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A multimodal analgesia (MMA) protocol has shown the effect of postoperative pain control and reduced the postoperative opioid consumption. However, it was questionable whether MMA could replace opioid-based patient-controlled analgesia (PCA) for postoperative pain control. Therefore, this study aimed to investigate whether an MMA protocol is non-inferior to opioid-based PCA for pain management after a minimally invasive colorectal cancer surgery.A randomized, open-label, non-inferiority clinical trial was conducted on patients undergoing laparoscopic or robotic resection of colorectal cancer. The patients were randomly assigned to either the PCA or MMA group. The MMA protocol included pregabalin, tramadol, wound infiltration, and transversus abdominis plane block. The primary outcome was the numeric rating scale (NRS) score for pain at rest 24 h postoperatively.Ninety-seven patients were included in the intention-to-treat analysis. The mean difference in NRS score at rest at 24 h was 0.25 (95% confidence interval, - 0.61 to 1.11). This result demonstrated the non-inferiority of MMA to PCA in our non-inferiority margin (- 1). Compared with the PCA group, the median remifentanil dose (996 vs. 654 μg; p 0.001) and time in the post-anesthesia care unit (35 vs. 25 min; p 0.001) were significantly less in the MMA group.Our MMA protocol successfully controlled postoperative pain and was non-inferior to morphine-based PCA based on patient-reported pain intensity, with no significant increase in adverse events. These results will help construct a strategy to reduce conventional opioid prescriptions for pain management after a minimally invasive colorectal cancer surgery. Trial Registration Number Trial Registration Clinical Research Information Service Identifier: KCT0002593.

Endoscopic tattooing with India ink is a popular method for identifying colonic lesions during minimally invasive surgery because it is highly challenging to localize lesions during laparoscopy. However, there is a perceived unmet need for the injection of India ink and carbon particle suspension due to various complications and inconstant durability during the perioperative period. In this study, carbon black-containing self-healing adhesive alginate/polyvinyl alcohol composite hydrogels were synthesized as endoscopic tattooing inks. Alginate (Alg) conjugated with phenylboronic acid (PBA) groups in the backbone was crosslinked with polyvinyl alcohol (PVA) because of the dynamic bonds between the phenylboronic acid in alginate and the cis-diol groups of PVA. The carbon black-incorporated Alg-PBA/PVA hydrogels exhibited self-healing and re-shapable properties, indicating that improved intraoperative localization could be achieved. In addition, the adhesive tattooing hydrogels were stably immobilized on the target regions in the intraperitoneal spaces. These carbon black-containing self-healing adhesive hydrogels are expected to be useful in various surgical procedures, including endoscopic tattooing.

Background Although many efforts have been made to decrease the incidence of anastomotic leak (AL), it remains one of the most serious complications of rectal cancer surgery. Many previous studies have reported an association between the ligation level of the inferior mesenteric artery (IMA) (high or low) and the incidence of AL after rectal cancer surgery. However, we cannot draw a solid conclusion because of the low quality and heterogeneity of those studies. Therefore, this study aims to investigate the impact of the IMA ligation level on the occurrence of AL after minimally invasive anterior resection of rectal cancer. Methods/design Patients with primary rectal cancer without distant metastases will be included after screening. They will be randomly assigned (1:1) to receive high or low ligation of the IMA. The primary endpoint is AL incidence; secondary endpoints are quality of life; urinary, sexual, and defecatory functions; and 3-year disease-free survival. We hypothesized that the incidence rate of AL would be 15% and 5% in the high- and low-ligation groups, respectively. With a two-sided α of 0.05 and a power of 0.8, the sample size is calculated to be 314 patients (157 per group), considering a 10% dropout rate. Discussion Although many studies have compared the short- and long-term outcomes of high and low ligation of the IMA in rectal cancer surgery, it is still debatable. This trial aims to help draw a more solid conclusion regarding the association between the IMA ligation level and AL incidence after rectal cancer surgery. We also hope to contribute to standardizing the method of rectal cancer surgery in this trial. Trial registration Clinical Research Information Service KCT0003523. Registered on February 18, 2019

Assays for cancer diagnosis via the analysis of biomarkers on circulating extracellular vesicles (EVs) typically have lengthy sample workups, limited throughput or insufficient sensitivity, or do not use clinically validated biomarkers. Here we report the development and performance of a 96-well assay that integrates the enrichment of EVs by antibody-coated magnetic beads and the electrochemical detection, in less than one hour of total assay time, of EV-bound proteins after enzymatic amplification. By using the assay with a combination of antibodies for clinically relevant tumour biomarkers (EGFR, EpCAM, CD24 and GPA33) of colorectal cancer (CRC), we classified plasma samples from 102 patients with CRC and 40 non-CRC controls with accuracies of more than 96%, prospectively assessed a cohort of 90 patients, for whom the burden of tumour EVs was predictive of five-year disease-free survival, and longitudinally analysed plasma from 11 patients, for whom the EV burden declined after surgery and increased on relapse. Rapid assays for the detection of combinations of tumour biomarkers in plasma EVs may aid cancer detection and patient monitoring.

Purpose: We analyzed the safety and feasibility of preoperative short-course radiotherapy (SCRT) followed by consolidation chemotherapy for patients with locally advanced rectal cancer (LARC).Methods: From April 2018 to May 2019, 19 patients with LACR were treated with SCRT followed by three cycles of consolidation chemotherapy with leucovorin, fluorouracil, and oxaliplatin (FOLFOX6) before surgery. Adjuvant chemotherapy relied on oxaliplatin. Tumor response, patient compliance, and toxicities were analyzed.Results: The median age was 60 years (range 44–71), and 16 of the patients were male. The median tumor height was 5 cm (range 0–9) from anal verge. All patients received a total dose of 25 Gy in five fractions. The number of cycles of FOLFOX6 before surgery was three in 17, four in one, five in one. Five patients required dose reductions in consolidation chemotherapy. The median interval between initiation of SCRT and surgery was 10.6 weeks (range 8.6–16.4). A pathologic complete response was seen in two patients (11%). Grade III toxicities to the preoperative treatment were seen in five patients (26%): diarrhea in two, a decreased white blood cell count in one, and anemia in two. Postoperative complications arising within 30 days developed in five patients (26%). During the median follow-up period of 20.4 months, there was no tumor recurrence. Conclusion: Preoperative SCRT followed by oxaliplatin-based consolidation chemotherapy showed acceptable toxicity and feasibility in patients with LARC. Prospective randomized trials are warranted to verify the efficacy and safety of this treatment strategy compared with conventional long-course concurrent chemoradiotherapy.

We aimed to evaluate whether a short distal resection margin (p p = 0.008). Subgroup analysis revealed that a distal resection margin of p = 0.001). A distal resection margin of

The manual reading of capsule endoscopy (CE) videos in small bowel disease diagnosis is time-intensive. Algorithms introduced to automate this process are premature for real clinical applications, and multi-diagnosis using these methods has not been sufficiently validated. Therefore, we developed a practical binary classification model, which selectively identifies clinically meaningful images including inflamed mucosa, atypical vascularity or bleeding, and tested it with unseen cases. Four hundred thousand CE images were randomly selected from 84 cases in which 240,000 images were used to train the algorithm to categorize images binarily. The remaining images were utilized for validation and internal testing. The algorithm was externally tested with 256,591 unseen images. The diagnostic accuracy of the trained model applied to the validation set was 98.067%. In contrast, the accuracy of the model when applied to a dataset provided by an independent hospital that did not participate during training was 85.470%. The area under the curve (AUC) was 0.922. Our model showed excellent internal test results, and the misreadings were slightly increased when the model was tested in unseen external cases while the classified ‘insignificant’ images contain ambiguous substances. Once this limitation is solved, the proposed CNN-based binary classification will be a promising candidate for developing clinically-ready computer-aided reading methods.

In this study, tidal stream energy resources of the Southwestern Sea of Korea were assessed using a numerical model, Modelo Hidrodinâmico (MOHID). This numerical model is based on the finite volume method, which allows numerical experiments on estuaries, coasts, and oceans. For the numerical experiment, we used grid data of at least 90 m resolution by applying bathymetry data created by the Korea Institute of Ocean Science & Technology (KIOST) and FES2012 data as a tidal boundary condition. Strong tidal currents occur in the Southwestern Sea of Korea due to the characteristics of the tidal systems of the West Sea and the South Sea, and the topographical characteristics of a Ria coast. These characteristics were appropriately reproduced by the numerical experiment. Accordingly, the average and maximum tidal currents calculated by the numerical model were used in the assessment. Two regions, Jangjuk and Maenggol-Geocha, were selected as the candidate areas for tidal stream energy development. In addition, the amounts of tidal stream energy resources were evaluated using geographical information system-based spatial analysis by applying the tidal current, depth data, and area of each region. The resource amounts were estimated to be 4,841 MW, with 5,743 tidal stream energy converters (TECs) for Jangjuk, and 3,497 MW, with 3,676 TECs for Maenggol-Geocha.

Background The introduction of complete mesocolic excision (CME) with central vascular ligation (CVL) for right-sided colon cancer has improved the oncologic outcomes. Recently, we have introduced a modified CME (mCME) procedure that keeps the same principles as the originally described CME but with a more tailored approach. Some retrospective studies have reported the favourable oncologic outcomes of laparoscopic mCME for right-sided colon cancer; however, no prospective multicentre study has yet been conducted. Methods This study is a multi-institutional, prospective, single-arm study evaluating the oncologic outcomes of laparoscopic mCME for adenocarcinoma arising from the right side of the colon. A total of 250 patients will be recruited from five tertiary referral centres in South Korea. The primary outcome of this study is 3-year disease-free survival. Secondary outcome measures include 3-year overall survival, incidence of surgical complications, completeness of mCME, and distribution of metastatic lymph nodes. The quality of laparoscopic mCME will be assessed on the basis of photographs of the surgical specimen and the operation field after the completion of lymph node dissection. Discussion This is a prospective multicentre study to evaluate the oncologic outcomes of laparoscopic mCME for right-sided colon cancer. To the best of our knowledge, this will be the first study to prospectively and objectively assess the quality of laparoscopic mCME. The results will provide more evidence about oncologic outcomes with respect to the quality of laparoscopic mCME in right-sided colon cancer. Trial registration ClinicalTrials.gov ID: NCT03992599 (June 20, 2019). The posted information will be updated as needed to reflect protocol amendments and study progress.

This study attempted to reveal the prognostic impact of microsatellite instability-high (MSI-H) colon cancer with tumor-infiltrating immune cells (TIICs) and immune checkpoint protein expression, which are good candidates for immunotherapy. The study included 89 patients with MSI-H colon cancer who underwent curative surgery at Kyungpook National University Chilgok Hospital. The expression status of specific inhibitory receptors, such as CD274 (programmed death-ligand 1, PD-L1), PDCD1 (programmed cell death 1, PD-1), cytotoxic T-lymphocyte-associated protein 4 (CTLA4), lymphocyte-activation gene 3 (LAG3), and indolamine 2′3′-dioxygenase 1 (IDO1), was retrospectively analyzed using immunohistochemistry (IHC). Among the 89 patients, CD274, LAG3, and IDO1 expressions in TIICs were observed in 68.6% (61 cases), 13.5% (12), and 28.1% (25) of patients, respectively. Meanwhile, CD274, CTLA4, and IDO1 were expressed in tumor cells of 24.7% (22 cases), 4.5% (4), and 72.0% (64) of patients, respectively. During the median follow-up duration of 39 months, 14 (15.7%) patients experienced disease recurrence. Among the five immune checkpoint proteins, CD274, LAG3, and IDO1 expressions in TIICs were significantly associated with a better disease-free survival (DFS) in a univariate analysis (P = 0.028, 0.037, and 0.030 respectively). Moreover, co-expression of CD274, LAG3, and IDO1 in TIICs showed an even better survival for DFS (P = 0.010). In a multivariate survival analysis, CD274, LAG3, and IDO1 expressions in TIICs remained as independent prognostic factors for a better DFS. CD274, LAG3, and IDO1 expressions in TIICs showed a better prognosis for patients with MSI-H colon cancer. Thus, the potential therapeutic implications of these immune checkpoint molecules should be further investigated.

Lateral pelvic lymph node dissection (LPND) is a challenging procedure due to its technical difficulty and higher incidence of surgical morbidity. We compared short-term outcomes between laparoscopic and robotic LPND in patients with rectal cancer. Between May 2006 and December 2014, prospectively collected data from consecutive patients undergoing robotic or laparoscopic total mesorectal excision (TME) with LPND were retrospectively compared. Patients’ demographics, perioperative outcomes, functional results, and initial oncologic outcomes were analyzed. Fifty and 35 patients underwent robotic or laparoscopic TME with LPND, respectively. Bilateral LPND was performed in 10 patients (20%) in the robotic group and 6 (17.1%) in the laparoscopic group. For unilateral pelvic dissection, the mean operative time was not significantly different between groups (robotic vs. laparoscopic group, 41.0 ± 15.8 min vs. 35.3 ± 13.4 min; P = 0.146), but the EBL was significantly lower in the robotic group (34.6 ± 21.9 mL vs. 50.6 ± 23.8 mL; P = 0.002). Two patients (4.0%) in the robotic group and 7 (20.0%) in the laparoscopic group underwent Foley catheter reinsertion for urinary retention postoperatively (P = 0.029). The mean number of harvested lateral pelvic lymph nodes (LPNs) was 6.6 (range 0–25) in the robotic group and 6.4 (range 1–14) in the laparoscopic group. Pathologic LPN metastatic rate was not different between groups (robotic vs. laparoscopic group, 28.0 vs. 41.2%; P = 0.243). During the median follow-up of 26.3 months, overall recurrence rate was not different between groups (robotic vs. laparoscopic group, 30.0 vs. 31.2%; P = 0.850). Three patients (6.0%) in the robotic group and 4 (11.4%) in the laparoscopic group developed local recurrence (P = 0.653). Robotic TME with LPND is safe and feasible with favorable short-term surgical outcomes.

Concurrent chemoradiotherapy (CRT) is the current standard of treatment for anal squamous carcinoma. However, local or metastatic recurrences remain significant after CRT with 5-fluorouracil (5-FU) and mitomycin C (MMC). Therefore, the present study evaluated the feasibility and efficacy of adding cisplatin to the classic CRT (5-FU, MMC, and radiotherapy). Twenty patients with histologically confirmed squamous cell carcinoma of the anus without metastatic disease were enrolled at Kyungpook National University Medical Center (Daegu, Korea) between January 2005 and December 2014. The CRT comprised of two cycles of 5-FU 750 mg/m2 days 1–4, MMC 10 mg/m2 day 1, and cisplatin 60 mg/m2 day 1 every 4 weeks and radiotherapy (59.6 Gy in 33 daily fractions). The primary endpoint was to determine the feasibility of FMC, while the secondary endpoints were the pathologic complete response (pCR) rate at 8 weeks following the completion of CRT, progression-free survival (PFS), and overall survival (OS). The treatment was generally well tolerated, and all patients received two cycles of FMC chemotherapy. Among the 20 patients, 17 were assessed for their pathologic response and 12 patients (70.6%) achieved pCR. The most common grade 3 or 4 hematologic toxicity was neutropenia (n = 3), while the most frequent severe non-hematologic toxicity was radiation dermatitis (n = 6, 30%). After a median follow-up duration of 45.5 months, the estimated 5-year PFS and overall survival rates were 88.9 and 88.1%, respectively. CRT with two cycles of a FMC regimen was found to be feasible for patients with anal squamous carcinoma. Further study is warranted to evaluate the efficacy of CRT with a FMC regimen.

The slag-metal reaction experiments were carried out using a high-frequency induction furnace to confirm the effect of slag composition on the removal rate of inclusions in molten steel through the CaO-based slags. The apparent rate constant of oxygen removal (k O) was obtained as a function of slag composition. It increased with increasing basicity, and the content of MgO and CaF2, whereas it decreased by increasing the content of Al2O3 in the slag. The removal rate of inclusions was strongly affected not only by the driving force of the chemical dissolution but also by the viscosity of the slags and fluxes.

Among the many additive manufacturing technologies, the directed energy deposition (DED) process has attracted significant attention because of the application of metal products. Metal deposited by the DED process has different properties than wrought metal because of the rapid solidification rate, the high thermal gradient between the deposited metal and substrate, etc. Additionally, many operating parameters, such as laser power, beam diameter, traverse speed, and powder mass flow rate, must be considered since the characteristics of the deposited metal are affected by the operating parameters. In the present study, the effect of energy input on the characteristics of H13 and D2 steels deposited by a direct metal tooling process based on the DED process was investigated. In particular, we report that the hardness of the deposited H13 and D2 steels decreased with increasing energy input, which we discuss by considering microstructural observations and thermodynamics.

Early postoperative intraperitoneal chemotherapy (EPIC) is a type of intraperitoneal chemotherapy for patients with colorectal cancer and peritoneal metastasis. However, there is a paucity of clinical studies evaluating the efficacy of EPIC after complete cytoreductive surgery. This study was designed to evaluate the efficacy of EPIC in patients who underwent complete surgical resection of peritoneal metastasis from colorectal cancer. A 1:2 matched case–control study was conducted in patients undergoing complete surgical resection of peritoneal metastases from colorectal cancer at our institution between January 2000 and November 2013. The operative and survival outcomes of patients receiving EPIC (EPIC group) and those who did not (no EPIC group) were compared. Thirty patients who were treated with EPIC were matched with 15 patients who did not receive EPIC. The 3-year overall survival (OS) and disease-free survival (DFS) were 74.3 and 53.0 % in the EPIC group and 34.7 and 7.5 % in the no EPIC group (EPIC group vs. no EPIC group: OS, P = 0.016; DFS, P = 0.002). Multivariate analysis identified EPIC and adjuvant systemic chemotherapy as independent prognostic factors for OS, whereas only EPIC was prognostic factor for DFS. For peritoneal-DFS, EPIC was the only significant variable in the univariate analysis (hazard ratio, 2.70; 95 % confidence interval 1.17–6.21; P = 0.020). EPIC is a safe and efficacious option for intraperitoneal chemotherapy to prevent peritoneal recurrence and prolong survival after complete resection of peritoneal metastasis from colorectal cancer.

To assess the complementary prognostic value of pre-treatment tumor apparent diffusion coefficient (ADC) for the prediction of tumor recurrence in patients with rectal cancer. From March 2012 to March 2013, a total of 128 patients with mid/lower rectal cancer who underwent pre-treatment rectal MRI were enrolled in this retrospective study. Two radiologists in consensus evaluated conventional imaging features (Cimg) in pre-treatment rectal MRI: tumor height from anal verge (≤5 cm vs. >5 cm), T stage (high vs. low), the presence or absence of lymph node metastasis, mesorectal fascia invasion, and extramural venous invasion. The mean tumor ADC values (TumorADC) based on high b-value (0, 1000 × 10−3 mm2/s) diffusion weight images were extracted. A multivariate Cox proportional hazard (CPH) regression was performed to evaluate the association of Cimg and TumorADC with the 3-year local recurrence (LR) rate. Predictive performance of two multivariate CPH models (Cimg only vs. Cimg + TumorADC) was compared using Harrell’s c index (HCI). TumorADC (Adjusted HR, 7.830; 95% CI 3.937–15.571) and high T stage (Adjusted HR, 8.039; 95% CI 2.405–26.874) were independently associated with the 3-year LR rate. The CPH model generated with T stage + TumorADC (HCI, 0.820; 95% CI 0.708–0.932) showed significantly higher HCI than that with T stage only (HCI, 0.742; 95% CI 0.594–0.889) (P = 0.009). In patients with mid/lower rectal cancer, integrating TumorADC to Cimg increases predictive performance of the CPH model than that with Cimg alone for the prediction of LR within 3 years after surgery.

The directed energy deposition process has been mainly applied to re-work and the restoration of damaged steel. Differences in material properties between the base and the newly deposited materials are unavoidable, which may affect the mechanical properties and durability of the part. We investigated the effect of heat treatment on the characteristics of tool steel deposited by the DED process. We prepared general tool steel materials of H13 and D2 that were deposited onto heat-treated substrates of H13 and D2, respectively, using a direct metal tooling process. The hardness and microstructure of the deposited steel before and after heat treatment were investigated. The hardness of the deposited H13 steel was higher than that of wrought H13 steel substrate, while that of the deposited D2 was lower than that of wrought D2. The evolution of the microstructures by deposition and heat treatment varied depending on the materials. In particular, the microstructure of the deposited D2 steel after heat treatment consisted of fine carbides in tempered martensite and it is expected that the deposited D2 steel will have isotropic properties and high hardness after heat treatment.

A good pathologic response to neoadjuvant chemoradiotherapy (CRT) in locally advanced rectal cancer (LARC) is associated with a better prognosis. However, there is no effective method to predict CRT response in LARC patients. Therefore, this study used whole-exome sequencing (WES) to identify novel biomarker predicting CRT benefit in LARC. Two independent tumor tissue sets were used to evaluate the genetic differences between the good CRT response group (15 patients achieved a pathologic complete response (pCR)) and the poor CRT response group (15 patients with pathologic stage III). After applying WES to the discovery set of 30 patients, additional samples (n = 67) were genotyped for candidate variants using TaqMan or Sanger sequencing for validation. Overall, this study included a total of 97 LARC patients. In the discovery and validation set, there was no known genetic mutation to predict response between two groups, while five candidate variants (BCL2L10 rs2231292, DLC1 rs3816748, DNAH14 rs3105571, ITIH5 rs3824658, and RAET1L rs912565) were found to be significantly associated with pCR. In the dominant model, the GC/CC genotype of DLC1 rs3816748 (p = 0.032), AC/CC genotype of DNAH14 rs3105571 (p = 0.009), and TT genotype of RAET1 rs912565 (p

Assuming an association between cancer and metabolism, oncogene-directed metabolic reprogramming in cancer has revealed new target strategies. For example, the LKB1-AMPK-mTOR signaling pathway genes are already known to alter the cell metabolism and to play a critical role in the malignant behavior of cancer. Accordingly, based on the assumption that genetic variations in the LKB1-AMPK-mTOR signaling pathway can change the intracellular signal in terms of metabolic reprogramming, the present study analyzed 18 single nucleotide polymorphisms (SNPs) of the STK11, PRKAA1, TSC1/2, and mTOR genes and their impact on the survival of patients with colorectal cancer. Seven hundred seventy-two patients with surgically resected colorectal adenocarcinoma were enrolled in the present study. Eighteen SNPs were selected from an in silico analysis based on previous evidence of association. The SNP genotyping was performed using a SEQUENOM MassARRAY. Among the 18 polymorphisms, three SNPs (STK11 rs741765, PRKAA1 rs461404, and TSC1 rs13295634) were significantly associated with disease-free survival (DFS) or overall survival (OS). In a multivariate analysis, the GG genotype of STK11, TT genotype of PRKAA1, and TG or GG genotype of TSC1 were identified as independent prognostic factors for a worse DFS (hazard ratio = 1.398, 1.408, and 1.388; p = 0.030, 0.013, and 0.002, respectively) and OS (hazard ratio = 1.431, 1.680, and 1.394; p = 0.038, 0.001, and 0.009, respectively). The present results suggest that genetic variants of the STK11, PRKAA1, and TSC1 genes could be used as prognostic biomarkers for patients with surgically resected colorectal cancer.

In recent decades, a combination of cytoreductive surgery and intraperitoneal chemotherapy has yielded improvements in the survival of patients with peritoneal carcinomatosis. Laparoscopic cytoreductive surgery and intraperitoneal chemotherapy comprise a challenging and rarely reported surgical procedure. Between November 2004 and February 2010, 29 patients underwent cytoreductive surgery and early postoperative intraperitoneal chemotherapy for peritoneal carcinomatosis secondary to colorectal cancer. Of the 29 patients, 15 underwent laparoscopic surgery and 14 underwent open surgery. The patient characteristics did not differ significantly between the two groups. Synchronous peritoneal carcinomatosis with a primary tumor was more common in the laparoscopic group, and the Gilly stage of peritoneal carcinomatosis was found more frequently in the open group. Complication rate and hospital stay were less in the laparoscopic group. However, the outcomes for the patients undergoing the combined treatment were similar between the two groups with respect to completeness of cytoreduction, operation morbidity, and overall survival. The laparoscopic group had a cytoreduction completeness of 86.7 % and an operative morbidity of 13.3 %. Operative mortality occurred for one patient after open surgery. Laparoscopic cytoreductive surgery and early postoperative intraperitoneal chemotherapy can be performed safely for selected patients with peritoneal carcinomatosis from colorectal cancer to a limited extent. Further studies with longer follow-up periods and larger numbers of patients are warranted to confirm the study findings.

Urinary and sexual dysfunction are recognized complications of rectal cancer surgery in men. This study compared robot-assisted total mesorectal excision (RTME) and laparoscopic total mesorectal excision (LTME) with regard to these functional outcomes. A series of 32 men who underwent RTME between February 1, 2009 and December 31, 2010 were matched 1:1 with patients who underwent LTME. The matching criteria were age, body mass index, tumor distance from the anal verge, neoadjuvant chemoradiation therapy, and tumor stage. Urinary and erectile function were evaluated using the International Prostatic Symptom Score (IPSS) and the five-item version of the International Index of Erectile Function (IIEF-5) scale. Data were collected from the two groups at baseline and at 3, 6, and 12 months after surgery and compared. The mean IPSS score did not differ between the two groups at baseline at any point of measurement. The mean baseline IIEF-5 score was similar between the two groups and was decreased at 3 months. The mean IIEF-5 score was significantly higher in the RTME group at 6 months than in the LTME group (14.1 ± 6.1 vs. 9.4 ± 6.6; p = 0.024). The interval decrease in IIEF-5 scores was significantly higher in the LTME group than in the RTME group at 6 months (4.9 ± 4.5 vs. 9.2 ± 4.7; p = 0.030). The men in the RTME group experienced earlier restoration of erectile function than did those in the LTME group. Bladder function was similar during the 12 months after RTME or LTME.

The thermodynamic equilibria between CaO-Al2O3-SiO2-CaF2-MgO(-MnO) slag and Fe-1.5 mass pct Mn-0.5 mass pct Si-0.5 mass pct Cr melt was investigated at 1873 K (1600 °C) in order to understand the effect of slag composition on the concentration of Al2O3 in the inclusions in Si-Mn-killed steels. The composition of the inclusions were mainly equal to (mol pct MnO)/(mol pct SiO2) = 0.8(±0.06) with Al2O3 content that was increased from about 10 to 40 mol pct by increasing the basicity of slag (CaO/SiO2 ratio) from about 0.7 to 2.1. The concentration ratio of the inclusion components, $$ {{X_{{{\text{Al}}_{2} {\text{O}}_{3} }} \cdot X_{\text{MnO}} } \mathord{\left/ {\vphantom {{X_{{{\text{Al}}_{2} {\text{O}}_{3} }} \cdot X_{\text{MnO}} } {X_{{{\text{SiO}}_{2} }} }}} \right. \kern-0pt} {X_{{{\text{SiO}}_{2} }} }} $$ , and the activity ratio of the steel components, $$ {{a_{\text{Al}}^{2} \cdot a_{\text{Mn}} \cdot a_{\text{O}}^{2} } \mathord{\left/ {\vphantom {{a_{\text{Al}}^{2} \cdot a_{\text{Mn}} \cdot a_{\text{O}}^{2} } {a_{\text{Si}} }}} \right. \kern-0pt} {a_{\text{Si}} }} $$ , showed a good linear relationship on a logarithmic scale, indicating that the activity coefficient ratio of the inclusion components, $$ {{\gamma_{{{\text{SiO}}_{2} }}^{i} } \mathord{\left/ {\vphantom {{\gamma_{{{\text{SiO}}_{2} }}^{i} } {\left( {\gamma_{{{\text{Al}}_{2} {\text{O}}_{3} }}^{i} \cdot \gamma_{\text{MnO}}^{i} } \right)}}} \right. \kern-0pt} {\left( {\gamma_{{{\text{Al}}_{2} {\text{O}}_{3} }}^{i} \cdot \gamma_{\text{MnO}}^{i} } \right)}} $$ , was not significantly changed. From the slag-steel-inclusion multiphase equilibria, the concentration of Al2O3 in the inclusions was expressed as a linear function of the activity ratio of the slag components, $$ {{a_{{{\text{Al}}_{2} {\text{O}}_{3} }}^{s} \cdot a_{\text{MnO}}^{s} } \mathord{\left/ {\vphantom {{a_{{{\text{Al}}_{2} {\text{O}}_{3} }}^{s} \cdot a_{\text{MnO}}^{s} } {a_{{{\text{SiO}}_{2} }}^{s} }}} \right. \kern-0pt} {a_{{{\text{SiO}}_{2} }}^{s} }} $$ on a logarithmic scale. Consequently, a compositional window of the slag for obtaining inclusions with a low liquidus temperature in the Si-Mn-killed steel treated in an alumina ladle is recommended.

Purpose We compared the outcomes of total knee arthroplasty (TKA) using the Genesis II prosthesis in which 3° of external rotation was incorporated into the femoral component and Nexgen LPS prosthesis in which the degree of external rotation was determined by the extent of intraoperative bone cutting. Materials and Methods Of the patients who underwent TKA for osteoarthritis between November 2006 and December 2009, 326 patients (572 knees) were included in this study. The prosthesis of choice was Genesis II in 199 knees and Nexgen LPS in 373 knees. The mean follow-up was 27 months (range, 24 to 51 months). The American Knee Society score (KSS) and function score (FS) were used for clinical assessments. The maximum flexion angle and patellar tilt were compared between the groups. Results At the final follow-up, no significant intergroup difference was observed regarding the KSS (p=0.217), FS (p=0.238), maximum flexion angle (p=0.124), and patellar tilt (p=0.156). Conclusions There was no significant difference in the clinical outcomes and patellar tilt between the prosthesis in which 3° of external rotation was incorporated into the femoral component and the prosthesis in which external rotation was determined based on bone cutting.

The present study evaluated the predictive and prognostic impact of initial fluorine-18-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) in patients with locally advanced rectal cancer treated with neoadjuvant concurrent chemoradiotherapy (CCRT). Eighty-one consecutive patients with locally advanced rectal cancer (cT3-T4 N−/N+) treated with neoadjuvant CCRT were enrolled. The FDG-PET/CT parameters, including the SUVmax, metabolic tumor volume (MTV, 50 % of SUVmax), and multiplication of the SUVmean and MTV (total lesion glycolysis, TLG), were analyzed in relation to the pathologic response and disease recurrence. Five patients (6.2 %) achieved a pathologic complete response (pCR) after CCRT followed by surgery. None of the FDG-PET/CT parameters was identified as a predictive factor for pCR. After a median follow-up period of 26.7 (range 10.9–63.3) months, 19 patients (23.5 %) presented a local and/or distant recurrence. In a multivariate analysis including the clinicopathologic parameters, the TLG of the primary tumor was associated with a worse disease-free survival after neoadjuvant CCRT (HR 20.035, 95 % CI 1.726–232.559; P = 00.017). The TLG of the primary tumor in the initial FDG-PET/CT can be considered as a prognostic factor for patients with locally advanced rectal cancer treated with neoadjuvant CCRT.

The effect of combinations of several deoxidizers, i.e., Mg-Al, Mg-Ti, Al-Ti, and Ce-Al, on the solidification structure of Fe-2 mass pct Ni-1 mass pct Mn-1 mass pct Mo alloy melt was investigated using a melt sampling and quenching method. Using this method, we evaluated the catalytic potency of several complex inclusion particles by taking the inclusion evolution process into account. Fine equiaxed crystals were obtained in the Mg-Ti-deoxidized steel wherein the MgO(MgAl2O4)-TiN complex compounds formed. However, the longer the holding time at high temperatures, the larger the fraction of Ti2O3, and very fine TiN formed because of microsegregation during solidification, resulting in poor equiaxed crystals. When the steel was deoxidized with Mg-Al, the initial structure was dominantly columnar. However, the longer the holding time, the larger the fraction of MgAl2O4 spinel, resulting in the formation of fine equiaxed crystals. Ce-Al complex deoxidation provided a relatively small portion of equiaxed crystals, whereas Ti-Al deoxidation produced the fewest equiaxed crystals because of the formation of alumina. The effectiveness of each inoculant particle for the crystallization of the primary δ-iron was explained well by the lattice disregistry concept.

Recently, a single-stapled technique (SST) was performed instead of the conventional double-stapled technique (DST) in laparoscopic low anterior resection for anastomosis, by placement of intracorporeal purse-string sutures on the distal rectum with transanal specimen extraction. This study aimed to compare the short-term outcomes between the two anastomotic techniques.Between July 2007 and April 2010, 60 patients underwent SST by laparoscopic or robotic procedure. These patients were matched 1:2 by age, gender, date of surgery, and tumor stage with 120 patients who underwent conventional DST in laparoscopic low anterior resection.The robotic-assisted operative approach was used more frequently in the SST group than in the DST group (61.7 % vs. 3.3 %, p 0.001). The mean operative time was 203.9 (range, 120-400) min for the SST group and 167.6 (range, 90-300) min for the DST group (p 0.001). For specimen removal, the transanal approach was used in the SST group, while the transabdominal approach was used for the DST group. The pain score (visual analogue scale) of the SST group was lower (4.5 vs. 5.6, p 0.001), although postoperative recovery was similar. Pathological examination revealed that the distal resection margin was significantly longer in the SST group (3.1 vs. 2.5 cm, p = 0.018). Postoperative morbidity including anastomotic leakage was similar in both groups.SST yielded equivalent short-term outcomes when compared to conventional DST and provided the advantages of minimal access and a longer distal resection margin. Therefore, SST in lower anterior resection may be a useful alternative to conventional DST.

We conducted a randomized clinical trial to investigate the efficacy of the selective α1A-adrenoceptor antagonist tamsulosin in preventing acute voiding difficulty after rectal cancer surgery. A total of 94 rectal cancer patients with an International Prostate Symptom Score (IPSS) of ≤7 were randomly assigned (1:1) to the tamsulosin group (0.2 mg/day orally for 7 days) (n = 47) or the control group (n = 47). The primary endpoint was the reinsertion rate of the urinary catheter after its removal on postoperative day (POD) 3. The secondary endpoints included the maximum (Qmax) and average (Qavg) urinary flow rates on POD 3, and the voided volume (VV), residual urine volume (RU), and IPSS on POD 7. Analyses were based on an intention-to-treat population. The reinsertion rate of the urinary catheter in the tamsulosin group was similar to that in the control group (23.4 vs. 21.3 %, respectively; p = 0.804). The postoperative voiding parameters and IPSS were not better in the tamsulosin group than in the control group after adjustments were made for the baseline measurements with analysis of covariance (Qmax, p = 0.537; Qavg, p = 0.399; VV, p = 0.645; RU, p = 0.703; IPSS, p = 0.761). Multivariate analysis revealed that being male was the only independent risk factor for reinsertion of the urinary catheter (odds ratio 0.239; 95 % confidence interval 0.069–0.823; p = 0.023). This controlled trial showed that tamsulosin at 0.2 mg/day does not prevent acute voiding difficulty after rectal cancer surgery.

To evaluate the technical feasibility, safety, and oncological outcomes of laparoscopic extended lateral pelvic lymph node dissection (LPLD) following total mesorectal excision (TME) in patients with advanced low rectal cancer. A review of a prospectively collected database at Kyungpook National University Hospital from May 2003 to September 2009 revealed a series of 16 consecutive laparoscopic TME with LPLD patients with preoperative diagnosis of lateral node metastasis. Data regarding patient demographics, operating time, perioperative blood loss, surgical morbidity, lateral lymph node status, functional outcome, and mid-term oncologic result were analyzed. In all 16 patients, the procedures were completed without conversion to open surgery. During the study period, robot-assisted laparoscopic LPLD was performed in two patients. Mean operative time was 321.9 min (range 220–510 min). The mean number of lateral lymph nodes harvested was 9.1 (range 3–19), and a total of nine patients (56.2%) had lymph node metastases. Postoperative mortality and morbidity were 0 and 31.2%, respectively. Recovery after the procedure was rapid, and mean hospital stay was 9.9 days (range 7–14 days). With median follow-up of 38 months, among nine patients who were lateral pelvic node positive, one patient experienced pelvic side-wall local recurrence (11.2%). Laparoscopic TME with LPLD is safe and feasible, with the advantage of a minimally invasive approach. Prospective controlled study comparing laparoscopy and conventional open surgery with long-term follow-up evaluation is needed to confirm the authors’ initial experience.

Microsatellite instability (MSI) is a molecular marker that can provide valuable prognostic information for colorectal cancer (CRC). However, the predictive role of the MSI status remains less clear than its role in prognostication due to mixed results from previous studies. Therefore, this study investigated the usefulness of the MSI status as a predictive factor for stage II or III CRC patients who received adjuvant doxifluridine therapy. Among 3030 patients with CRC who underwent surgical resection between 1997 and 2006, 564 patients were diagnosed with stage II or III, and adjuvant doxifluridine therapy was administered to 394 patients (70.0%). The MSI status was assessed using the markers BAT25 and BAT26, and samples with instability at both markers were scored as exhibiting high-frequency MSI (MSI-H). Among the 564 patients, 290 patients (51.4%) had stage II, and MSI-H was found in 41 patients (7.3%). With a median follow-up duration of 35.1 months (range, 0.5-135.2), the 5-year overall survival (OS) rate and relapse-free survival (RFS) rate were 87.5 and 76.2%, respectively. MSI-H showed a favorable survival trend for OS (P = 0.098) and significant survival benefit for RFS (P = 0.037) in all patients. In a univariate analysis, the doxifluridine-treated patients with MSI-H showed improved RFS compared to those with low or stable MSI (MSI-L/S) (P = 0.036), while the MSI status was not significantly associated with OS (P = 0.107). In a multivariate analysis, MSI-H was not significantly associated with RFS (Hazard ratio = 2.467, P = 0.125). In conclusion, this study confirmed the positive prognostic role of MSI-H. However, MSI-H patients with stage II or III CRC did not seem to benefit from doxifluridine adjuvant therapy.

Endothelial nitric oxide synthase (eNOS)-derived nitric oxide (NO) is involved in numerous physiologic and pathophysiologic process including tumor angiogenesis and apoptosis. Accordingly, the present study analyzed polymorphisms of eNOS gene and their impact on the prognosis for patients with colorectal cancer. Four hundred and forty-four consecutive patients with surgically resected colorectal adenocarcinoma were enrolled in the present study. The genomic DNA was extracted from fresh colorectal tissue and 2 polymorphisms of eNOS gene (eNOS T786C and eNOS G894T) determined using a real-time PCR genotyping assay. The 2 eNOS gene polymorphisms were successfully amplified, and the frequencies of each genotype are as follows [T786C: TT (82.2%), TC (16.9%), CC (0.9%); G894T: GG (82.0%), GT (17.3%), TT (0.7%)]. Multivariate survival analysis including stage, age, site of disease, and CEA level showed that these polymorphisms were not associated with survival. For the clinicopathologic parameters, CEA level and TNM stage were significant prognostic factors in a Cox model for survival. The eNOS gene polymorphisms investigated in this study were not found to be an independent prognostic marker for Korean patients with surgically resected colorectal cancer. However, further studies are warranted to clarify the role of the eNOS gene polymorphisms as a prognostic biomarker for colorectal patients with cancer.

The aim of this study is to compare short-term outcomes and surgical quality of robot-assisted (RAP) and laparoscopic (LAP) total mesorectal excision (TME) in patients with low rectal cancer.From December 2007 to June 2009, 41 consecutive patients with low rectal cancer underwent TME by robot-assisted procedures. The lowest tumor margins were below peritoneal reflection and 1.0-8.0 cm above the anal verge. These patients were matched 1:2 by age, gender, body mass index, date of surgery, American Society of Anesthesiologists score, and tumor stage, with 82 patients who underwent conventional LAP. Macroscopic quality of the specimens and operative and postoperative outcomes were compared.Mean operation time was 168.0 ± 49.3 min for LAP group and 231.9 ± 61.4 min for RAP group (P0.001). Time to regular diet (RAP, 6.7 days vs. LAP, 6.6 days) and length of stay (RAP, 9.9 days vs. LAP, 9.4 days) were similar. The proportion of surgeries performed with the modified natural orifice techniques (totally intracorporeal procedures with transanal or transvaginal retrieval of specimens) was significantly higher in the RAP group (RAP, 48.8% vs. LAP, 13.4%; P0.001). There were no between-group differences in specimen quality, including distal resection margins, harvested lymph nodes, and circumferential margins. The overall major complication rates were similar (RAP, 9.8% vs. LAP, 7.3%; P = 0.641).RAP was safe and effective for patients with low rectal cancer. Furthermore, the technical advantages of robot surgical systems may allow a novel approach using hybrid natural orifice surgery.

In recent years, robot-assisted surgery using the da Vinci System® has been proposed as an alternative to traditional open or laparoscopic procedures. The aim of this study was to compare the short-term outcomes for open, laparoscopic, and robot-assisted rectal resection for cancer. Two hundred sixty-three patients with rectal cancer who underwent curative resection between 2007 and 2009 were included. Patients were classified into an open surgery group (OS, n = 88), a laparoscopic surgery group (LAP, n = 123), and a robot-assisted group (RAP, n = 52). Data analyzed include operating time, length of recovery, methods of specimen extraction, quality of total mesorectal excision, and morbidity. The mean operating time was 233.8 ± 59.2 min for the OS group, 158.1 ± 49.2 min for the LAP group, and 232.6 ± 52.4 min for the RAP group (p

Anal incontinence is experienced by some patients with rectal cancer who received low anterior resection. This study was to examine the efficacy and adverse effects of the alpha-1 adrenergic agonist phenylephrine, which causes contraction of the internal anal sphincter and raises the resting pressure in these patients. Thirty-five patients with anal incontinence were treated with 30% phenylephrine or a placebo randomly allocated in a double-blind study. The efficacy of the drug was assessed by changes in the following standardized questionnaire scores: the fecal incontinence severity index (FISI), fecal incontinence quality of life (FIQL) scales, and a global efficacy question. Anal sphincter function was evaluated using anorectal manometry. Phenylephrine did not improve either the FISI score or any of the four FIQL scores. Five of 17 (29%) patients reported subjective improvement after phenylephrine compared with 4 of 12 (33%) using the placebo. The maximum resting anal pressure did not differ between baseline and after 4 weeks application of phenylephrine (30.0 to 27.3 mmHg). In the phenylephrine group, allergic dermatitis was developed in five patients and headache in two. In the patients with anal incontinence after low anterior resection for rectal cancer, phenylephrine gel did not seem to be helpful in relieving symptoms with some adverse effects.

Wide-ranging costs of laparoscopic surgery (LAP) are associated with variations in the experience levels of surgeons. There is no available report on the changes of economic outcomes relative to the LAP learning curve in the treatment of colorectal cancer. In the present study, we have compared changes in economic outcomes according to the LAP learning curve with the economic outcomes of open surgery (OS) for rectosigmoid cancer. A total of 197 patients with rectosigmoid cancer were included in this analysis; 116 received LAP and 81 received OS. Scatter of operative times demonstrated an early learning period of 37 cases in LAP. The following outcomes were compared between LAP and OS during the early learning period and experienced periods; operating room (OR) costs, OR-related hospital profit, total hospital charge, and patient payment. During the median interval of two periods according to the laparoscopic surgery learning curve, there was an inflation rate of about 10% on the medical charges such as operation, radiology, laboratory, and admission fee. Operating room costs were significantly higher after LAP during the two periods, but the median difference between LAP and OS decreased during the experienced period ($3,055 to $1,850). With increasing operative experience in LAP, the OR-related hospital deficit improved (−$1,072 to−$840). Total hospital charges were significantly higher for LAP than for OS in the early learning period (p 0.05). During the experienced period, patients paid a lower surcharge for LAP ($1,885–$1,118). Total hospital charges for laparoscopic surgery were substantially higher than those of open surgery during the early learning period, but become similar during the experienced period. The shortening of the learning period is a critical factor for achieving cost-effective laparoscopic surgery.

Reactive diffusion during isothermal annealing was examined in a Ti−Al−Si temary system. When a TiAl/TiSi2 reaction couple was annealed at 1373 K for 200 h, the product phase sequence was observed as TiAl/TiAl2/Ti2Al5/TiAl3/Ti5Si4/TiSi/TiSi2, in which the integrated diffusion coefficient of Ti2Al5 showed the lowest value. A Ti-rich Ti5Si3 phase appeared when an additional Ti flux was provided between the TiAl/TiSi2 reaction. The growth kinetics for both the TiAl/TiSi2 (direction reaction) and TiAl/Ti/TiSi2 reactions (Ti biased reaction) were identified, and a comparison of the morphology of the product phases was provided. The chemical potential variation and mass balance exhibited guidance in predicting the diffusion pathway during isothermal annealing. It appears that a biasing reaction (i.e., controlling component flux) is an effective tool for the phase selection and morphology changes during isothermal annealing.