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Purpose: It is known that as the T stage of a carcinoma progresses, the prognosis becomes poorer. However, there are few studies about factors that affect the prognosis of T4 advanced colon cancer. This study aimed to identify the prognostic factors associated with disease-free survival (DFS) and overall survival (OS) in T4 colon cancer.Methods: Patients diagnosed with stage T4 on histopathology after undergoing curative surgery for colon cancer between March 2009 and March 2018 were retrospectively analyzed for factors related to postoperative survival. Primary outcomes were DFS and OS.Results: Eighty-two patients were included in the study. DFS and OS of the pathologic (p) T4b group were not inferior to that of the pT4a group. Multivariate analysis showed that differentiation (hazard ratio [HR], 4.994; P = 0.005), and laparoscopic surgery (HR, 0.323; P = 0.008) were significant prognostic factors for DFS, while differentiation (HR, 7.904; P ≤ 0.001) and chemotherapy (HR, 0.344; P = 0.038) were significant prognostic factors for OS.Conclusion: Tumor differentiation, laparoscopic surgery, and adjuvant chemotherapy were found to be significant prognostic factors in patients with T4 colon cancer. Adjuvant chemotherapy and curative resections by laparoscopy might improve the prognosis in these patients.

Purpose: To identify factors significantly associated with the mortality of patients with left colonic perforation, and to compare the outcome of Hartmann’s procedure (HP) and primary repair (PR) or primary anastomosis (PA) in patients with left colonic perforation without factors associated with mortality.Methods: This retrospective study included patients who underwent surgery for left colonic perforation from January 2009 to February 2018. Preoperative factors related to postoperative mortality, including vital signs, laboratory findings, and intraoperative findings, were analyzed by type of operation. The chi-square, Fisher exact, and Mann-Whitney U-tests were used to analyze the data.Results: Ninety-one patients were included (36 men, 55 women), and 15 (16.5%) died postoperatively. Prognostic factors were age, leukopenia, thrombocytopenia, bleeding tendency, acute kidney injury, hemodynamic instability, and the existence of feculent ascites. Leukopenia and longer operative time were independent risk factors for mortality. Seventy-nine patients did not have leukopenia and 30 of these patients who underwent PR without diversion were excluded from the subanalysis. HP was performed in 30 patients, and PR with diversion and PA with or without diversion were performed in 19. Compared to the other operative methods, HP had no advantage in reducing hospital mortality (P=0.458) and morbidity.Conclusion: Leukopenia could be an objective prognostic factor for left colonic perforation. Although HP is the gold standard for septic left colonic perforation, it did not improve the hospital mortality of the patients without leukopenia. For such patients, PR or PA may be suggested as an alternative option for left colonic perforation.

Summary: Background/Objective: Axillary lymph node staging (ALNS) is an important step in the treatment of breast cancer and sentinel lymph node biopsy (SLNB) is a standard procedure for ALNS. Recently, the use of positron emission tomography/computed tomography (PET/CT) for whole body staging in patients with breast cancer has been increasing. The negative predictive value (NPV) of the specific diagnostic modality is the crucial value for excluding axillary lymph node metastasis (ALNM) and guiding the decision not to proceed with axillary lymph node dissection. The aim of this study was to identify patient groups in which PET/CT yields a high NPV for ALNS. Methods: We reviewed data from the records of 262 patients with breast cancer who underwent PET/CT before surgery between February 2009 and March 2018. We searched for factors associated with pathological axillary lymph node metastasis in patients with negative ALNM on PET/CT. Then, we calculated the NPV of PET/CT for ALNS in the patient group without the identified factors and in all patients. Results: Age ≥75 years and tumor size on ultrasonography (US) ≥ 15 mm were the associated factors; the NPV of PET/CT in patients without these factors compared to all patients was 97.2% versus 88.7%. Conclusion: The NPV of PET/CT for ALNS in patients younger than 75 years and with tumor size on US

Although several scoring systems have been used to differentiate simple acute appendicitis from perforated appendicitis, no particular system has been widely accepted. Therefore, this study aimed to investigate preoperative factors associated with complicated appendicitis and to develop a scoring system that distinguishes complicated appendicitis in children aged

Purpose: Adjuvant chemotherapy (AC) is recommended for patients with stage II colorectal cancer with adverse features. However, the effect of adjuvant treatment in elderly patients with high-risk stage II colorectal cancer remains controversial. This study aimed to investigate the oncologic outcomes in elderly high-risk stage II colorectal cancer patients who underwent curative resection with or without AC.Methods: Patients aged over 70 years having stage II colorectal adenocarcinoma with at least 1 adverse feature who underwent radical surgery between 2008 and 2017 at a single center were included. We compared recurrence-free survival (RFS) and overall survival (OS) between patients who received more than 80% of the planned AC cycle (the AC+ group) and those who did not receive it (the AC− group).Results: The AC+ and AC– group contained 46 patients and 50 patients, respectively. The log-rank test revealed no significant intergroup differences in RFS (P = 0.083) and OS (P = 0.122). In the subgroup of 27 patients with more than 2 adverse features, the AC+ group (n = 16) showed better RFS (P = 0.006) and OS (P = 0.025) than the AC− group. In this subgroup, AC was the only significant factor affecting RFS in the multivariate analysis (P = 0.023). AC was significantly associated with OS (P = 0.033) in the univariate analysis, but not in the multivariate analysis (P = 0.332).Conclusion: Among elderly patients with stage II high-risk colorectal cancer, the AC+ group did not show better RFS or OS than the AC− group. However, selected patients with more than 2 adverse features might benefit from AC.

Purposes To identify factors significantly associated with mortality of patients with left colonic perforation, and to compare the outcome of the Hartmann procedure (HP) and primary repair (PR) or primary anastomosis (PA) in left colonic perforation patients without factors associated with mortality. Methods This retrospective study included patients who underwent surgery for left colonic perforation from January 2009 to February 2018. Preoperative factors related to postoperative mortality, including vital signs, laboratory findings, and intraoperative findings, were analyzed by type of operation. The chi-square, Fisher exact, and Mann-Whitney U tests were used to analyze the data. Results Ninety-one patients were included (36 men, 55 women), and 15 (16.5%) died postoperatively. Risk factors were age, leukopenia, thrombocytopenia, bleeding tendency, acute renal failure, hemodynamic instability, and existence of generalized peritonitis and feculent ascites. Advanced age, leukopenia, and acute renal failure were independent risk factors for mortality. Seventy-nine patients did not have leukopenia, and among them, 30 patients who underwent PR without diversion were excluded from the sub-analysis. HP was performed in 30 patients, and PR with diversion and PA with or without diversion were performed in 19. Compared to the other operative methods, HP had no benefit for reducing overall mortality (p=0.458) and morbidity. Conclusions Leukopenia could be an objective prognostic factor for left colonic perforation. Although HP is the gold standard for septic left colonic perforation, it did not improve overall mortality of the patients without leukopenia. For such patients, PR or PA could be a good option for left colonic perforation.

Purpose: Weight change during chemotherapy is reported to be associated with a worse prognosis in breast cancer. Our study was aimed to evaluate the relation of weight change during AC (anthracycline+cyclophosphamide) +taxanes chemotherapy and recurrence. Methods: Patients included 89 women diagnosed with breast cancer who have been treated by AC+taxenes chemotherapy regimen. The weight variation between prechemotherapy and postchemotherapy was calculated ([weight at postchemotherapy-weight at prechemotherapy]/weight at prechemotherapy×100) and categorized into either weight change (≥5%) or stable ( Results: During chemotherapy, 37of total 89 patients (41.6%) presented notable weight change and 52 patients (58.4%) were not weight change. Median follow-up period was 45.1 months, 17 of total 89 patients (19.1%) presented recurrence on the radiologic image tests. Eight of 17 recurrence patients were presented notable weight change, 9 patients were not weight change. In univariate analyses, weight change was not associated with recurrence. Conclusion: In our study, weight change during AC+taxanes chemotherapy in breast cancer was not associated with recurrence. Many studies that relation of weight change and recurrence were presented various result. So, we need more clinical studies many patients included and well designed.

Background The luminal subtype of breast cancer is sensitive to anti-estrogen therapy and shows a better prognosis than that of human epidermal growth factor receptor2 (HER2)-enriched or triple-negative breast cancer. However, the luminal type of breast cancer is heterogeneous and can have aggressive clinical features. We investigated the clinical implications of single hormone receptor negativity in a luminal B HER2-negative group. Methods We collected luminal B HER2-negative breast cancer data that were estrogen receptor (ER) and/or progesterone receptor (PR) positive, Ki 67 high (>14 %), and HER2 negative and divided them into the ER- and PR-positive group and the ER- or PR-negative group. We analyzed the clinical and pathological data and survival according to ER or PR loss. Results There were no statistical differences in TNM stage, breast and axillary operative methods, or number of tumors between the ER- and PR-positive group and ER- or PR-negative group. However, the ER- or PR-negative group was associated with older age (≥45 years), higher histological grade, lower Bcl-2 expression, and far higher Ki 67 (>50 %). Disease-free survival (DFS) and overall survival (OS) were shorter in the ER- or PR-negative group than that in the ER- and PR-positive group (p = 0.0038, p = 0.0071). Conclusions ER- or PR-negative subgroup showed worse prognosis than ER- and PR-positive subgroup in the luminal B HER2-negative group. We could consider the negativity of ER or PR as prognostic marker in luminal B HER2-negative subtype of breast cancer. Electronic supplementary material The online version of this article (doi:10.1186/s12957-016-0999-x) contains supplementary material, which is available to authorized users.

Purpose Luminal-type breast cancer has a good prognosis compared to other types, such as human epidermal growth factor receptor 2 and triple negative types. Luminal-type breast cancer is classified into luminal A and B, according to the proliferation index. We investigated the clinicopathological factors that affect the prognosis of the luminal-type subgroups. Methods We reviewed the medical records and the pathologic reports of 159 luminal-type breast cancer patients who were treated between February 2005 and November 2007. We divided luminal-type breast cancer into luminal A and B, according to Ki-67 (cutoff value, 14%) and analyzed the clinicopathologic factors, such as age at diagnosis, intensity score of estrogen receptor and progesterone receptor, histologic grade, and Bcl-2. Moreover, we compared the disease-free survival (DFS) of each group. Results In the univariate analysis, age (p=0.004), tumor size (p=0.010), lymph node metastasis (p=0.001), and Bcl-2 (p=0.002) were statistically significant factors in luminal-type breast cancer. In the multivariate analysis, lymph node (p=0.049) and Bcl-2 (p=0.034) were significant relevant factors in luminal-type breast cancer. In the subgroup analysis, the increased Bcl-2 (cutoff value, 33%) was related with a longer DFS in the luminal B group (p=0.004). Conclusion In our study, luminal A breast cancer showed a longer DFS than luminal B breast cancer, further, Bcl-2 may be a potent prognostic factor in luminal-type breast cancer.

17세 여자가 골반염증성질환으로 입원하여 항생제 치료를 시작하였다. 증상 호전 중 입원 5일째 갑자기 오심과 구토 증상이 시작되었다. 보존적 처치에도 불구하고 증상이 심해져 7일째 시행한 단순복부촬영과 복부골반 전산화단층촬영에서 허혈성 소장폐쇄 소견이 보였다. 응급개복술을 시행하였고 소장 장간막 부위에 그물막이 붙어 유착띠가 형성되어 있었고 20 cm 정도의 소장이 끼어 있었다. 부분 그물막절제술, 유착띠박리술, 부수적으로 충수돌기절제술을 시행하였다. 수술 후 증상은 완전히 소실되었으며 11개월간 외래 추적 관찰에서도 특이사항은 없었다. 이 증례는 골반염과 동반된 오심 구토 증상이 지속될 경우 골반염증질환의 드문 합병증인 장폐쇄를 의심하여야 하겠고, 정확한 진단과 의사결정을 위해 단순복부촬영뿐만 아니라 복부골반 전산화단층촬영의 유용성을 보여준다. 저자들은 Chlamydia trachomatis 감염에 의한 골반염성 질환 환자에서 발생한 유착성 소장폐쇄 1예를 경험하였기에 이에 간단한 문헌 고찰을 함께 보고하는 바이다.