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Background: The aim of the study was to evaluate factors for predicting lymph node metastasis in patients who had T1 and T2 colorectal cancer.Methods: A total of 224 patients with T1 or T2 colorectal cancers who underwent radical surgery with regional lymphadenectomy from January 1999 to January 2008 were analyzed.Results: Predictive factors for lymph node metastasis and prognostic factors were analyzed. Tumor stage was classified as T1 in 69 (30.8%) and T2 in 155 (69.2%) of patients. The overall incidence of lymph node metastasis was 21.0% (14.5% for T1 cancer and 23.9% for T2 cancer; P = 0.112). The node positive and negative groups were similar with regard to patient demographics, except that the former contained a significantly higher number of lymphovascular invasion and perineural invasion cases. During the median follow-up period of 49 months, the 5-year overall and disease-free survival rates for patients without lymph node metastasis were 97.1% and 94.6%, which were significantly higher than the rates for those with lymph node metastasis (85.5%, P = 0.008, and 82.0%, P = 0.007, respectively). A multivariate analysis revealed that lymph node status was the only significant independent prognostic factor for both overall survival (P = 0.025) and disease-free survival (P = 0.040). Moreover, the presence of lymphovascular invasion (P < 0.001) or perineural invasion (P = 0.004) was an independent predictor for lymph node metastasis.Conclusion: Lymph node metastasis was the most powerful predictor for poorer survival in patients with T1 or T2 colorectal cancer. For patients with positive lymphovascular or perineural invasion, radical surgery should be recommended because of a greater chance for lymph node metastasis. [ABSTRACT FROM AUTHOR]

The aim of the present study was to evaluate the expression of standard CD44 (CD44s) in colorectal cancer (CRC), its relationship with clinicopathological characteristics, and its potential prognostic significance. CD44s levels were measured on immunohistochemistry in tumors and surrounding normal mucosa from 74 patients with primary colorectal carcinomas. The patients were followed for a median period of 37 months. Expression of CD44s in primary tumor and surrounding normal mucosa tissues was demonstrated in 100% (74/74) and 37.9% (28/74), respectively. The expression of CD44s in tumors was significantly associated with the depth of invasion ( P = 0.034) and lymph node involvement ( P = 0.031). A significant difference was observed between the overall survival and level of tumor CD44s expression, especially for stage IV carcinoma ( P = 0.038). Multivariate analysis indicated that TNM stage ( P = 0.020) and tumor CD44s expression ( P = 0.008) were independent predictors of overall survival in adenocarcinomas. CD44s overexpression may be an independent unfavorable prognostic factor for overall survival in advanced CRC, especially stage IV disease. Further investigation, however, is necessary to assess the biological roles of CD44 in CRC, and validate their possible value as novel therapeutic targets. [ABSTRACT FROM AUTHOR]

Background: After local excision of early rectal cancer, revision radical resection is recommended for patients with high-risk pathologic stage T1 (pT1) or pT2 cancer, but the revision procedure has high morbidity rates. We evaluated the efficacy of adjuvant concurrent chemoradiotherapy (CCRT) for reducing recurrence after local excision in these patients.Methods: Eighty-three patients with high-risk pT1 or pT2 rectal cancer underwent postoperative adjuvant CCRT after local excision. We defined high-risk features as pT1 having tumor size ≤3 cm, and/or resection margin (RM) ≤3 mm, and/or lymphovascular invasion (LVI), and/or non-full thickness excision such as endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD), or unknown records regarding those features, or pT2 cancer. Radiotherapy was administered with a median dose of 50.4 Gy in 1.8 Gy fraction size over 5-7 weeks. Concurrent 5-fluorouracil and leucovorin were administered for 4 days in the first and fifth weeks of radiotherapy.Results: The median interval between local excision and radiotherapy was 34 (range, 11-104) days. Fifteen patients (18.1 %) had stage pT2 tumors, 22 (26.5 %) had RM of ≥3 mm, and 21 (25.3 %) had tumors of ≥3 cm in size. Thirteen patients (15.7 %) had LVI. Transanal excision was performed in 58 patients (69.9 %) and 25 patients (30.1 %) underwent EMR or ESD. The median follow-up was 61 months. The 5-year overall survival (OS), locoregional relapse-free survival (LRFS), and disease-free survival (DFS) rates for all patients were 94.9, 91.0, and 89.8 %, respectively. Multivariate analysis did not identify any significant factors for OS or LRFS, but the only significant factor affecting DFS was the pT stage (p = 0.027).Conclusions: In patients with high-risk pT1 rectal cancer, adjuvant CCRT after local excision could be an effective alternative treatment instead of revision radical resection. However, patients with pT2 stage showed inferior DFS compared to pT1. [ABSTRACT FROM AUTHOR]

BACKGROUND: The oncologic impact of anastomotic leakage after rectal cancer surgery remains controversial. METHODS: Between January 1999 and December 2010, 1,148 patients with rectal cancer who underwent curative surgery with sphincter preservation were retrospectively reviewed. Using the propensity score matching method, 328 patients with fibrin glue were matched to 328 patients without fibrin glue, and oncologic outcomes were compared in the matched groups. RESULTS: Anastomotic leakage was diagnosed in 76 patients (6.6%). On multivariate analysis, fibrin glue was the independent predictor of prevention of anastomotic leakage. In the 656 matched groups, patients with anastomotic leakage had significantly worse 5-year local recurrence-free survival and disease-free survival than those without leakage. Multivariate analysis confirmed that anastomotic leakage was an independent prognostic factor of both local recurrence and disease-free survival, but the use of fibrin glue was not associated with the long-term outcomes when controlling for confounders. CONCLUSIONS: Anastomotic leakage is a major independent prognostic factor for long-term outcomes. Fibrin glue has a protective effect of anastomosis, without oncologic advantages. [ABSTRACT FROM AUTHOR]

BACKGROUND: This study was designed to evaluate the prognostic significance of the positivity of lymphovascular (LVI) and perineural invasion (PNI) in patients with locally advanced colorectal cancer. METHODS: From January 1999 to December 2009, 1,437 consecutive patients who underwent curative surgery for stage II or III colorectal cancer were analyzed. Patients were then categorized into 4 groups: LVI-/PNI- (n = 850), LVI+ only (n = 178), PNI+ only (n = 271), and LVI+/PNI+ (n = 138). RESULTS: With amedian follow-up period of 56 months, the 5-year overall survival rates of patientswith LVI-/PNI-, LVI+ only, PNI+ only, and LVI+/PNI+ were 82%, 73%, 71%, and 56%, respectively (P < .001), and the 5-year disease-free survival rates of patients with LVI-/PNI-, LVI+ only, PNI+ only, and LVI+/PNI+were 80%, 70%, 65%, and 46%, respectively (P<.001). In multivariate analysis, LVI+/PNI+ was an independent prognostic factor for both overall survival (P<.001) and disease-free survival (P<.001). CONCLUSIONS: Positivity of both LVI and PNI is a strong predictor of overall and disease-free survival in patients with stages II and III colorectal cancer. [ABSTRACT FROM AUTHOR]

Background: The role of laparoscopic colorectal resection for patients undergoing a simultaneous operation for liver metastases had not been established. This study compared the outcomes between laparoscopic and open colorectal resections for patients undergoing simultaneous surgery for liver metastases. Methods: This study reviewed 40 consecutive patients undergoing simultaneous R0 resection of synchronous liver metastases between January 2003 and August 2008. In the study, 20 patients who underwent laparoscopic colorectal resection were matched with 20 patients who had an open approach. All available clinicopathologic variables possibly associated with outcome were compared. Results: The laparoscopic and open groups had similar demographics. No patient undergoing the laparoscopic procedure experienced conversion to the open technique. No postoperative mortality occurred in either group. The estimated blood loss was significantly lower in the laparoscopic group than in the open group. Although the operating time in the laparoscopic group was significantly longer (358 vs. 278 min; p = 0.004), the patients in this group had bowel function return 1 day sooner on the average than those in the open group. No significant differences in postoperative complications were observed between the groups. The overall survival was 58.7% at 3 years and 49.2% at 5 years. The 3-year overall survival rate in the laparoscopic group was not significantly different from that in the open group (52.8 vs. 61.0%; p = 0.713). Conclusions: Laparoscopic colorectal resection with simultaneous resection of liver metastases has an outcome similar to that for an open approach but some short-term advantages. [ABSTRACT FROM AUTHOR]

Purpose: This study was designed to evaluate the impact of resection for primary colorectal cancer on oncologic outcomes in patients with synchronous colorectal liver metastases.Methods: A retrospective analysis was performed on 91 consecutive patients with synchronous colorectal liver metastases who underwent resection of the primary colorectal cancer between December 1999 and December 2007. Of the 91 patients, 54 (59.3%) also underwent complete (R0) resection for liver metastases, and 84 (92.3%) received postoperative chemotherapy. The oncologic outcomes and prognostic factors were analyzed.Results: Operative mortality was 1.1%, and morbidity was 37.4%. The 3- and 5-year overall survival rates were 44.5% and 26.8%, respectively. A multivariate analysis revealed that residual disease after surgery (non-R0 resection; p = 0.003), lymph node metastasis of the primary tumor (p = 0.015), and no postoperative chemotherapy (p = 0.001) were independent prognostic factors for poor survival. Independent predictors of an inability to achieve a complete resection were the presence of three or more liver metastases and the presence of extrahepatic disease at exploration. Significant differences in survival existed among the three risk stratification groups (no-, low-, and high-risk groups; p < 0.001).Conclusions: The inability to safely render the liver and colon microscopically free of disease should cause a surgeon to reconsider synchronous colectomy and hepatectomy. A multidisciplinary approach that combines both complete resection of synchronous colorectal liver metastases and postoperative chemotherapy may achieve improved survival in patients with synchronous colorectal liver metastases. [ABSTRACT FROM AUTHOR]

Background: Approximately 20 % of all patients with colorectal cancer are diagnosed as having Stage IV cancer; 80 % of these present with unresectable metastatic lesions. It is controversial whether chemotherapy with or without primary tumor resection (PTR) is effective for the treatment of patients with colorectal cancer with unresectable metastasis. Primary tumor resection could prevent tumor-related complications such as intestinal obstruction, perforation, bleeding, or fistula. Moreover, it may be associated with an increase in overall survival. However, surgery delays the use of systemic chemotherapy and affects the systemic spread of malignancy.Methods/design: Patients with colon and upper rectal cancer patients with asymptomatic, synchronous, unresectable metastasis will be included after screening. They will be randomized and assigned to receive chemotherapy with or without PTR. The primary endpoint measure is 2-year overall survival rate and the secondary endpoint measures are primary tumor-related complications, quality of life, surgery-related morbidity and mortality, interventions with curative intent, chemotherapy-related toxicity, and total cost until death or study closing day. The authors hypothesize that the group receiving PTR following chemotherapy would show a 10 % improvement in 2-year overall survival, compared with the group receiving chemotherapy alone. The accrual period is 3 years and the follow-up period is 2 years. Based on the inequality design, a two-sided log-rank test with α-error of 0.05 and a power of 80 % was conducted. Allowing for a drop-out rate of 10 %, 480 patients (240 per group) will need to be recruited. Patients will be followed up at every 3 months for 3 years and then every 6 months for 2 years after the last patient has been randomized.Discussion: This randomized controlled trial aims to investigate whether PTR with chemotherapy shows better overall survival than chemotherapy alone for patients with asymptomatic, synchronous unresectable metastasis. This trial is expected to provide evidence so support clear treatment guidelines for patients with colorectal cancer with asymptomatic, synchronous unresectable metastasis.Trial Registration: Clinicaltrials.gov NCT01978249 . [ABSTRACT FROM AUTHOR]

Schwannomas of the colon are rare and are difficult to diagnose preoperatively, since they often defy endoscopic and radiographic detection. Immunohistochemical stains are useful postoperatively to confirm this tumor, but more reliable diagnostic techniques (such as colonoscopic biopsy with immunohistochemistry) have emerged to enhance preoperative diagnostic accuracy. Here we report an instance of schwannoma arising in the ascending colon, where immunohistochemical staining of a preoperative biopsy facilitated diagnosis. After laparoscopic resection, histologic examination was confirmatory. [ABSTRACT FROM AUTHOR]

Background: The common p53 codon 72 polymorphism has been investigated as a risk factor for cancer in different populations; however, the results have been inconsistent. This study investigated the risk of developing gastric or colorectal cancer associated with the p53 codon 72 polymorphism in a Korean population. Methods: We conducted a large-scale case-control study that included 2,213 gastric cancer patients; 1,829 colorectal cancer patients; and 1,700 healthy controls. Genotyping was performed with real-time polymerase chain reaction (PCR), using a TaqMan single-nucleotide polymorphism (SNP) genotyping assay. Results: The frequencies of Arg/Arg, Arg/Pro, and Pro/Pro genotypes of the p53 codon 72 polymorphism were 43.3, 42.0, and 13.0% in the gastric cancer patients; 40.5, 45.0, and 14.0% in the colorectal cancer patients; and 43.2, 45.6, and 11.2% in the controls, respectively. The Pro/Pro genotype was associated with an increased risk of gastric [age- and sex-adjusted odds ratio (OR) = 1.25, 95% confidence interval (CI) = 1.01-1.56, P = 0.04] and colorectal cancer (OR = 1.36, 95% CI = 1.07-1.72, P = 0.01). There were no significant interactions between the p53 codon 72 polymorphism and smoking or drinking. Conclusions: Our results suggest that the Pro/Pro genotype is associated with modest increases in the risks of gastric cancer and colorectal cancer in a Korean population. [ABSTRACT FROM AUTHOR]

Background: This study was designed to investigate an association between the methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism and the risk of gastric and colorectal cancer in the Korean population. Methods: We conducted a population-based large-scale case-control study involving 2,213 patients with newly diagnosed gastric cancer, 1,829 patients with newly diagnosed colorectal cancer, and 1,700 healthy controls. Genotyping was performed with peripheral blood DNA for MTHFR C677T polymorphisms. The statistical significance was estimated by logistic regression analysis. Results: The MTHFR C677T frequencies of CC, CT, and TT genotypes were 35.2%, 47.5%, and 17.3% among stomach cancer, 34%, 50.5%, and 15.5% in colorectal cancer, and 31.8%, 50.7%, and 17.5% in the controls, respectively. The MTHFR 677TT genotype showed a weak opposite association with colorectal cancer compared to the homozygous CC genotype [adjusted age and sex odds ratio (OR) = 0.792, 95% confidence interval (CI) = 0.638-0.984, P = 0.035]. Subjects with the MTHFR 677CT showed a significantly reduced risk of gastric cancer compared whose with the 677CC genotype (age- and sex-adjusted OR = 0.810; 95% CI = 0.696-0.942, P = 0.006). We also observed no significant interactions between the MTHFR C677T polymorphism and smoking or drinking in the risk of gastric and colorectal cancer. Conclusions: The T allele was found to provide a weak protective association with gastric cancer and colorectal cancer. [ABSTRACT FROM AUTHOR]

Accurate preoperative staging is essential in determining the optimal therapeutic planning for individual patients. The computed tomography (CT) in the preoperative staging of colorectal cancer, even if controversial, may be useful for planning surgery and/or neoadjuvant therapy, particularly when local tumor extension into adjacent organs or distant metastases are detected. There have been significant changes in the CT technology with the advent of multi-detector row CT (MDCT) scanner. Advances in CT technology have raised interest in the potential role of CT for detection and staging of colorectal cancer. In recent studies, MDCT with MPR images has shown promising accuracy in the evaluation of local extent and nodal involvement of colorectal cancer. Combined PET/CT images have significant advantages over either alone because it provides both functional and anatomical data. Therefore, it is natural to expect that PET/CT would improve the accuracy of preoperative staging of colorectal cancer. The most significant additional information provided by PET/CT relates to the accurate detection of distant metastases. For the evaluation of patients with colorectal cancer, CT has relative advantages over PET/CT in regard to the depth of tumor invasion through the wall, extramural extension, and regional lymph node metastases. PET/CT should be performed on selected patients with suggestive but inconclusive metastatic lesions with CT. In addition, PET/CT with dedicated CT protocols, such as contrast-enhanced PET/CT and PET/CT colonography, may replace the diagnostic CT for the preoperative staging of colorectal cancer. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which discusses the recurrence of port-site metastasis following laparoscopy-assisted low anterior surgery.

A correction to the article "p53 codon 72 polymorphism in patients with gastric and colorectal cancer in a Korean population," by Hye-Rim Song and colleagues is presented.