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Cancer-cell-derived exosomes confer oncogenic properties in their tumor microenvironment and to other cells; however, the exact mechanism underlying this process is unclear. Here, we investigated the roles of cancer-cell-derived exosomes in colon cancer. Exosomes were isolated from colon cancer cell lines, HT-29, SW480, and LoVo, using an ExoQuick-TC kit, identified using Western blotting for exosome markers, and characterized using transmission electron microscopy and nanosight tracking analysis. The isolated exosomes were used to treat HT-29 to evaluate their effect on cancer progression, specifically cell viability and migration. Cancer-associated fibroblasts (CAFs) were obtained from patients with colorectal cancer to analyze the effect of the exosomes on the tumor microenvironment. RNA sequencing was performed to evaluate the effect of the exosomes on the mRNA component of CAFs. The results showed that exosome treatment significantly increased cancer cell proliferation, upregulated N-cadherin, and downregulated E-cadherin. Exosome-treated cells exhibited higher motility than control cells. Compared with control CAFs, exosome-treated CAFs showed more downregulated genes. The exosomes also altered the regulation of different genes involved in CAFs. In conclusion, colon cancer-cell-derived exosomes affect cancer cell proliferation and the epithelial–mesenchymal transition. They promote tumor progression and metastasis and affect the tumor microenvironment.

Since the da Vinci SP (dVSP) surgical system was introduced, single-incision robotic surgery (SIRS) for colorectal diseases has gained increasing acceptance. We compared the short-term outcomes of SIRS using dVSP with those of conventional multiport laparoscopic surgery (CMLS) to verify its efficacy and safety in colon cancer. The medical records of 237 patients who underwent curative resection for colon cancer by a single surgeon were retrospectively reviewed. Patients were divided into two groups according to surgical modality: SIRS (RS group) and CMLS (LS group). Intra- and postoperative outcomes were analyzed. Of the 237 patients, 140 were included in the analysis. Patients in the RS group (n = 43) were predominantly female, younger, and had better general performance than those in the LS group (n = 97). The total operation time was longer in the RS group than in the LS group (232.8 ± 46.0 vs. 204.1 ± 41.7 min, P

Cancer cell-derived exosomes deliver oncogenic factors to other cells and their tumour microenvironment. We aimed to investigate the role of cancer cell-derived exosomes in colon cancer. Exosomes were isolated from colon cancer cell lines HT-29, SW480, and LoVo. Subsequently, HT-29 cells were treated with these exosomes to evaluate the effect of exosomes on cancer progression. MTT and wound-healing assays were performed to evaluate the effect of exosomes on cellular viability and migration. Moreover, we obtained cancer-associated fibroblasts (CAFs) from patients with colorectal cancer to analyse the effects of cancer cell-derived exosomes on the tumour microenvironment. We performed RNA sequencing to evaluate changes in the mRNA components of the CAFs after exosome treatment. Compared with control cells, exosome-treated cells showed significantly increased proliferation. Regarding western blotting for epithelial-mesenchymal transition markers, exosome-treated cells showed N-cadherin upregulation followed by E-cadherin downregulation. In the wound-healing assay, exosome-treated cells exhibited increased mobile properties. Additionally, exosome-treated CAFs showed increased downregulated genes. In the functional enrichment analysis, exosomes derived from each cell affected different gene regulation pathways. Our findings suggest that cancer cell-derived exosomes are crucially involved in tumour progression and metastasis by affecting the tumour microenvironment.

Obesity has been known to contribute to technical difficulties in surgery. Until now, body mass index (BMI) has been used to measure obesity. However, there are reports that BMI does not always correspond to the visceral fat. Recently, bioelectrical impedance analysis (BIA) has been used for body composition analysis. This study aimed to evaluate the usefulness of the body composition index obtained using a BIA device in predicting short-term postoperative outcomes.Data of patients who underwent elective major colorectal surgery using minimally invasive techniques were reviewed retrospectively. Body composition status was recorded using a commercial BIA device the day before surgery. The relationship between BMI, body composition index, and short-term postoperative outcomes, including operative time, was analyzed.Sixty-six patients were enrolled in this study. In the correlation analysis, positive correlation was observed between BMI and body composition index. BMI and body composition index were not associated with short-term postoperative outcomes. Percent body fat (odds ratio, 4.226; 95% confidence interval [CI], 1.064-16.780; P=0.041) was found to be a statistically significant factor of prolonged operative time in the multivariate analysis. Correlation analysis showed that body fat mass was related to prolonged operative time (correlation coefficients, 0.245; P=0.048). In the area under curve analysis, body fat mass showed a statistically significant predictive probability for prolonged operative time (body fat mass: area, 0.662; 95% CI, 0.531-0.764; P=0.024).The body composition index can be used as a predictive marker for prolonged operative time. Further studies are needed to determine its usefulness.

The da Vinci SP Surgical System (dVSP; Intuitive Surgical, Sunnyvale, CA, USA) was introduced to overcome this limitation of single-incision laparoscopic surgery. This new surgical platform has been demonstrated favorable performance in colorectal surgery and its use has been increasing. And, in accordance with the increment of adoption of dVSP, the indication to apply this platform has been expanding. Herein, we report a technique of right hemicolectomy with extended lymphadenectomy beyond conventional lymph node dissection using dVSP.

The da Vinci SP Surgical System (dVSP; Intuitive Surgical, Sunnyvale, CA, USA) was introduced to perform pure single-incision surgery in 2018. This new surgical platform demonstrated favorable performance compared with the positive aspect of single-incision laparoscopic surgery and robot surgery. To date, its use has mainly been in urological and gynecological procedures. We report a case of successful robotic single-incision right hemicolectomy for cecal cancer with the dVSP.

Background The da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA) was introduced to overcome the limitations of single-incision laparoscopic surgery, which is challenging due to its restrictions regarding triangulation and retraction. The purpose of this article is to describe the initial experience with single-incision surgery using the da Vinvci Single-Port Platform (dVSP). Methods The medical records of patients with colorectal disease, who underwent single-incision robotic surgery using the dVSP, were retrospectively reviewed. Results Five patients with appendiceal and colorectal cancer, and two with diverticulitis were enrolled. All procedures were completed using a pure single-incision approach, with an exception for low anterior resection. There were two minor complications. For patients with colorectal cancer, the number of retrieved lymph nodes and status of the resection margin were acceptable, and cosmetic results were satisfactory. Conclusion The dVSP is a novel surgical platform that can be used as an alternative surgical modality for colorectal surgery.

Purpose Narrow pelvis has been considered an adverse factor for postoperative and oncologic outcomes after rectal cancer surgery. The aim of this study was to investigate the validity of using only axial CT scan images to calculate the pelvic cross-sectional area for the prediction of adverse outcomes after rectal cancer surgery. Methods The medical records of patients who underwent rectal cancer surgery were reviewed and analyzed retrospectively. Axial images of CT scan were used to measure the pelvic cross-sectional area. Pelvic surgical site infection (SSI), positive resection margin, and early local recurrence were adopted as end-points to analyze the impact of pelvimetry on surgical outcome. Results The mean pelvic cross-sectional area was 84.3 ± 10.9 cm2. Males had significantly smaller pelvic areas than females (P < 0.001). Comparing pelvic cross-sectional areas according to the surgical outcomes, the results indicated that patients with pelvic SSI and local failure (positive resection margin or local recurrence within 1 year) have significantly smaller cross-sectional-area than SSI and local failure-free patients (P = 0.013 and P = 0.031). A calculated cross-sectional area of 88.8 cm2 was determined as the cutoff value for the prediction of pelvic SSI and/or local failure, which was significant in a validating analysis. Conclusion The pelvic cross-sectional area obtained from a routine axial CT scan image was associated with pelvic SSI, positive resection margin, and early local recurrence. It might be an intuitive, feasible, and easily adoptable method for predicting surgical outcomes.

Aim To identify the candidate marker predicting treatment response and survival outcome in rectal cancer patients who received preoperative chemoradiotherapy (CRT). Patients and methods Between 2000 and 2015, 159 patients with histologically-confirmed rectal adenocarcinoma underwent preoperative CRT followed by surgery. Among them, 70 patients were enrolled and the expression of survivin, cancer stem cell markers (CD44 and CD133) and epithelial-mesenchymal transition markers (E-cadherin and TWIST1) in pretreatment biopsy specimens were evaluated by immunohistochemistry. Associations between the expression of markers and clinical outcomes were evaluated. Results The median follow-up period of all patients was 71 (range=15-203) months. Five-year overall (OS), disease-free (DFS), locoregional recurrence-free (LRRFS) and distant metastasis-free (DMFS) survival were 80.5%, 60.2% 90.1% and 76.5%, respectively. A significant association between survivin overexpression and worse treatment outcome was shown on univariate analyses for OS, DFS and DMFS (p=0.022, 0.002, and 0.005, respectively). On multivariate analysis, survivin overexpression was an adverse prognosticator for DFS and DMFS (p=0.007 and 0.015, respectively), with a borderline significant trend towards a shorter OS (p=0.069). Four other single biomarkers were not associated with survival outcomes. However, overexpression of both survivin and CD44 was significantly associated with worse OS on multivariate analysis (p=0.003). Conclusion Survivin combined with CD44 might be a candidate biomarker for the prediction of recurrence and survival in patients who received preoperative CRT for rectal cancer. Further research with a larger population is needed to validate these results.

Background Integrins play a critical role in carcinogenesis. Integrin β1 localization is regulated by the guanosine-5′-triphosphate hydrolase Rab25 and integrin β1 levels are elevated in the serum of colon cancer patients; thus, the present study examined the effects of epidermal growth factor (EGF) and Rab25 on integrin β1 localization in colon cancer cells. Methods HCT116 human colon cancer cells were treated with increasing concentrations of EGF, and cell proliferation and protein expression were monitored by MTT and western blot analyses, respectively. Cell fractionation was performed to determine integrin β1 localization in the membrane and cytosol. Integrin β1 extracellular shedding was monitored by enzyme-linked immunosorbent assays (ELISAs) with culture supernatants from stimulated cells. HCT116 cells were transfected with Rab25-specific siRNA to determine the significance of Rab25 in integrin β1 trafficking in the presence of EGF. Results Total integrin β1 expression increased in response to EGF and subsequently decreased at 24 h post-stimulation. A similar decrease was observed in purified membrane fractions, whereas no changes were observed in cytosolic levels. ELISAs using media from stimulated cell cultures demonstrated increased integrin β1 levels corresponding to the decrease observed in membrane fractions, suggesting that EGF induces integrin receptor shedding. EGF stimulation in Rab25-knockdown cells resulted in integrin β1 accumulation in the membrane, suggesting that Rab25 promotes integrin endocytosis. Conclusions Integrin β1 is shed from colon cancer cells in response to EGF stimulation in a Rab25-dependent manner. These results further the present understanding of the role of integrin β1 in colon cancer progression.

Purpose Lymph-node metastasis is considered as critical prognostic factor in colorectal cancer. A preoperative evaluation of lymph-node metastasis can also help to determine the range of distant lymph node dissection. However, the reliability of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in the detection of lymph-node metastasis is not fully known. Methods The medical records of 433 patients diagnosed with colorectal cancer were reviewed retrospectively. FDG-PET/CT and CT were performed on all patients. Lymph nodes were classified into regional and distant lymph nodes according to the American Joint Committee on Cancer (AJCC) Cancer Staging Manual, 7th edition. Results The patients included 231 males (53.3%) and 202 females (46.7%), with a mean age of 64.7 ± 19.0 years. For regional lymph nodes, the sensitivity of FDG-PET/CT was lower than that of CT (57.1% vs. 73.5%, P < 0.001). For distant lymph nodes, the sensitivity of FDG-PET/CT was higher than that of CT (64.7% vs. 52.9%, P = 0.012). The sensitivity of FDG-PET/CT for regional lymph nodes was higher in patients with larger primary tumors. The positivity of lymph-node metastasis for FDG-PET/CT was affected by carcinoembryonic antigen levels, tumor location, and cancer stage for regional lymph nodes and by age and cancer stage for distant lymph nodes (P < 0.05). Conclusion The sensitivity of FDG-PET/CT for regional lymph-node metastasis was not superior to that of CT. However, FDG-PET/CT provides helpful information for determining surgical plan especially in high risk patients group.

Fournier's gangrene is a gas‐forming, necrotising soft tissue infection affecting the perineum. It spreads rapidly along the deep fascial planes and is associated with a high mortality rate. With a growing elderly population with comorbidities, the frequency of severe cases of Fournier's gangrene is expected to increase. We retrospectively reviewed 20 patients diagnosed with Fournier's gangrene at our institution from 2003 to 2014 and analysed data. Thirteen patients had diabetes mellitus, two had been diagnosed with liver cirrhosis, and four were chronic alcoholics. Of 15 patients admitted to an intensive care unit, 11 underwent colostomy, and 4 required skin grafts for wound healing. The wide wounds of two patients were healed using vacuum‐assisted closure (VAC (®)) dressing without additional surgery. The mortality rate was 25%, and the patients whose Fournier's gangrene severity index (FGSI) score was higher than 9 points or whose blood urea nitrogen (BUN) level was higher than 50 mg/dl had a poor prognosis. In order to treat Fournier's gangrene, aggressive surgical treatment, including wide debridement and stoma creation, should be considered as soon as possible to improve survival rates. Additionally, VAC dressing is helpful in healing the wide debridement wound without additional reconstructive surgery.

Purpose: The purpose of this study was to describe factors affecting body image and sexual life for colorectal cancer patients with stoma. Methods: A cross-sectional descriptive correlational study was applied to 102 ostomates from June to November in 2015 using self-report questionnaires: the Body image scale (BIS), and the Derogatis interview for sexual functioning self report (DISF-SR). Results: The influencing factors for body image were ‘need for preoperative sexual education and sexual counseling’ (β=-.29, p=.003), and clinical stage II of colorectal cancer (β=-.26, p=.006). The influencing factor for sexual life was educational level (college education or higher) (β=.21, p=.02). Conclusion: The results of this study showed that colorectal cancer patients with stoma had a negative body image. The sexual counseling and education for ostomates should be approached by considering gender characteristics.

Caveolin is a major component of caveolae which is a plasma membrane microdomain. The emerging role of caveolin in tumorigenesis was based mainly on in vitro experiments with cancer cell lines. We performed semi-quantitative RT-PCR for caveolin, Akt and EGFR to understand the role of caveolins in colorectal tumor biology. Cancer tissue samples and the neighboring normal colon mucosa were obtained from 95 colorectal cancer patients who underwent operations at Ewha Womans University Mokdong Hospital. With these fresh tissues, semi-quantitative RT-PCR was performed by coamplification of the gene for caveolin-1, EGFR and Akt-1 with β-actin. The average age was 60.21 ± 13.33 years old, and sex ratio was 1.44:1. Caveolin-1 is more expressed in tumors than normal mucosa (P = 0.025). The expression of caveolin-1 and Akt-1 had a definitive positive relationship (P = 0.002). But, the expression of caveolin-1 and EGFR was not significantly related. We could not find correlations between caveolin-1 expression and clinical factors. In conclusion, caveolin-1 is more expressed in cancer tissues than normal colon and related with Akt-1, not with EGFR expression in colorectal cancer tissues, which suggests that signaling for caveolin-1 affects Akt-1 activation, but this reaction is not initiated by EGFR stimulation in colon cancer.

Purpose The assurance of a negative resection margin is significant in rectal cancer as it indicates a reduced risk of local recurrence; thus, sufficient length of the resection margin is strongly required. The purpose of this study was to analyze the relationship between the length of the distal resection margin (DRM) and local recurrence or survival rate and to evaluate the possibility of performing sphincter-conserving surgery. Methods The medical records of 218 rectal cancer patients were analyzed. Patients were classified into three groups according to the length of the DRM as follows: group 1, DRM < 1 cm; group 2, 1 cm ≤ DRM ≤ 2 cm; and group 3, DRM > 2 cm. Results Of 218 patients enrolled, 81 were in group 1, 66 in group 2, and 71 in group 3. The 5-year survival rates were 78.2%, 78.2%, and 76.8% for groups 1, 2, and 3, respectively, and there were no statistically significant differences in survival (P = 0.913). Local recurrence was found in 2 patients in group 1, 1 patient in group 2, and 1 patient in group 3; there were no statistically significant differences in local recurrence (P = 0.908). Conclusion A DRM of < 1 cm did not impair the oncologic outcomes of rectal cancer patients. Our results indicated that surgeons should keep in mind to consider the option of sphincter-conserving surgery with adjuvant chemoradiotherapy even in very low rectal cancer.

X-linked inhibitor-of-apoptosis protein (XIAP) interacts with caspase-9 and inhibits its activity, whereas Smac (also known as DIABLO) relieves this inhibition through interaction with XIAP. Here we show that XIAP associates with the active caspase-9-Apaf-1 holoenzyme complex through binding to the amino terminus of the linker peptide on the small subunit of caspase-9, which becomes exposed after proteolytic processing of procaspase-9 at Asp315. Supporting this observation, point mutations that abrogate the proteolytic processing but not the catalytic activity of caspase-9, or deletion of the linker peptide, prevented caspase-9 association with XIAP and its concomitant inhibition. We note that the N-terminal four residues of caspase-9 linker peptide share significant homology with the N-terminal tetra-peptide in mature Smac and in the Drosophila proteins Hid/Grim/Reaper, defining a conserved class of IAP-binding motifs. Consistent with this finding, binding of the caspase-9 linker peptide and Smac to the BIR3 domain of XIAP is mutually exclusive, suggesting that Smac potentiates caspase-9 activity by disrupting the interaction of the linker peptide of caspase-9 with BIR3. Our studies reveal a mechanism in which binding to the BIR3 domain by two conserved peptides, one from Smac and the other one from caspase-9, has opposing effects on caspase activity and apoptosis.

Phospholipase D (PLD) catalyzes the hydrolysis of phosphatidylcholine (PC) to produce phosphatidic acid (PA) and choline. PLD is a major enzyme implicated in important cellular processes, such as cell proliferation. We designed this study to investigate the expression of PLD in human breast carcinomas and non-malignant tissues using RT-PCR, Western blot analysis, immunohistochemistry and an Arf-dependent PLD activity assay. We examined about 550 bp of PCR product and 120 kDa of PLD protein. Our results showed that PLD protein and mRNA levels were overexpressed in 14 of 17 breast cancer tissues. We also observed increased expression by immunohistochemistry and Arf-dependent PLD activity in microsomes of human breast tumors, which correlated well with PLD expression. PLD expression was elevated in human breast tumors compared with normal breast tissues. These results implicate a possible role of PLD in human breast tumorigenesis and suggest that PLD may be useful as a marker for malignant disease in the breast.

Purpose: Chest computed tomography is performed frequently for the preoperative pulmonary staging in colorectal cancers (CRCs) regardless of the result of chest x-ray (CXR) due to its high sensitivities and specificities. The advancement of CT technology detects more indeterminate lung lesions that may require further investigations, referrals and follow-up. The aim of this study was to suggest a guideline for performing chest CT for preoperative pulmonary staging in colorectal cancer. Methods: We performed a retrospective analysis of the records of patients who had chest CT preformed without the evidence of metastasis on CXR for preoperative pulmonary staging. Results: Of 21 patients with metastatic nodules on chest CT, 23.8% showed pulmonary metastasis on positron emission tomography, 47.6% showed extrapulmonary metastasis on preoperative evaluation and 61.9% showed elevated serum carcinoembryonic antigen level above 10 ng/mL. These results showed significant value compared to patients without metastatic nodules. But, in analyzing patients with or without indeterminate nodules in the three contents listed above, there was no significance. Conclusion: In the patients with CRC who show normal CXR and exhibit positivity in PET, preoperative extrapulmonary metastasis and elevated serum CEA level above 10 ng/mL preoperatively, chest CT would be helpful in preoperative staging.

Purpose In the metastatic process, interactions between circulating tumor cells (CTCs) and the extracellular matrix or surrounding cells are required. β1-Integrin may mediate these interactions. The aim of this study was to investigate whether β1-integrin is associated with the detection of CTCs in colorectal cancer. Methods We enrolled 30 patients with colorectal cancer (experimental group) and 30 patients with benign diseases (control group). Blood samples were obtained from each group, carcinoembryonic antigen (CEA) mRNA for CTCs marker and β1-integrin mRNA levels were estimated by using reverse transcription-polymerase chain reaction, and the results were compared between the two groups. In the experimental group, preoperative results were compared with postoperative results for each marker. In addition, we analyzed the correlation between the expressions of β1-integrin and CEA. Results CEA mRNA was detected more frequently in colorectal cancer patients than in control patients (P = 0.008). CEA mRNA was significantly reduced after surgery in the colorectal cancer patients (P = 0.032). β1-Integrin mRNA was detected more in colorectal cancer patients than in the patients with benign diseases (P < 0.001). In colorectal cancer patients, expression of β1-integrin mRNA was detected more for advanced-stage cancer than for early-stage cancer (P = 0.033) and was significantly decreased after surgery (P < 0.001). In addition, expression of β1-integrin mRNA was significantly associated with that of CEA mRNA in colorectal cancer patients (P = 0.001). Conclusion In conclusion, β1-integrin is a potential factor for forming a prognosis following surgical resection in colorectal cancer patients. β1-Integrin may be a candidate for use as a marker for early detection of micrometastatic tumor cells and for monitoring the therapeutic response in colorectal cancer patients.

Purpose: Livin is associated with drug response in several cancers. The aim of this study was to investigate the effect of silencing the livin gene expression on anticancer drug response in colorectal cancer. Methods: siRNA was transfected at different concentrations (0, 10, and 30nM) into HCT116 cells, then cells were treated with either 5-fluorouracil (FU)/leucovorin (LV) or oxaliplatin (L-OHP)/5-FU/LV. Cellular viability and apoptosis were evaluated following silencing of livin gene expression combined with treatment with anticancer drugs. Results: Livin gene expression was effectively suppressed by 30nM siRNA compared with control and 10nM siRNA. The 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide assay showed that proliferation was effectively inhibited in cells treated with a combination of both siRNA and an anticancer drug, compared to cells treated with siRNA-Livin or anticancer drug alone. In particular, the combination of 30nM siRNA and L-OHP/5-FU/LV resulted in a 93.8% and 91.4% decrease, compared to untreated control or L-OHP/5-FU/LV alone, respectively. Cellular proliferation was most effectively suppressed by a combination of 30nM of siRNA and L-OHP/5-FU/LV compared to other combinations. Conclusion: siRNA-mediated down-regulation of livin gene expression could significantly suppress colon cancer growth and enhance the cytotoxic effects of anticancer drugs such as 5-FU and L-OHP. The results of this study suggest that silencing livin gene expression in combination with treatment with anticancer drugs might be a novel cancer therapy for colorectal cancer.

5-Fluorouracil (5-FU) based chemotherapy has been commonly used to treat metastatic or advanced colon cancer as an adjuvant chemotherapy. Although the side effects of 5-FU such as gastrointestinal problems and neutropenia and thrombocytopenia are common, not many cases of 5-FU related encephalopathy are reported. Hyperammonemic encephalopathy is a rare central nervous system toxicity following 5-FU chemotherapy manifesting as altered mental status with elevated ammonia levels with no radiologic abnormality. We report one case of 5-FU induced hyperammonemic encephalopathy occurring after Folfox4 (oxaliplatin, folinic acid and 5-fluorouracil) chemotherapy in a colon cancer patient who presented with confused mental status soon after the chemotherapy and review the 5-FU related encephalopathy.

To determine the clinicopathologic characteristics of surgically treated ulcerative colitis (UC) patients, and to compare the characteristics of UC patients with colitis-associated cancer (CAC) to those without CAC.Clinical data on UC patients who underwent abdominal surgery from 1980 to 2013 were collected from 11 medical institutions. Data were analyzed to compare the clinical features of patients with CAC and those of patients without CAC.Among 415 UC patients, 383 (92.2%) underwent total proctocolectomy, and of these, 342 (89%) were subjected to ileal pouch-anal anastomosis. CAC was found in 47 patients (11.3%). Adenocarcinoma was found in 45 patients, and the others had either neuroendocrine carcinoma or lymphoma. Comparing the UC patients with and without CAC, the UC patients with CAC were characteristically older at the time of diagnosis, had longer disease duration, underwent frequent laparoscopic surgery, and were infrequently given preoperative steroid therapy (P0.001-0.035). During the 37 mo mean follow-up period, the 3-year overall survival rate was 82.2%.Most Korean UC patients experience early disease exacerbation or complications. Approximately 10% of UC patients had CAC, and UC patients with CAC had a later diagnosis, a longer disease duration, and less steroid treatment than UC patients without CAC.

AIM: To study whether hemoglobin could amplify colon cancer cell proliferation via reactive oxygen species (ROS) production. METHODS: Colon cancer cell line HT-29 was grown in the conventional method using RPMI1640 media. The viability of the cells was measured using the colorimetric MTT [3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide] assay after adding hemoglobin. We determined reactive oxygen species levels to be indicators of oxidative stress in HT 29 cell lines with and without hemoglobin and/or 5-fluorouracil (5-FU), 5’-deoxy-5-fluorouridine (5-DFUR) using fluorometric dichlorofluorescin diacetate (DCFH-DA) assay. RESULTS: Cellular proliferation was increased with hemoglobin in a concentration-dependent manner. A significant increment on ROS levels was found in HT 29 cells following hemoglobin incubation. The cytotoxic effects of 5-FU and 5-DFUR were significantly blunted by administration of hemoglobin. There was a slight increase of peroxiredoxin 1, superoxide dismutase 1 concentration according to different hemoglobin concentrations. CONCLUSION: Hemoglobin has a cellular proliferative effect on HT-29 colon cancer cell line by production of ROS. Also, hemoglobin abates cytotoxic effects of chemotherapeutic agents such as 5-FU and 5-DFUR.

Pak interacting exchange factor (betaPix) is a recently cloned protein that contains a multidomain with many potential binding sites and is known to be involved in the regulation of Cdc42/Rac GTPases and Pak kinase activity. These domains of betaPix appear to play a critical role in the regulation of the cytoskeletal organization. The overexpression of betaPix enhances the activation of p38, which is thought to be an important downstream effector of the Rho GTPase family (Rac, Cdc42), which are involved in increased membrane ruffling and cell motility. This increase of cell mobility is an important feature of cancer invasion. We examined the expression of betaPix-a in human breast cancer tissues and adjacent normal tissues obtained from 39 breast cancer patients. Immunoblot analysis and RT-PCR revealed that betaPix-a expression was significantly increased in 37 of the 39 breast cancer tissues (94.9%) versus normal breast tissues. Immunohistochemical analysis showed that breast cancer tissues have consistently stronger immunoreactivity to betaPix-a antibodies than normal tissues. betaPix-a overexpression was inversely associated with extensive intraductal component (P

See Article on Page 246-251 Stomach cancer is still the most common malignancy in Korea in spite of its dramatically decreasing tendency during the last two decades. More importantly, the incidence of colorectal cancer has been increasing during the same period, so clinicians frequently experience synchronous or metachronous stomach cancer with colorectal cancer. Several reports on colorectal cancer with stomach cancer have been published in Asian countries. In 2010, Yoon et al. [1] reported clinicopathologic data for colorectal cancer with synchronous and metachronous stomach cancer. They reviewed 8,680 patients who underwent surgery for primary sporadic colorectal cancer from 1989 to 2008. They revealed that the incidences of synchronous and metachronous gastric cancer were 0.93 and 1.4%, respectively (combined 2.4%). The standardized incidence ratio was 1.199 (95% confidence interval, 1.005 to 1.420). This result is slightly lower than the data for Japan [2] published in 1999. However, Eom et al. [3] reported that the incidence of synchronous or metachronous cancer with gastric cancer was 3.4% based on data for 4,593 patients who underwent gastric cancer surgery. The most common other primary cancer was colorectal cancer (20.1%), followed by lung cancer and liver cancer. Actually, this result is little different from the results published in other papers. Wu et al. [4] analyzed 99 multiple primary cancers with gastric cancer in Taiwan. In the 77 male patients, prostate cancer was the most common (19.5%), followed by cancers of the colon (18.2%) and liver (14.3%). In the 22 female patients, colon cancer was the most common (31.9%), followed by breast and cervix cancers (22.7%). Such data revealed the importance of colorectal cancer screening because colorectal cancer is second common cancer occurring with stomach cancer. In Korea, Lim et al. [5] reported a prospective study that analyzed the esophagogastroduodenoscopy results from 1,542 consecutive colorectal cancer patients. In their series, synchronous gastric cancers were detected in 31 cases (2.0%). Of these 31 cases, 26 had early gastric cancer (EGC, 83.9%) and 5 had advanced gastric cancer. Ten (38.5%) of the 26 EGC cases were managed using an endoscopic mucosal resection. Compared to colorectal cancer patients without synchronous gastric cancer, the group of patients with synchronous gastric cancer was older (65.5+/-9.6 vs. 58.4+/-11.3 years, P = 0.001) and had a greater proportion of males (77.4 vs. 59.4%, P = 0.043). In this research from July 2005 to June 2010, the authors included a total of 123 patients with stomach cancer (86 male), and 246 consecutive, age- and sex-matched persons without stomach cancer were analyzed. All of them underwent a colonoscopy within 6 months after undergoing a gastroscopy. The prevalence of colorectal neoplasms was significantly higher in the stomach cancer group (35.8%) than in the control group (17.9%, P < 0.001). This paper reports on a kind of case-control study, but still had a weak point of no randomization and retrospective analysis. Also, the authors analyzed all kinds of neoplasms in the colon, including tubular adenomas, villous adenomas and adenocarcinomas. The incidences of pure adenocarcinomas were 6.8% and 0% in the stomach cancer group and the normal control group, respectively. Another weak point is the small size of materials compared to other reports. We have to be cautious in accepting the statistical results reported in this paper. The biology of stomach cancer is apparently different from that of colorectal cancer, as are the risk factors for occurrence and the incidence of relapse. A larger-scale epideiologic study would be essential before concluding that the incidence of colorectal cancer in patients with stomach cancer is higher than it is in the general population.

Purpose: In recent years, many psychological problems in patients with stomas have been addressed in a number of studies. But there are only a few studies that use objective measures to take into account self-appraisal by patients with permanent or temporary stomas. The aim of this study is to compare the psychological attitude of patients with permanent and temporary stomas and to determine the most appropriate psychological supportive care. Methods: Sixty-five patients, who received a stoma between January 2009 and March 2012, were classified into two groups with either permanent or temporary stomas and were observed prospectively. We developed a questionnaire with the aid of a psychiatrist to analyze the grade of psychological attitude of self-appraisal of patients. The questionnaire was categorized into three parts; body image scale, self-esteem scale, and depression scale. Patients responded to the questionnaire 4 weeks after the operation and the answers of each group were compared. Results: Out of 65 patients, 42 received temporary stomas and 23 received permanent stomas. There was no significant mean difference between permanent and temporary stoma patients in the body image scale, the self-esteem scale, and the depression scale. However, patients with a permanent stoma tended to have a worse body image and lower self-esteem on some specific items within the questionnaires. Conclusion: Patients with stomas have negative attitudes toward themselves and some meaningful differences were found between different types of stoma applied. Surgeons should be concerned about postoperative psychological support for patients with stomas.

Purpose Adjuvant chemotherapy is routinely recommended for locally advanced colorectal cancer (CRC). There are very few data for the optimal starting date of adjuvant chemotherapy after the surgery. This study aimed to evaluate the effectiveness of earlier adoption of adjuvant chemotherapy after curative surgery for stage III CRC. Methods In this study, 159 patients with stage III CRC, who had undergone a curative resection, were enrolled retrospectively. Patients were categorized into 3 groups representing different timings to initiate the chemotherapy; less than 2 weeks (group 1), 3 to 4 weeks (group 2), and more than 5 weeks (group 3). The overall survival rate (OS) and the relapse-free survival rate (RFS) were analyzed to evaluate the effectiveness of adjuvant chemotherapy. Results The 5-year OSs of the patients were 73.7% in group 1, 67.0% in group 2, and 55.2% in group 3. The 5-year RFSs of the patients were 48.8% in group 1, 64.7% in group 2, and 57.1% in group 3. There were no significant differences in either the OS or the RFS (P = 0.200, P = 0.405). Conclusion Starting chemotherapy earlier than 6 weeks after surgery does not show any significant difference. Thus, although adjuvant chemotherapy should preferably begin within 6 weeks, the starting date should not necessarily be hastened, and the patient's general condition should be taken into consideration.

Corresponding author: Kwang Ho Kim, Department of Surgery, Ewha Womans University School of Medicine, 911-1 Mok-dong, Yangcheon-gu, Seoul 158-710, Korea Tel: 82-2-2650-5585, Fax: 82-2-2644-7984 E-mail: eastgate@ewha.ac.kr This article is the Korean version of "Epidermal growth factor receptor mutations in colorectal cancer patients.". Secondary publication (J Korean Soc Coloproctol 2011,27:127-32 doi:10.3393/ jksc.2011.27.3.127). 대장암 환자의 임상양상에 따른 EGFR Mutation의 발생 빈도

87세 여자 환자가 3일 전부터 시작된 복통으로 응급실로 왔다. 환자는 복통이 시작된 후 치료 없이 집에서 지내다가 증상이 악 화되어 내원 당일 지역 의원을 방문하여 복부초음파를 시행한 결 과 10 cm 크기의 낭성 병변과 담석을 동반한 팽창된 담낭이 발견 되었고(Fig. 1), 복부 전산화단층촬영(Fig. 2)에서 담낭과 총담관 의 담석이 있고 소망 주위의 비정상적인 관강 외 공기 음영과 함께 공기액체층을 동반한 액체 저류가 관찰되어 추가 검사와 치료를 위하여 본원 응급실로 전원되었다. 응급실 내원 당시 환자는 급성 병색을 보였으며 복부는 전반적으로 팽만된 상태로, 상복부에 심 한 압통 및 반발통을 호소하고 있었고, 활력 징후는 혈압 100/60 mmHg, 호흡수 22회/분, 맥박 120회/분, 체온 38.2C로 불안정 한 상태였다. 30년 전 시행한 녹내장 수술 외에 기타 기저 질환 및 입원, 수술력은 없었다. 혈액검사 결과 백혈구 10,220/μL, 중성구 89.6%였으며, CRP Images and Solution Ewha Med J 2013;36(2):153-155 http://dx.doi.org/10.12771/emj.2013.36.2.153 pISSN 2234-3180 • eISSN 2234-2591

See Article on Page 132-139 The anastomotic leakage is a crucial complication after colorectal surgery and has a variable incidence, occurring in up to 1.8 to 12% of cases [1-3]. The importance of this potential complication is emphasized to colorectal surgeons, especially in the case of lower rectal surgery, because it is a major cause of surgical morbidity and mortality, early local recurrence for cancer surgery and the need for advertent additional surgery. Also, leakage increases both the hospital stay and the medical cost. The stem cell engineering technique is an emerging field of medicine and has been put on the stage because of the hidden potential of stem cells. Collawn et al. [4] recently reported the effectiveness of adipose-derived stromal cells in the skin wound healing process. Adipose tissue is a major reservoir of mesenchymal stem cells, which can be differentiated into endothelial progenitors, adipocytes, chondrocytes, etc. This article showed very promising results for the use of adipose stem cells in the bowel wall healing process. Rat adipose tissue harvested from the suprascapular and inguinal areas was used. After 14 days of organ culture, the outgrown cells in the fibrin matrix were recovered by selective degradation of the fibrin matrix, plated on tissue culture dishes, and propagated using a conventional two-dimensional culture. In vitro and in vivo experiments revealed that the experimental group showed significantly favorable histopathologic features, including less inflammation and more microvascular density. However, this feature does not confirm stem cell effects because vascular endothelial growth factor was used to induce endothelial differentiation during the cell manipulation stage. If this new technique is to be applied to clinical fields, an easier and more conventional process without additional pharmacological treatment would be expected.