BACKGROUND Behcet’s disease(BD),a chronic vasculitic disorder affecting multiple organs,is characterized by recurrent oral and genital ulcers,arthritis,vasculitis,and intes-tinal ulcers.Although intestinal involvemen...BACKGROUND Behcet’s disease(BD),a chronic vasculitic disorder affecting multiple organs,is characterized by recurrent oral and genital ulcers,arthritis,vasculitis,and intes-tinal ulcers.Although intestinal involvement of BD is common in East Asia,the efficacy and long-term outcomes of surgical treatment of intestinal BD still remain to be established.AIM To evaluate the postoperative clinical course of intestinal BD and determine factors associated with its recurrence.METHODS Data from patients who underwent surgical treatment for intestinal BD between January 2010 and August 2021 were retrospectively reviewed.Patients’demo-graphics,clinical features,postoperative course,complications,and follow-up data were evaluated.RESULTS We analyzed 39 surgeries in 31 patients.The mean patient age was 45.1 years,and the mean interval between the diagnosis of intestinal BD and surgical treatment was 4.9 years(range 1.0-8.0 years).The most common indication for surgery was medical intractability(n=16,41.0%),followed by fistula or abscess(n=11,28.2%).Laparoscopic approaches were used in 19 patients(48.7%),and 5 patients(12.8%)underwent emergency surgeries.The most common surgical procedure was ileocecal resection(n=18,46.2%),followed by right colectomy(n=11,28.2%).A diverting stoma was created in only one patient(2.6%).During a mean follow-up period of 45(range 8-72)months,eight cases(20.5%)of recurrence in five patients required reoperation.The interval between operations was 12.1 months(range 6.3-17.8 mo).Four patients(10.3%)experienced recurrence within 1 year postoperatively,and all eight recurrences occurred within 2 years of the initial surgery.The reoperation rates at 1 and 3 years were 10.3%and 20.5%,respectively.A redo ileocolic anastomosis was performed in all recurrent cases.In multivariate Cox regression analysis,emergency surgery[hazard ratio(HR)9.357,95%confidence interval(CI):1.608-54.453,P=0.013]and elevated C-reactive protein(CRP)levels(HR 1.154,95%CI:1.002–1.328,P=0.047),but not medication use,were predictors of recurrence.CONCLUSION Surgical resection is a feasible treatment option for complicated BD.Reoperation is associated with severe inflam-matory conditions,reflected by increased CRP levels and the requirement for emergency surgery.展开更多
BACKGROUND Optimal surveillance strategies for stage III colorectal cancer(CRC)are lacking,and intensive surveillance has not conferred a significant survival benefit.AIM To examine the association between surveillanc...BACKGROUND Optimal surveillance strategies for stage III colorectal cancer(CRC)are lacking,and intensive surveillance has not conferred a significant survival benefit.AIM To examine the association between surveillance intensity and recurrence and survival rates in patients with stage III CRC.METHODS Data from patients with pathologic stage III CRC who underwent radical surgery between January 2005 and December 2012 at Asan Medical Center,Seoul,Korea were retrospectively reviewed.Surveillance consisted of abdominopelvic computed tomography(CT)every 6 mo and chest CT annually during the 5 year follow-up period,resulting in an average of three imaging studies per year.Patients who underwent more than the average number of imaging studies annually were categorized as high intensity(HI),and those with less than the average were categorized as low intensity(LI).RESULTS Among 1888 patients,864(45.8%)were in HI group.Age,sex,and location were not different between groups.HI group had more advanced T and N stage(P=0.002,0.010,each).Perineural invasion(PNI)was more identified in the HI group(21.4%vs 30.3%,P<0.001).The mean overall survival(OS)and recurrence-free interval(RFI)was longer in the LI group(P<0.001,each).Multivariate analysis indicated that surveillance intensity[odds ratio(OR)=1.999;95%confidence interval(CI):1.680–2.377;P<0.001],pathologic T stage(OR=1.596;95%CI:1.197–2.127;P=0.001),PNI(OR=1.431;95%CI:1.192–1.719;P<0.001),and circumferential resection margin(OR=1.565;95%CI:1.083–2.262;P=0.017)in rectal cancer were significantly associated with RFI.The mean post-recurrence survival(PRS)was longer in patients who received curative resection(P<0.001).Curative resection rate of recurrence was not different between HI(29.3%)and LI(23.8%)groups(P=0.160).PRS did not differ according to surveillance intensity(P=0.802).CONCLUSION Frequent surveillance with CT scan do not improve OS in stage III CRC patients.We need to evaluate role of other surveillance method rather than frequent CT scans to detect recurrence for which curative treatment was possible because curative resection is the important to improve post-recurrence survival.展开更多
BACKGROUND Stem cell transplantation is a promising therapeutic option for curing perianal fistula in Crohn’s disease(CD).Anti-tumor necrotic factor(TNF)therapy combined with drainage procedure is effective as well.H...BACKGROUND Stem cell transplantation is a promising therapeutic option for curing perianal fistula in Crohn’s disease(CD).Anti-tumor necrotic factor(TNF)therapy combined with drainage procedure is effective as well.However,previous studies are limited to proving whether the combination treatment of biologics and stem cell transplantation improves the effect of fistula closure.AIM This study aimed to evaluate the long-term outcomes of stem cell transplantation and compare Crohn’s perianal fistula(CPF)closure rates after stem cell transplantation with and without anti-TNF therapy,and to identify the factors affecting CPF closure and recurrence.METHODS The patients with CD who underwent stem cell transplantation for treating perianal fistula in our institution between Jun 2014 and December 2022 were enrolled.Clinical data were compared according to anti-TNF therapy and CPF closure.RESULTS A total of 65 patients were included.The median age of females was 26 years(range:21-31)and that of males was 29(44.6%).The mean follow-up duration was 65.88±32.65 months,and complete closure was observed in 50(76.9%)patients.The closure rates were similar after stem cell transplantation with and without anti-TNF therapy(66.7%vs 81.6%at 3 year,P=0.098).The patients with fistula closure had short fistulous tract and infrequent proctitis and anorectal stricture(P=0.027,0.002,and 0.008,respectively).Clinical factors such as complexity,number of fistulas,presence of concurrent abscess,and medication were not significant for closure.The cumulative 1-,2-,and 3-year closure rates were 66.2%,73.8%,and 75.4%,respectively.CONCLUSION Anti-TNF therapy does not increase CPF closure rates in patients with stem cell transplantation.However,both refractory and non-refractory CPF have similar closure rates after additional anti-TNF therapy.Fistulous tract length,proctitis,and anal stricture are risk factors for non-closure in patients with CPF after stem cell transplantation.展开更多
文摘BACKGROUND Behcet’s disease(BD),a chronic vasculitic disorder affecting multiple organs,is characterized by recurrent oral and genital ulcers,arthritis,vasculitis,and intes-tinal ulcers.Although intestinal involvement of BD is common in East Asia,the efficacy and long-term outcomes of surgical treatment of intestinal BD still remain to be established.AIM To evaluate the postoperative clinical course of intestinal BD and determine factors associated with its recurrence.METHODS Data from patients who underwent surgical treatment for intestinal BD between January 2010 and August 2021 were retrospectively reviewed.Patients’demo-graphics,clinical features,postoperative course,complications,and follow-up data were evaluated.RESULTS We analyzed 39 surgeries in 31 patients.The mean patient age was 45.1 years,and the mean interval between the diagnosis of intestinal BD and surgical treatment was 4.9 years(range 1.0-8.0 years).The most common indication for surgery was medical intractability(n=16,41.0%),followed by fistula or abscess(n=11,28.2%).Laparoscopic approaches were used in 19 patients(48.7%),and 5 patients(12.8%)underwent emergency surgeries.The most common surgical procedure was ileocecal resection(n=18,46.2%),followed by right colectomy(n=11,28.2%).A diverting stoma was created in only one patient(2.6%).During a mean follow-up period of 45(range 8-72)months,eight cases(20.5%)of recurrence in five patients required reoperation.The interval between operations was 12.1 months(range 6.3-17.8 mo).Four patients(10.3%)experienced recurrence within 1 year postoperatively,and all eight recurrences occurred within 2 years of the initial surgery.The reoperation rates at 1 and 3 years were 10.3%and 20.5%,respectively.A redo ileocolic anastomosis was performed in all recurrent cases.In multivariate Cox regression analysis,emergency surgery[hazard ratio(HR)9.357,95%confidence interval(CI):1.608-54.453,P=0.013]and elevated C-reactive protein(CRP)levels(HR 1.154,95%CI:1.002–1.328,P=0.047),but not medication use,were predictors of recurrence.CONCLUSION Surgical resection is a feasible treatment option for complicated BD.Reoperation is associated with severe inflam-matory conditions,reflected by increased CRP levels and the requirement for emergency surgery.
文摘BACKGROUND Optimal surveillance strategies for stage III colorectal cancer(CRC)are lacking,and intensive surveillance has not conferred a significant survival benefit.AIM To examine the association between surveillance intensity and recurrence and survival rates in patients with stage III CRC.METHODS Data from patients with pathologic stage III CRC who underwent radical surgery between January 2005 and December 2012 at Asan Medical Center,Seoul,Korea were retrospectively reviewed.Surveillance consisted of abdominopelvic computed tomography(CT)every 6 mo and chest CT annually during the 5 year follow-up period,resulting in an average of three imaging studies per year.Patients who underwent more than the average number of imaging studies annually were categorized as high intensity(HI),and those with less than the average were categorized as low intensity(LI).RESULTS Among 1888 patients,864(45.8%)were in HI group.Age,sex,and location were not different between groups.HI group had more advanced T and N stage(P=0.002,0.010,each).Perineural invasion(PNI)was more identified in the HI group(21.4%vs 30.3%,P<0.001).The mean overall survival(OS)and recurrence-free interval(RFI)was longer in the LI group(P<0.001,each).Multivariate analysis indicated that surveillance intensity[odds ratio(OR)=1.999;95%confidence interval(CI):1.680–2.377;P<0.001],pathologic T stage(OR=1.596;95%CI:1.197–2.127;P=0.001),PNI(OR=1.431;95%CI:1.192–1.719;P<0.001),and circumferential resection margin(OR=1.565;95%CI:1.083–2.262;P=0.017)in rectal cancer were significantly associated with RFI.The mean post-recurrence survival(PRS)was longer in patients who received curative resection(P<0.001).Curative resection rate of recurrence was not different between HI(29.3%)and LI(23.8%)groups(P=0.160).PRS did not differ according to surveillance intensity(P=0.802).CONCLUSION Frequent surveillance with CT scan do not improve OS in stage III CRC patients.We need to evaluate role of other surveillance method rather than frequent CT scans to detect recurrence for which curative treatment was possible because curative resection is the important to improve post-recurrence survival.
基金Supported by the grants from the Asan Institute for Life Sciences,Asan Medical Center,Seoul,Korea,No.2019IF0593 and No.2020IP0039.
文摘BACKGROUND Stem cell transplantation is a promising therapeutic option for curing perianal fistula in Crohn’s disease(CD).Anti-tumor necrotic factor(TNF)therapy combined with drainage procedure is effective as well.However,previous studies are limited to proving whether the combination treatment of biologics and stem cell transplantation improves the effect of fistula closure.AIM This study aimed to evaluate the long-term outcomes of stem cell transplantation and compare Crohn’s perianal fistula(CPF)closure rates after stem cell transplantation with and without anti-TNF therapy,and to identify the factors affecting CPF closure and recurrence.METHODS The patients with CD who underwent stem cell transplantation for treating perianal fistula in our institution between Jun 2014 and December 2022 were enrolled.Clinical data were compared according to anti-TNF therapy and CPF closure.RESULTS A total of 65 patients were included.The median age of females was 26 years(range:21-31)and that of males was 29(44.6%).The mean follow-up duration was 65.88±32.65 months,and complete closure was observed in 50(76.9%)patients.The closure rates were similar after stem cell transplantation with and without anti-TNF therapy(66.7%vs 81.6%at 3 year,P=0.098).The patients with fistula closure had short fistulous tract and infrequent proctitis and anorectal stricture(P=0.027,0.002,and 0.008,respectively).Clinical factors such as complexity,number of fistulas,presence of concurrent abscess,and medication were not significant for closure.The cumulative 1-,2-,and 3-year closure rates were 66.2%,73.8%,and 75.4%,respectively.CONCLUSION Anti-TNF therapy does not increase CPF closure rates in patients with stem cell transplantation.However,both refractory and non-refractory CPF have similar closure rates after additional anti-TNF therapy.Fistulous tract length,proctitis,and anal stricture are risk factors for non-closure in patients with CPF after stem cell transplantation.
