invasion, TNM stage, and postoperative relapse (p<0.05). Patients in Group 3 demonstrated the worst survival rate. Abnormal postoperative CEA levels, lymph node metastasis, and location of the tumor were independent prognostic factors for survival. CONCLUSION: The survival of patients with high postoperative CEA levels due to unknown reasons may be extended if they are exhaustively tested with sensitive diagnostic methods and treated at an early stage

Body Image and Cosmesis After Laparoscopic or Open Appendectomy

Introduction: Minimally invasive techniques, such its laparoscopic appendectomy (LA), are thought to produce better cosmetic results. The aim of this study was to evaluate the body image and cosmesis of patients after both LA and open appendectomy (OA)

Surgical Treatment of Sacrococcygeal Pilonidal Disease

Pilonidal disease is usually observed in the sacrococcygeal region of young male adults. Because of the absence of a consensus on the treatment of the disease, high recurrence rates, high direct and indirect cost and need for a long wound care, it is a highly reputable disease. High incidence rates in the working population along with high recurrence rates led the surgeons to focus on the treatment of the disease intensely. In this article, the surgical treatment option for sacrococcygeal pilonidal disease has been briefly reviewed. [Archives Medical Review Journal 2013; 22(4.000): 486-498

Prognostic Value of Lymph Node Ratio for Colorectal Cancer

Objective: This study was designed to assess the prognostic value of lymph node ratio (LNR) in patients with nonmetastatic colorectal cancer treated with radical resection

Coexistence of Colon Cancer and Diverticilutis Complicated with Diverticular Abscess

Coexistence of a diverticular abscess and colorectal cancer is an extremely rare phenomenon. The clinical presentation and the extension of a diverticular abscess could cause mis-staging of colon cancer. We are presenting an overstaged colon cancer due to a diverticular abscess penetrating into the abdominal wall. A 65-year-old male patient with a history of an enlarging mass in the left lower quadrant of the abdomen was admitted to our service. Diagnostic studies revealed a sigmoid tumor communicating with an abdominal wall mass. The patient was clinically staged as T4 N1. Exploration revealed a diverticular abscess penetrating into the abdominal wall and a sigmoid tumor. Histopathological examination reported an intermediately differentiated T3 N0 adenocarcinoma of the sigmoid colon. After an uneventful postoperative recovery, the patient was referred to chemotherapy. [Arch Clin Exp Surg 2015; 4(4.000): 231-233

Hospital Experience, Body Image, and Cosmesis After Laparoscopic or Open Splenectomy

Background: Laparoscopic splenectomy (LS) is becoming the "gold standard" technique for splenectomy. The aim of this study was to evaluate the hospital experience, body image, and cosmesis after LS or open splenectomy (OS)

Coexistence of pancreatic tuberculosis with systemic brucellosis: a case report

Isolated pancreatic tuberculosis is an extremely rare clinical entity and is difficult to diagnose particularly in immunocompetent individuals. Clinical findings and symptomatology of brucellosis are often similar to tuberculosis thus making the differentiation amongst the two entities difficult. We report a case of pancreatic tuberculosis with systemic brucellosis in a 29 year old veterinarian who presented with epigastric pain and loss of appetite. Initial investigations revealed leukocytosis with moderately elevated transaminase, gamma glutamyl transferase, amylase and lipase levels. Imaging studies revealed an anechoic multiloculated cyst in the body and tail of the pancreas. Given the patient's occupational risk coupled with the presence of a positive Brucella agglutination test (with a titer of 1:320); a diagnosis of pancreatitis secondary to brucellosis was given. In addition to standard pancreatitis therapy of bowel rest with intravenous fluid/electrolyte replacement, anti-brucellosis therapy was also administered. The patient's initial response to therapy was positive however, 6 weeks into therapy, his abdominal pain recurred and repeat CT scan revealed the development of a pseudocyst in the pancreas. After failing a second attempt at conservative supportive therapy, the patient underwent an explorative laparotomy. Histological examination of the resected pancreatic specimen showed necrosis and was positive for tuberculosis by polymerase chain reaction. Herein, we describe the first case reported in the medical literature of the coexistence of systemic brucellosis with pancreatic tuberculosis. We suggest that the possibility of the coexistence of brucellosis with tuberculosis be kept in mind when assessing pancreatitis patients in endemic regions and in individuals with occupational risk hazards

Prognostic Value of the Lymph Node Ratio in Rectal Cancer

Objective: The pathologic staging of rectal cancer is an important prognostic factor. A sufficient number of harvested lymph nodes is necessary for accurate staging. In patients with an insufficient number of dissected lymph nodes, the lymph node ratio (LNR) can be used as a prognostic factor. The aim of this study was to determine the effect of the LNR on the prognosis of patients with rectal cancer. Materials and Methods: A total of 130 patients who had rectal adenocarcinoma and who underwent surgery between 1996 and 2011 were included in this study. Age, gender, serum carcinoembryonic antigen, type of surgery, and pathological features were retrieved retrospectively. Cut-off values for LNR were 1/12, 1/4, and 1/2; patients were stratified into four groups according to this ratio. The relationship between disease-free survival (DFS) and overall survival (OS) and LNR was investigated. Cumulative survival curves were calculated by the Kaplan Meier method, and survival differences between groups were calculated by the log-rank test. Results: The mean number of lymph nodes examined was 11.5+/-8. In 75 of all patients (57.7%), fewer than 12 lymph nodes were harvested. Seventy-six patients (58.5%) were evaluated as N0, 35 (26.9%) were N1, and 19 (14.6%) were N2. The number of patients in these LNR groups was 87 (66.9%), 13 (10%), 17 (13.1%), and 13 (10%), respectively. The 5-year survival rate was found to be 72.3% in the LNR1 group, 55.6% in the LNR2 group, 44.4% in the LNR3 group, and 22.2% in the LNR4 group. The difference in OS and DFS rates was significant (p<0.001 for both). Conclusion: The LNR for rectal cancer has a prognostic effect on both DFS and OS. Thus, it may be beneficial for adjuvant therapy decisions, especially in patients with an insufficient number of dissected lymph nodes. [Arch Clin Exp Surg 2014; 3(4.000): 207-212