48 results on '"Yih-Jong Chern"'
Search Results
2. Association between personality types and low anterior resection syndrome in rectal cancer patients following surgery
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Ting‐Yu Chiang, Yu‐Jen Hsu, Yih‐Jong Chern, Chun‐Kai Liao, Wen‐Sy Tsai, Pao‐Shiu Hsieh, Hung‐Chih Hsu, Yu‐Fen Lin, Hsiu‐Lan Lee, and Jeng‐Fu You
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LAR syndrome ,personality ,rectal cancer ,Type A ,Type D ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract Purpose Low anterior resection syndrome (LARS) has had many impacts on the lives of patients and substantial differences in emotional and social functions. The aim of this study was to investigate the correlation analysis of different personality traits in rectal cancer patients with LARS after undergoing curative surgery. Methods This study was designed as a prospective cohort study. The inclusion criteria included (1) participants diagnosed with rectal cancer who underwent surgical resection of malignant tumors and (2) ECOG 0–1. The primary outcome was the correlation between different personality traits and low anterior resection syndrome in rectal cancer patients after radical surgery. Low anterior resection syndrome incidence rates were estimated by questionnaires and personality groups by the Type A and Type D Scale‐14 Personality Inventory. Results For all 161 participants in this study, the presence of a tumor at the lower anal verge and the receipt of neoadjuvant CCRT had a statistically significant positive correlation with the LARS score at 1 month, 6 months, and 1 year (Pearson correlation coefficient = −0.283, −0.374, and − 0.205, respectively), with a p value of less than 0.05. Personalities with Type A, Type D, and Type D‐SI scores had a statistically significant positive correlation with LARS score at 1 month (Pearson correlation coefficient = 0.172, 0.162, and 0,164, p value = 0.03, 0.04, and 0.04). Conclusion Type A and Type D personalities are highly linked to LARS. Personalized support approaches can ultimately assist rectal cancer patients in overcoming difficulties after surgery and recovery and enhance their functional outcomes.
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- 2024
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3. Metformin increases pathological responses to rectal cancers with neoadjuvant chemoradiotherapy: a systematic review and meta-analysis
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I-Li Lai, Jeng-Fu You, Wen-Sy Tsai, Yu-Jen Hsu, Yih-Jong Chern, and Ming-Ying Wu
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Rectal cancer ,Neoadjuvant chemoradiotherapy ,Metformin ,Pathological response ,Diabetes mellitus ,Meta-analysis ,Surgery ,RD1-811 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract Background To summarize the chemo-radio effect of metformin in rectal cancers with neoadjuvant chemoradiotherapy on pathological response, tumor regression grade (TRG), and T/N downstaging. Methods PubMed, MEDLINE, Embase, and Cochrane Database of collected reviews were searched up to June 30, 2022. This study conducted systematic review and meta-analysis based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) sheet. Odds ratios (ORs) and confidence intervals (CIs) which calculated by random-effects models were displayed in forest plots. Newcastle–Ottawa scale was used to assess the risk of bias of the observational cohort studies. Results This systematic review and meta-analysis comprised eight cohorts out of seven studies, with 2294 patients in total. We performed two-way comparison for metformin in diabetic patients vs (1) non-metformin drugs in diabetic patients and (2) nondiabetic patients. In diabetes patient studies, the metformin group had a significantly increased pathological response on TRG (OR: 3.28, CI: 2.01–5.35, I 2 = 0%, p
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- 2023
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4. Potential short-term outcome advantage of low vs. high ligation of inferior mesenteric artery for sigmoid and rectal cancer: propensity score matching analysis
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Chia-Chen Hsu, Yu-Jen Hsu, Yih-Jong Chern, Bor-Kang Jong, Chun-Kai Liao, Pao-Shiu Hsieh, Wen-Sy Tsai, and Jeng-Fu You
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Colorectal cancer ,Inferior mesenteric artery ,Propensity score matching ,Low ligation ,Anastomosis leakage ,Surgery ,RD1-811 - Abstract
Abstract Background Whether to ligate the inferior mesenteric artery at its root during anterior resection for sigmoid colon or rectal cancer is still under debate. This study compared the surgical outcomes, postoperative recovery, and anastomotic leakage between high and low ligation of the inferior mesenteric artery through a subgroup analysis. Methods This was a retrospective analysis of prospectively collected data. All patients who underwent colorectal resection for rectosigmoid cancer between December 2016 and December 2019 were enrolled. According to the surgical ligation level of the inferior mesenteric artery, the patients were categorized into either the high or low ligation group. The investigated population was matched using the propensity score method. Results Overall, 894 patients with sigmoid or rectal cancer underwent elective anterior resection with high (577 patients) or low (317 patients) ligation of the inferior mesenteric artery. After the propensity score matching, 245 patients in each group were compared. High ligation of the inferior mesenteric artery was associated with higher incidence of anastomotic leakage (14.9% vs. 5.6%, P = 0.041) for mid- to low-rectum tumors and a higher incidence of complications (8.6% vs. 3.3%, P = 0.013) of grades 1–2 according to the Clavien–Dindo classification system. Conclusion Compared with high ligation, low ligation of the inferior mesenteric artery resulted in lower likelihood of morbidity and mortality in rectal and sigmoid cancers. Moreover, low ligation was less likely to result in anastomosis leakage in mid- to low-rectal cancers.
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- 2023
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5. Comparison of short-term and medium-term outcomes between intracorporeal anastomosis and extracorporeal anastomosis for laparoscopic left hemicolectomy
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Li-Ming Wang, Bor-Kang Jong, Chun-Kai Liao, Ya-Ting Kou, Yih-Jong Chern, Yu-Jen Hsu, Pao-Shiu Hsieh, Wen-Sy Tsai, and Jeng-Fu You
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Intracorporeal anastomosis ,Extracorporeal anastomosis ,Laparoscopy surgery ,Left hemicolectomy ,Disease-free survival ,Surgery ,RD1-811 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract Background Few studies have evaluated the feasibility and safety of intracorporeal anastomosis (IA) for left hemicolectomy. Here, we aimed to investigate the potential advantages and disadvantages of laparoscopic left hemicolectomy with IA and compare the short- and medium-term outcomes between IA and extracorporeal anastomosis (EA). Methods We retrospectively analyzed 133 consecutive patients who underwent laparoscopic left hemicolectomies from July 2016 to September 2019 and categorized them into the IA and EA groups. Patients with stage 4 disease and conversion to laparotomy or those lost to follow-up were excluded. Postoperative outcomes between IA and EA groups were compared. Short-term outcomes included postoperative pain score, bowel function recovery, complications, duration of hospital stay, and pathological outcome. Medium outcomes included overall survival and disease-free survival for at least 2 years. Results After excluding ineligible patients, the remaining 117 underwent IA (n = 40) and EA (n = 77). The IA group had a shorter hospital stay, a shorter time to tolerate liquid or soft diets, and higher serum C-reactive protein level on postoperative day 3. There was no difference between two groups in operative time, postoperative pain, specimen length, or nearest margin. A 2-year overall survival (IA vs. EA: 95.0% vs. 93.5%, p = 0.747) and disease-free survival (IA vs. EA: 97.5% vs. 90.9%, p = 0.182) rates were comparable between two groups. Conclusions Laparoscopic left hemicolectomy with IA was technically feasible, with better short-term outcomes, including shorter hospital stays and shorter time to tolerate liquid or soft diets. The IA group had higher postoperative serum C-reactive protein level; however, no complications were observed. Regarding medium-term outcomes, the overall survival and disease-free survival rates were comparable between IA and EA procedures.
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- 2022
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6. Neoadjuvant Short-Course Radiotherapy Followed by Consolidation Chemotherapy before Surgery for Treating Locally Advanced Rectal Cancer: A Systematic Review and Meta-Analysis
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Chun-Kai Liao, Ya-Ting Kuo, Yueh-Chen Lin, Yih-Jong Chern, Yu-Jen Hsu, Yen-Lin Yu, Jy-Ming Chiang, Pao-Shiu Hsieh, Chien-Yuh Yeh, and Jeng-Fu You
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rectal cancer ,short course radiotherapy ,consolidation chemotherapy ,pathological complete response ,overall survival ,disease free survival ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Neoadjuvant short course radiotherapy (SCRT) followed by consolidation chemotherapy (CCT) is an alternative treatment for locally advanced rectal cancer (LARC). We performed this systematic review and meta-analysis to explore the tumor response and oncological outcomes of this new approach compared to conventional chemoradiotherapy (CRT). An online search of the PubMed, Embase, and Cochrane Library databases was performed. This review included 7507 patients from 14 different cohorts. The pCR rate was higher with SCRT + CCT than that with CRT (RR: 1.60; 95% CI: 1.35–1.91; p < 0.01). SCRT + CCT provided a higher ypN0 response (RR: 1.06; 95% CI: 1.01–1.12; p = 0.02). There were no differences in R0 resection and positive CRM rates; however, more sphincter-preservation surgeries were performed in the SCRT + CCT arm (RR: 1.06; 95% CI: 1.01–1.11; p = 0.02). There was no difference in the OS and DFS between the SCRT + CCT and the CRT arms (OS: HR: 0.85, p = 0.07; DFS: HR: 0.88, p = 0.08). The compliance and toxicity were comparable between the SCRT and CRT groups. In the subgroup analysis, patients who underwent four or more cycles of CCT had better pCR and DFS events. Therefore, SCRT followed by consolidation chemotherapy might be an effective alternative treatment for LARC.
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- 2022
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7. Advantage of laparoscopic surgery in patients with generalized obesity operated for colorectal malignancy: A retrospective cohort study
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Yen-Lin Yu, Yu-Jen Hsu, Chun-Kai Liao, Yueh-Chen Lin, Jeng-Fu You, Wen-Sy Tsai, Bor-Kang Jong, and Yih-Jong Chern
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laparoscopic surgery ,obesity ,BMI ,colorectal cancer ,minimal invasive surgery ,Surgery ,RD1-811 - Abstract
BackgroundBecause of the progression of minimally invasive surgery skills and obesity in colorectal surgery, we aimed to evaluate the short-term outcomes of colorectal cancer resections in patients with generalized obesity at a single teaching hospital with mature surgical techniques and training programs.MethodsA total of 537 patients were diagnosed with CRC and had a body mass index ≥30 kg/m2 between January 2009 and December 2019 at a single institution. 265 patients underwent open surgery and 272 patients underwent laparoscopic surgery. Data were analysed to explore the independent risk factors for postoperative complications.ResultsThe laparoscopic group had less blood loss (73 ± 128 vs. 148 ± 290 ml, p
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- 2023
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8. Localization of Colorectal Cancer Lesions in Contrast-Computed Tomography Images via a Deep Learning Approach
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Prasan Kumar Sahoo, Pushpanjali Gupta, Ying-Chieh Lai, Sum-Fu Chiang, Jeng-Fu You, Djeane Debora Onthoni, and Yih-Jong Chern
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colorectal cancer ,deep learning ,localization ,computed tomography ,Technology ,Biology (General) ,QH301-705.5 - Abstract
Abdominal computed tomography (CT) is a frequently used imaging modality for evaluating gastrointestinal diseases. The detection of colorectal cancer is often realized using CT before a more invasive colonoscopy. When a CT exam is performed for indications other than colorectal evaluation, the tortuous structure of the long, tubular colon makes it difficult to analyze the colon carefully and thoroughly. In addition, the sensitivity of CT in detecting colorectal cancer is greatly dependent on the size of the tumor. Missed incidental colon cancers using CT are an emerging problem for clinicians and radiologists; consequently, the automatic localization of lesions in the CT images of unprepared bowels is needed. Therefore, this study used artificial intelligence (AI) to localize colorectal cancer in CT images. We enrolled 190 colorectal cancer patients to obtain 1558 tumor slices annotated by radiologists and colorectal surgeons. The tumor sites were double-confirmed via colonoscopy or other related examinations, including physical examination or image study, and the final tumor sites were obtained from the operation records if available. The localization and training models used were RetinaNet, YOLOv3, and YOLOv8. We achieved an F1 score of 0.97 (±0.002), a mAP of 0.984 when performing slice-wise testing, 0.83 (±0.29) sensitivity, 0.97 (±0.01) specificity, and 0.96 (±0.01) accuracy when performing patient-wise testing using our derived model YOLOv8 with hyperparameter tuning.
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- 2023
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9. Deciding the operation type according to mismatch repair status among hereditary nonpolyposis colorectal cancer patients: should a tailored approach be applied, or does one size fit all?
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Chun-Kai Liao, Yueh-Chen Lin, Yu-Jen Hsu, Yih-Jong Chern, Jeng-Fu You, and Jy-Ming Chiang
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HNPCC ,MMR status ,Extended colectomy ,Metachronous CRC ,Overall survival ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 ,Genetics ,QH426-470 - Abstract
Abstract Background Although extended colectomy (EC) was recommended for HNPCC patients, previous studies did not show significantly improved overall survival. Immunohistochemical (IHC) stain of mismatch repair (MMR) gene protein expression is now a feasible and reliable test clinically. Therefore, we tried to investigate whether we could use MMR IHC stain to select operation types in HNPCC patients. Patients and methods Between 1995 and 2013, 186 HNPCC patients were collected. Status of MMR protein expression, perioperative clinic-pathological variables and post-operative follow up status were analyzed by multivariate analyses. Results Sixty-five percent (121 of 186) patients of these HNPCC patients demonstrated loss of at least one MMR protein. There were several significant differences existing between deficient MMR (dMMR) and proficient MMR (pMMR) subgroups in terms of clinic-pathological characteristics. With the average follow-up duration of 93.9 months, we observed significantly high risk of developing metachronous CRC between SC and EC subgroups (crude rate 8.5% vs. 0%, p = 0.035). However, no significant difference was observed among the presence of extra-colonic tumors (12.4% vs. 5.8%, p = 0.284). The positive and negative prediction rate of metachronous CRC in dMMR subgroup was 12.8 and 87.2% while 1.9 and 98.1% in the pMMR subgroup. Survival outcomes were significantly affected by MMR status and resection types by multivariate analysis. Significantly better OS in dMMR subgroup (HR = 0.479, 95% CI: 0.257–0.894, p = 0.021) comparing with pMMR subgroup was observed. However, significant improved DFS (HR = 0.367, 95% CI: 0.172–.0787, p = 0.010) but not significant for OS (HR = 0.510, 95% CI: 0.219–1.150, p = 0.103) for EC subgroup compared with SC subgroup. Differences existing among different subgroups by combing extent of resection and MMR status. In dMMR subgroup, SC, compared with EC, demonstrated significantly worse DFS by multivariate analyses (HR = 3.526, 95% CI: 1.346–9.236, p = 0.010) but not for OS (HR = 2.387, 95% CI: 0.788–7.229, p = 0.124), however, no significantly differences of OS and DFS in pMMR subgroup between SC and EC were found. Conclusions Significantly better overall survival and higher rate of metachronous CRC exist in dMMR subgroup of HNPCC patients comparing with pMMR subgroup. Extended colectomy significantly improved DFS and was thus recommended for dMMR subgroup but not pMMR subgroup of HNPCC patients.
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- 2021
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10. Prognostic value of the C-reactive protein to albumin ratio in colorectal cancer: an updated systematic review and meta-analysis
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Chun-Kai Liao, Yen-Lin Yu, Yueh-Chen Lin, Yu-Jen Hsu, Yih-Jong Chern, Jy-Ming Chiang, and Jeng-Fu You
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C-reactive protein to albumin ratio ,Colorectal cancer ,Meta-analysis ,Overall survival ,Disease-free survival ,Surgery ,RD1-811 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract Backgrounds The inflammatory biomarker “C-reactive protein to albumin ratio (CAR)” has been reported to significantly correlate to a variety of human cancers. However, there are conflicting results regarding the prognostic value of CAR in colorectal cancer. Previous studies mainly assessed patients in Eastern countries, so their findings may not be applicable to the Western population. Therefore, this updated meta-analysis aimed to investigate the prognostic value of pre-treatment CAR and outcomes of patients with colorectal cancer. Methods We conducted a systematic search for eligible literature until October 31, 2020, using PubMed and Embase databases. Studies assessing pre-treatment CAR and outcomes of colorectal cancer were included. Outcome measures included overall survival, disease-free survival, progression-free survival, and clinicopathological features. The pooled hazard ratios (HR) with 95% confidence intervals (CI) were used as effective values. Results A total of 15 studies involving 6329 patients were included in this study. The pooled results indicated that a high pre-treatment CAR was associated with poor overall survival (HR 2.028, 95% CI 1.808−2.275, p < 0.001) and poor disease-free survival/progression-free survival (HR 1.768, 95% CI 1.321–2.365, p < 0.001). Subgroup analysis revealed a constant prognostic value of the pre-treatment CAR despite different study regions, sample size, cancer stage, treatment methods, or the cut-off value used. We also noted a correlation between high pre-treatment CAR and old age, male sex, colon cancer, advanced stage (III/IV), large tumor size, poor differentiation, elevated carcinoembryonic antigen levels, neutrophil-to-lymphocyte ratio, and the modified Glasgow prognostic score. Conclusions High pre-treatment CAR was associated with poor overall survival, disease-free survival, and progression-free survival in colorectal cancer. It can serve as a prognostic marker for colorectal cancer in clinical practice.
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- 2021
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11. Prognostic value of regional lymph node involvement in patients with metastatic colorectal cancer: palliative versus curative resection
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Ya-Ting Kuo, Wen-Sy Tsai, Hsin-Yuan Hung, Pao-Shiu Hsieh, Sum-Fu Chiang, Cheng-Chou Lai, Yih-Jong Chern, Yu-Jen Hsu, and Jeng-Fu You
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Surgery ,RD1-811 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract Background Approximately 20% of patients with colorectal cancer are initially diagnosed with stage IV disease. This study aims to examine the role of regional lymph node (LN) status in metastatic colorectal cancer (mCRC) with respect to clinicopathologic features and survival outcomes. Methods We investigated 1147 patients diagnosed with mCRC and had undergone surgical resection of the primary CRC. A total of 167 patients were placed in the LN-negative (LN−) group and another 980 in the LN-positive (LN+) group. Results LN+ patients exhibited a significantly higher rate of T4 tumors (p = 0.008), poorly differentiated adenocarcinoma (p < 0.001), lymphovascular invasion (p < 0.001), and perineural invasion (p < 0.001) than those in the LN− group. LN− patients had a significantly higher rate of lung metastasis (p < 0.001), whereas the rate of peritoneal seeding (p < 0.001) and systemic node metastasis (p < 0.001) was both significantly higher in the LN+ group. The 5-year overall survival (OS) in the LN+ group was significantly poorer than that in the LN− group (LN− vs. LN+ 23.2% vs. 18.1%; p = 0.040). In patients with curative resection, the 5-year OS rate has no significant difference between the two groups (LN− vs. LN+ 19.5% vs. 24.3%; p = 0.890). Conclusions Metastatic CRC patients with LN+ who underwent primary tumor resection may present with more high-risk pathological features, more peritoneal seeding, and systemic node metastasis, but less lung metastasis than LN− patients. LN+ patients had poorer long-term outcomes compared with that in LN− patients. Nevertheless, with curative resection, LN+ patients could have similar survival outcomes as LN− patients.
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- 2021
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12. The risk factors of local recurrence and distant metastasis on pT1/T2N0 mid-low rectal cancer after total mesorectal excision
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I-Li Lai, Jeng-Fu You, Yih-Jong Chern, Wen-Sy Tsai, Jy-Ming Chiang, Pao-Shiu Hsieh, Hsin-Yuan Hung, and Yu-Jen Hsu
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Rectal cancer ,Local recurrence ,Distant metastasis ,Radical resection ,Total mesorectal excision ,Surgery ,RD1-811 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract Background Radical resection is associated with good prognosis among patients with cT1/T2Nx rectal cancer. However, still some of the patients experienced cancer recurrence following radical resection. This study tried to identify the postoperative risk factors of local recurrence and distant metastasis separately. Methods This retrospective, single-center study comprised of 279 consecutive patients from Linkou branch of Chang Gung Memorial Hospital in 2005–2016 with rectal adenocarcinoma, pT1/T2N0M0 at distance from anal verge ≤ 8cm, who received curative radical resection. Results The study included 279 patients with pT1/pT2N0 mid-low rectal cancer with median follow-up of 73.5 months. Nineteen (6.8%) patients had disease recurrence in total. Nine (3.2%) of them had local recurrence, and fourteen (5.0%) of them had distant metastasis. Distal resection margin < 0.9 (cm) (hazard ratio = 4.9, p = 0.050) was the risk factor of local recurrence. Preoperative carcinoembryonic antigen (CEA) ≥ 5 ng/mL (hazard ratio = 9.3, p = 0.0003), lymph node yield (LNY) < 14 (hazard ratio = 5.0, p = 0.006), and distal resection margin < 1.4cm (hazard ratio = 4.0, p = 0.035) were the risk factors of distant metastasis. Conclusion For patients with pT1/pT2N0 mid-low rectal cancer, current multidisciplinary treatment brings acceptable survival outcome. Insufficient distal resection margin attracted the awareness of risk factors for local recurrence and distant metastasis as a foundation for future research.
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- 2021
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13. Short- and medium-term outcomes of intracorporeal versus extracorporeal anastomosis in laparoscopic right colectomy: a propensity score-matched study
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Chun-Kai Liao, Yih-Jong Chern, Yueh-Chen Lin, Yu-Jen Hsu, Jy-Ming Chiang, Wen-Sy Tsai, Pao-Shiu Hsieh, Hsin-Yuan Hung, Chien-Yuh Yeh, and Jeng-Fu You
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Right hemicolectomy ,Laparoscopic surgery ,Propensity score ,Resection margin ,Intracorporeal anastomosis ,Peritoneal recurrence ,Surgery ,RD1-811 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract Backgrounds Though better short-term outcomes were frequently reported, differences in specimen parameters and the rate of subsequent peritoneal recurrence between intracorporeal anastomosis (IA) and extracorporeal anastomoses (EA) for laparoscopic right hemicolectomy have not been analyzed. We aimed to compare the pathologic differences and oncological outcomes between these two approaches. Methods We retrospectively analyzed 217 consecutive patients who underwent laparoscopic right hemicolectomies from September 2016 to April 2018 and classified them into IA and EA groups, based on the approach used. Propensity score matching analysis was performed, after which 101 patients were included in each group with the patients matched for demographics, tumor stage, and localization. Results The IA group had a longer operative time, shorter length of stay, shorter time to first flatus and tolerating a soft diet, and better pain scale scores at postoperative day 3. No inter-group differences in conversion, postoperative complication, mortality, or readmission rates were found. The IA group had a longer resected colon length (23.67 vs. 19.75 cm, p = 0.010) and nearest resected margin (7.51 vs. 5.40 cm, p = 0.010) for cancer near the hepatic flexure. There are comparable 3-year overall survival (87.7% vs. 89.6%, p = 0.604) and disease-free survival (75.0% vs. 75.7%, p = 0.842) between the IA and EA groups. The rate of peritoneal recurrence was similar between the two groups (5.9% vs. 7.9%, p = 0.580). Conclusions The overall survival, disease-free survival, and the rate of peritoneal recurrence were comparable between the IA and EA procedures. IA ensures better recovery and comparable complications to EA and achieved a more precise tumor excision; thus, IA can be considered a safe procedure for patients with right-sided colon lesions.
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- 2021
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14. Skin Toxicity as a Predictor of Survival in Metastatic Colorectal Cancer Patients Treated with Anti-EGFR: Fact or Fallacy?
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Ting-Yu Chiang, Hung-Chih Hsu, Yih-Jong Chern, Chun-Kai Liao, Yu-Jen Hsu, Wen-Sy Tsai, Pao-Shiu Hsieh, Yu-Fen Lin, Hsiu-Lan Lee, and Jeng-Fu You
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metastatic CRC ,mCRC ,skin toxicity ,survival ,anti-EGFR ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
The primary treatment for metastatic colorectal cancer (mCRC) consists of targeted therapy and chemotherapy to improve survival. A molecular target drug with an anti-epidermal growth factor receptor (EGFR) antagonist is recommended when the RAS and BRAF genes are normal. About 50–70% of patients using anti-EGFR antagonists will experience skin reactions. Some studies have shown that severe skin reactions caused by anti-EGFR antagonists may be linked to overall survival (OS) and progression-free survival (PFS), but the results are still uncertain. These data of mCRC patients who underwent anti-EGFR therapy between October 2017 and October 2018 were analyzed retrospectively. A total of 111 patients were included in this study. The survival results showed that gender, age, body mass index, primary tumor site, and recurrence did not significantly affect OS and PFS. However, the first-line anti-EGFR inhibitor treatment was significantly associated with OS (p < 0.001) and PFS (p < 0.001). There was no significant difference in the incidence of acne between males and females in grades 1 and 2, while males have a greater risk in grades 3 and 4 than females (20.3 vs. 4.8%; p-value = 0.041). Skin toxicity was not a predictor of anti-EGFR treatment response in this investigation.
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- 2023
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15. Survival analysis of local excision vs total mesorectal excision for middle and low rectal cancer in pT1/pT2 stage and intermediate pathological risk
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I-Li Lai, Jeng-Fu You, Yih-Jong Chern, Wen-Sy Tsai, Jy-Ming Chiang, Pao-Shiu Hsieh, Hsin-Yuan Hung, Chien-Yuh Yeh, Sum-Fu Chiang, Cheng-Chou Lai, Rei-Ping Tang, Jinn-Shiun Chen, and Yu-Jen Hsu
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Rectal cancer ,Local excision ,Total mesorectal excision ,Chemoradiation ,Sphincter-sparing surgery ,Surgery ,RD1-811 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract Background Local excision (LE) is a feasible treatment approach for rectal cancers in stage pT1 and presents low pathological risk, whereas total mesorectal excision (TME) is a reasonable treatment for more advanced cancers. On the basis of the pathology findings, surgeons may suggest TME for patients receiving LE. This study compared the survival outcomes between LE with/without chemoradiation and TME in mid and low rectal cancer patients in stage pT1/pT2, with highly selective intermediate pathological risk. Methods This retrospective study included 134 patients who received TME and 39 patients who underwent LE for the treatment of intermediate risk (pT1 with poor differentiation, lymphovascular invasion, perineural invasion, relatively large tumor, or small-sized pT2 tumor) rectal cancer between 1998 and 2016. Results Overall survival (OS), disease-free survival (DFS), and cumulative recurrence rate (CRR) were similar between the LE (3-year DFS 92%) and TME (3-year DFS 91%) groups. Following subgrouping into an LE with adjuvant therapy group and a TME without adjuvant therapy group, the compared survival outcomes (OS, DFS, and CRR) were found not to be statistically different. The temporary and permanent ostomy rates were higher in the TME group than in the LE group (p < 0.001). Rates of early and late morbidity following surgery were higher in the TME group (p = 0.005), and LE had similar survival compared with TME. Conclusion For patients who had mid and low rectal cancer in stage pT1/pT2 and intermediate pathological risk, LE with chemoradiation presents an alternative treatment option for selected patients.
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- 2019
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16. Preoperative Cancer Inflammation Prognostic Index as a Superior Predictor of Short- and Long-Term Outcomes in Patients with Stage I–III Colorectal Cancer after Curative Surgery
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Jeng-Fu You, Yu-Jen Hsu, Yih-Jong Chern, Ching-Chung Cheng, Bor-Kang Jong, Chun-Kai Liao, Pao-Shiu Hsieh, Hung-Chih Hsu, and Wen-Sy Tsai
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colorectal cancer ,cancer inflammation prognostic index ,carcinoembryonic antigen ,neutrophil-to-lymphocyte ratio ,survival ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Inflammatory reactions play a crucial role in cancer progression and may contribute to systemic inflammation. In routine clinical practice, some inflammatory biomarkers can be utilized as valuable predictors for colorectal cancer (CRC). This study aims to determine the usefulness of a novel cancer-inflammation prognostic index (CIPI) marker derived from calculating carcinoembryonic antigen (CEA) multiplied by the neutrophil-to-lymphocyte ratio (NLR) values established for non-metastatic CRCs. Between January 1995 and December 2018, 12,092 patients were diagnosed with stage I to III primary CRC and had radical resection—they were all included in this study for further investigation. There were 5996 (49.6%) patients in the low-CIPI group and 6096 (50.4%) patients in the high-CIPI group according to the cutoff value of 8. For long-term outcomes, the high-CIPI group had a significantly higher incidence of recurrence (30.6% vs. 16.0%, p < 0.001) and worse relapse-free survival (RFS) and overall survival (OS) rates (p < 0.001). High CIPI was an independent prognostic factor for RFS and OS in univariate and multivariate analyses. This research is the first to document the independent significance of CIPI as a prognostic factor for CRC. To ensure that it works, this CIPI needs to be tested on more CRC prediction models.
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- 2022
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17. The Nuts and Bolts of Implementing a Modified ERAS Protocol for Minimally Invasive Colorectal Surgery: Group Practice vs. Solo Practice
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Zhen-Hao Yu, Yih-Jong Chern, Yu-Jen Hsu, Bor-Kang Jong, Wen-Sy Tsai, Pao-Shiu Hsieh, Ching-Chung Cheng, and Jeng-Fu You
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colorectal cancer ,enhanced recovery after surgery ,group practice ,minimally invasive surgery ,Medicine - Abstract
AIM: The ERAS protocol consists of multiple items that aim to improve the outcomes of patients receiving surgery. Adhering to the protocol is difficult. We wondered whether surgeons practicing the ERAS protocol in a group would improve patient outcomes. Methods: All patients who underwent colorectal resection for benign disease or malignancy from November 2017 to December 2018 were collected and reviewed retrospectively. According to the physician’s ward round strategy, the patients were categorized into two groups, either by solo practice or group practice. Results: This study enrolled 724 patients and divided them into two groups according to the practice method: group practice (n = 256) and solo practice (n = 468). The group practice cohort had less postoperative morbidity (14.0% vs. 21.4%, p = 0.048) and shorter postoperative hospital stays (mean: 6.6 ± 3.2 vs. 8.6 ± 5.5, p < 0.05) than the solo practice cohort. Group practice (p < 0.001), natural orifice specimen extraction (NOSE) procedure (p < 0.001), and blood loss >50 mL (p = 0.039) significantly affected discharge within 5 days postoperatively in multivariate analyses. Conclusions: Group practice based on a modified ERAS protocol shortens postoperative hospital stays with fewer morbidities compared with solo practice in which patients receive elective minimally invasive colorectal surgery.
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- 2022
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18. Transanal Total Mesorectal Excision (TaTME) versus Laparoscopic Total Mesorectal Excision for Lower Rectal Cancer: A Propensity Score-Matched Analysis
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Yueh-Chen Lin, Ya-Ting Kuo, Jeng-Fu You, Yih-Jong Chern, Yu-Jen Hsu, Yen-Lin Yu, Jy-Ming Chiang, Chien-Yuh Yeh, Pao-Shiu Hsieh, and Chun-Kai Liao
- Subjects
transanal total mesorectal excision (TaTME) ,rectal cancer ,local recurrence ,disease free survival ,overall survival ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Studies have reported positive short-term and histopathological results of transanal total mesorectal excision (TaTME) for mid-low rectal cancer. The long-term oncological outcomes are diverse, and concerns regarding the high local recurrence (LR) rate of TaTME have recently increased. We retrospectively analyzed 298 consecutive patients who underwent Laparoscopic TME (LapTME) or TaTME between January 2015 and December 2019. Propensity score-matching (PSM) was performed with patients matched for demographics and stage. After PSM, 63 patients were included in each group. The TaTME group had a longer mean operative time (394 vs. 333 min, p < 0.001). The blood loss, diverting stoma rate, and conversion rate were similar. Postoperatively, TaTME and LapTME had compatible complications, recovery, and hospital stay. A similar specimen quality was detected in both groups. After a mean follow-up period of 41–47 months, TaTME had less LR than LapTME (9.5% vs. 23.8%, p = 0.031). The 3-year overall survival was 80.3% in the TaTME group and 73.6% in the LapTME group (p = 0.331). The 3-year disease-free survival (DFS) rate was 72.0% in the TaTME group and 56.6% in the LapTME group (p = 0.038). In conclusion, better DFS and fewer LR events were observed after TaTME; thus, TaTME can be considered a safe and feasible approach in patients with low rectal cancer.
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- 2022
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19. Tegafur–Uracil/Leucovorin Plus Oxaliplatin (TEGAFOX) as Consolidation Regimen after Short-Course Radiotherapy Is Effective for Locally Advanced Rectal Cancer
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Chun-Kai Liao, Ya-Ting Kuo, Yih-Jong Chern, Yu-Jen Hsu, Yueh-Chen Lin, Yen-Lin Yu, Pao-Shiu Hsieh, Jy-Ming Chiang, Chien-Yuh Yeh, and Jeng-Fu You
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short-course radiotherapy ,locally advanced rectal cancer ,consolidation chemotherapy ,neoadjuvant rectal score ,TEGAFOX ,FOLFOX ,Medicine - Abstract
This study aimed to explore the safety and efficacy of neoadjuvant SCRT and tegafur–uracil/leucovorin plus oxaliplatin (TEGAFOX) for LARC in comparison to those of the modified 5-fluorouracil, leucovorin, and oxaliplatin (mFOLFOX-6) regimen. We retrospectively evaluated 15 and 22 patients with LARC who underwent SCRT, followed by consolidation chemotherapy with TEGAFOX and mFOLFOX-6 before surgery, respectively, between January 2015 and December 2019. The primary endpoint was the tumor response rate. The secondary endpoints were compliance, toxicity, complications, overall survival (OS), and disease-free survival (DFS). The dose reduction rate was lower in the TEGAFOX group (0 vs. 9.1% (n = 2)). No grade III-IV toxicities occurred in the TEGAFOX group. Two and four patients in the TEGAFOX and mFOLFOX-6 groups, respectively, achieved clinical complete responses. The pathologic complete response rate was lower in the TEGAFOX group (7.7% vs. 17.6%). Overall, 11 (73.3%) and 17 (81.0%) patients had a neoadjuvant rectal (NAR) score of p = 0.884) and 3-year DFS (72% vs. 71.6%, p = 0.824) rates. TEGAFOX, as consolidation chemotherapy after SCRT, achieves good tumor downstaging and patient compliance in LARC. The toxicity, complications, and surgical outcomes are similar to those of mFOLFOX-6. Thus, TEGAFOX can be considered a chemotherapy option for rectal cancer treatment.
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- 2022
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20. Decreasing Postoperative Pulmonary Complication Following Laparoscopic Surgery in Elderly Individuals with Colorectal Cancer: A Competing Risk Analysis in a Propensity Score–Weighted Cohort Study
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Yih-Jong Chern, Jeng-Fu You, Ching-Chung Cheng, Jing-Rong Jhuang, Chien-Yuh Yeh, Pao-Shiu Hsieh, Wen-Sy Tsai, Chun-Kai Liao, and Yu-Jen Hsu
- Subjects
colorectal cancer ,elderly ,laparoscopy surgery ,outcome ,propensity score ,competing risk ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Advanced age is a risk factor for major abdominal surgery due to a decline in physical function and increased comorbidities. Although laparoscopic surgery provides good results in most patients with colorectal cancer (CRC), its effect on elderly patients remains unclear. This study aimed to compare the short- and long-term outcomes between open and laparoscopic surgeries in elderly patients with CRC. Total 1350 patients aged ≥75 years who underwent curative resection for stage I–III primary CRC were enrolled retrospectively and were divided into open surgery (846 patients) and laparoscopy (504 patients) groups. After propensity score weighting to balance an uneven distribution, a competing risk analysis was used to analyze the short-term and long-term outcomes. Postoperative mortality rates were lower in the laparoscopy group, especially due to pulmonary complications. Postoperative hospital stay was significantly shorter in the laparoscopy group than in the open surgery group. Overall survival, disease-free survival, and competing risk analysis showed no significant differences between the two groups. Laparoscopic surgery for elderly patients with CRC significantly decreased pulmonary-related postoperative morbidity and mortality in this large cohort study. Laparoscopic surgery is a favorable method for elderly patients with CRC than open surgery in terms of less hospital stay and similar oncological outcomes.
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- 2021
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21. The Clinical Utility of the Geriatric Nutritional Risk Index in Predicting Postoperative Complications and Long-Term Survival in Elderly Patients with Colorectal Cancer after Curative Surgery
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Chun-Kai Liao, Yih-Jong Chern, Yu-Jen Hsu, Yueh-Chen Lin, Yen-Lin Yu, Jy-Ming Chiang, Chien-Yuh Yeh, and Jeng-Fu You
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geriatric nutritional risk index (GNRI) ,colorectal cancer ,complication ,prognosis ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Research on the relationship between the geriatric nutritional risk index (GNRI) and postoperative complications/oncological outcomes in elderly colorectal cancer (CRC) patients is limited. This study investigated the prognostic value of the GNRI in aged CRC patients. We retrospectively analyzed 1206 consecutive CRC patients aged over 75 years who underwent curative-intent surgery from January 2008 to December 2015 and categorized them into high GNRI (≥98) and low GNRI (p = 0.037). Surgical site infection, wound dehiscence and pneumonia were more common in patients with GNRI < 98. Survival analysis showed significantly worse overall survival and disease-free survival in the low GNRI group (both p < 0.001). In the multivariate analysis, GNRI < 98 was an independent risk factor for OS (HR: 1.329, p = 0.031) and DFS (HR: 1.312, p = 0.034). Thus, preoperative GNRI can be effectively used to predict postoperative complications and long-term survival in elderly CRC patients after curative surgery.
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- 2021
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22. Colon Tissues Classification and Localization in Whole Slide Images Using Deep Learning
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Pushpanjali Gupta, Yenlin Huang, Prasan Kumar Sahoo, Jeng-Fu You, Sum-Fu Chiang, Djeane Debora Onthoni, Yih-Jong Chern, Kuo-Yu Chao, Jy-Ming Chiang, Chien-Yuh Yeh, and Wen-Sy Tsai
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convolutional neural networks ,colon cancer ,primary tumor ,deep learning ,transfer learning ,classification ,Medicine (General) ,R5-920 - Abstract
Colorectal cancer is one of the leading causes of cancer-related death worldwide. The early diagnosis of colon cancer not only reduces mortality but also reduces the burden related to the treatment strategies such as chemotherapy and/or radiotherapy. However, when the microscopic examination of the suspected colon tissue sample is carried out, it becomes a tedious and time-consuming job for the pathologists to find the abnormality in the tissue. In addition, there may be interobserver variability that might lead to conflict in the final diagnosis. As a result, there is a crucial need of developing an intelligent automated method that can learn from the patterns themselves and assist the pathologist in making a faster, accurate, and consistent decision for determining the normal and abnormal region in the colorectal tissues. Moreover, the intelligent method should be able to localize the abnormal region in the whole slide image (WSI), which will make it easier for the pathologists to focus on only the region of interest making the task of tissue examination faster and lesser time-consuming. As a result, artificial intelligence (AI)-based classification and localization models are proposed for determining and localizing the abnormal regions in WSI. The proposed models achieved F-score of 0.97, area under curve (AUC) 0.97 with pretrained Inception-v3 model, and F-score of 0.99 and AUC 0.99 with customized Inception-ResNet-v2 Type 5 (IR-v2 Type 5) model.
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- 2021
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23. A Prediction Model for Metachronous Peritoneal Carcinomatosis in Patients with Stage T4 Colon Cancer after Curative Resection
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Tzong-Yun Tsai, Jeng-Fu You, Yu-Jen Hsu, Jing-Rong Jhuang, Yih-Jong Chern, Hsin-Yuan Hung, Chien-Yuh Yeh, Pao-Shiu Hsieh, Sum-Fu Chiang, Cheng-Chou Lai, Jy-Ming Chiang, Reiping Tang, and Wen-Sy Tsai
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T4 colon cancer ,metachronous peritoneal carcinomatosis ,prediction model ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
(1) Background: The aim of this study was to develop a prediction model for assessing individual mPC risk in patients with pT4 colon cancer. Methods: A total of 2003 patients with pT4 colon cancer undergoing R0 resection were categorized into the training or testing set. Based on the training set, 2044 Cox prediction models were developed. Next, models with the maximal C-index and minimal prediction error were selected. The final model was then validated based on the testing set using a time-dependent area under the curve and Brier score, and a scoring system was developed. Patients were stratified into the high- or low-risk group by their risk score, with the cut-off points determined by a classification and regression tree (CART). (2) Results: The five candidate predictors were tumor location, preoperative carcinoembryonic antigen value, histologic type, T stage and nodal stage. Based on the CART, patients were categorized into the low-risk or high-risk groups. The model has high predictive accuracy (prediction error ≤5%) and good discrimination ability (area under the curve >0.7). (3) Conclusions: The prediction model quantifies individual risk and is feasible for selecting patients with pT4 colon cancer who are at high risk of developing mPC.
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- 2021
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24. Comparison of laparoscopic and open surgery for colorectal malignancy in obese patients: a propensity score-weighted cohort study.
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Yu-Jen Hsu, Yen-Lin Yu, Jing-Rong Jhuang, Jeng-Fu You, Chun-Kai Liao, Wen-Sy Tsai, Yi-Ping Pan, and Yih-Jong Chern
- Abstract
Background: Insufficient evidence exists to ascertain the long-term prognosis in patients with obesity undergoing laparoscopic surgery versus open surgery for colorectal cancer. Methods: Employing an institutional database from 2009 to 2019, we assessed individuals with a BMI of greater than or equal to 30 kg/m2 who underwent surgery for primary stage I-III colorectal adenocarcinoma. The authors used propensity score-weighted analysis to compare short-term and oncologic outcomes between laparoscopic and open surgical approaches. Results: This study enrolled 473 patients (open vs. laparoscopic surgery: 220 vs. 253; median follow-up period, 60 months). The laparoscopy group showed a significantly longer operative time (252 vs. 212 min), a higher anastomotic-leakage rate (5.14% vs. 0.91%), and a greater proportion of Clavien-Dindo class greater than III complications (5.93% vs. 1.82%). The open group showed a higher wound infection rate (7.27% vs. 3.16%) and a higher readmission rate (6.36% vs. 2.37%). After propensity score weighting, laparoscopy was inferior to open surgery in terms of long-term overall survival (hazard ratio: 1.43), disease-free survival (1.39), and recurrence rate (21.1% vs. 14.5%). In the subgroup analysis, female patients, older individuals, stage III patients, patients with rectal cancer, and those who underwent surgery after 2014 showed inferior long-term outcomes after laparoscopy. Conclusions: Laparoscopic colorectal cancer surgery for patients with obesity requires significant caution. Despite good shortterm outcomes, this procedure is associated with hidden risks and poor long-term prognoses. In female patients, older individuals, stage III patients, patients with rectal cancer, and those treated in the late surgery era subgroups, caution is advised when performing laparoscopic surgery. [ABSTRACT FROM AUTHOR]
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- 2024
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25. Tumor Marker Trajectories and Survival Analysis in Patients With Normal Carcinoembryonic Antigen Ranges After Colorectal Cancer Resection.
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Yih-Jong Chern, Hsin-Yin Hsu, Yu-Jen Hsu, Le-Yin Hsu, Wen-Sy Tsai, Chun-Kai Liao, Bor-Kang Jong, and Jeng-Fu You
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- 2024
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26. Upfront primary tumor resection versus upfront systemic therapy for metastatic colorectal cancer: a systematic review and meta-analysis from randomized controlled trials and propensity score matched studies
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Shih-Jung Lo, Shu-Huan Huang, I-Li Lai, Yih-Jong Chern, Yu-Jen Hsu, Chun-Kai Liao, Ching-Chung Cheng, Wen-Sy Tsai, Pao-Shiu Hsieh, and Jeng-Fu You
- Abstract
Purpose The standard initial treatment for metastatic colorectal cancer (mCRC) remains debated. This study investigated whether upfront primary tumor resection (PTR) or upfront systemic therapy (ST) provides better survival outcomes for patients with mCRC.Methods The PubMed, Embase, Cochrane Library, and ClinicalTrials.gov databases were searched for studies published at any time from January 1, 2004, to December 31, 2022. Randomized controlled trials (RCTs) and prospective or retrospective cohort studies (RCSs) utilizing propensity score matching (PSM) or inverse probability treatment weighting (IPTW) were included. We evaluated overall survival (OS) and short-term (60-day) mortality in these studies.Results After reviewing 3,626 articles, we identified 10 studies including a total of 38,947 patients. OS differed significantly between the upfront PTR and upfront ST arms (hazard ratio [HR] 0.62; 95% CI: 0.57–0.68; p Conclusions In RCTs, upfront PTR for mCRC did not improve OS and enhanced the risk of 60-day mortality. By contrast, in RCSs, PSM or IPTW provided improved OS. Therefore, whether upfront PTR should be used for mCRC remains unclear. Further large RCTs are required.
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- 2023
27. Effect of short-course radiotherapy followed by oxaliplatin-based consolidation chemotherapy on organ preservation in locally advanced rectal cancer
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Chun-Kai Liao, Ya-Ting Kuo, Yu-Jen Hsu, Yih-Jong Chern, Yen-Lin Yu, Yueh-Chen Lin, Pao-Shiu Hsieh, Jy-Ming Chiang, Chien‐Yuh Yeh, and Jeng-Fu You
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Gastroenterology - Published
- 2023
28. Increased standardised incidence ratio of cardiovascular diseases among colorectal cancer patients
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Hsin-Yin Hsu, Yih-Jong Chern, Cheng-Tzu Hsieh, Tzu-Lin Yeh, Ming-Chieh Tsai, Chia-Chun Wang, Bo-Yu Hsiao, Jing-Rong Jhuang, Chun-Ju Chiang, Wen-Chung Lee, and Kuo-Liong Chien
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Adult ,Cohort Studies ,Male ,Cardiovascular Diseases ,Risk Factors ,Incidence ,Gastroenterology ,Humans ,Female ,Middle Aged ,Colorectal Neoplasms - Abstract
Purpose Evidence regarding the relationship between colorectal cancer and the risk of cardiovascular disease (CVD) is limited. Thus, in this study, we aimed to determine the standardised incidence ratio (SIR) of CVDs in colorectal cancer patients in Taiwan. Methods A population-based cohort study enrolling the incident colorectal cancer population based on the Cancer Registry Database from 2007 to 2016 was conducted (n = 94,233, mean age: 62.4 years, 43.0% women). New cases of CVD, including coronary heart disease and ischemic stroke, through 31 December 2018 were obtained from the National Health Insurance Research Database and National Death Registry. Compared with the general population (n = 1,977,659, mean age: 44.3 years, 49.6% women), age- and sex-specific SIRs for CVDs were calculated by the time since diagnosis. Results A total of 6852 cardiovascular events occurred in colorectal cancer patients during a median follow-up of 4.4 years. The SIR of CVD was highest in the first year after diagnosis (SIR: 1.45, 95% confidence interval: 1.39–1.50); however, this decreased to the same value as that of the general population in later years. Similar patterns were observed for the SIR of coronary heart disease. However, the SIR of ischemic stroke among colorectal cancer patients was low from the second year following cancer diagnosis. Conclusions Colorectal cancer patients are at an increased risk of developing CVD, especially coronary heart disease, during the first 3 years following colorectal cancer diagnosis.
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- 2022
29. Usefulness of close surveillance for rectal cancer patients after neoadjuvant chemoradiotherapy
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Yu-Jen Hsu, Yih-Jong Chern, I-Li Lai, Sum-Fu Chiang, Chun-Kai Liao, Wen-Sy Tsai, Hsin-Yuan Hung, Pao-Shiu Hsieh, Chien-Yuh Yeh, Jy-Ming Chiang, Yen-Lin Yu, and Jeng-Fu You
- Subjects
General Medicine - Abstract
It is controversial whether patients who achieve clinical complete remission (cCR) of rectal cancer should be treated with the “watch and wait” (W&W) or radical resection (RR) strategy. Our study aimed to compare the survival outcomes and ostomy rate of the W&W and RR strategies. Between January 2008 and December 2015, we investigated 26 patients who achieved pathologic complete remission after undergoing RR and 36 patients who adopted the W&W strategy because of cCR. The tumor regrowth, salvage surgery, recurrence, disease-free, and overall survival (OS) rates were assessed. In our study, recurrences occurred in nine and two patients from the W&W and RR groups, respectively. Each patient in the RR group had a temporary or permanent ostomy, but only three (8.3%) had an ostomy in the W&W group. The 5-year recurrence rate was 25.0% in the W&W group and 7.7% in the RR group. Six patients (16.7%) had tumor regrowth in the W&W group, and all were resectable when regrowth. The 5-year OS rates between the two groups were nonsignificant. There is no specific risk factor for recurrence and OS. Under close surveillance, the W&W group achieved similar OS to the RR group and benefited from a lower ostomy rate.
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- 2022
30. Transrectal natural orifice specimen extraction in left hemicolectomy for tumours around the splenic flexure: Old wine in new bottles
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Chien-Yu Yeh, Chun-Kai Liao, Pao-Shiu Hsieh, Yu-Jen Hsu, Ching-Chung Cheng, Bor-Kang Jong, Jeng-Fu You, Hsin-Yuan Hung, Wen-Sy Tsai, and Yih-Jong Chern
- Subjects
Natural Orifice Endoscopic Surgery ,Splenic flexure ,Laparoscopic surgery ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Gastroenterology ,Rectum ,Microsurgery ,Anus ,Enterotomy ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Neoplasms ,medicine ,Humans ,Laparoscopy ,Left hemicolectomy ,business ,Colectomy ,Nose ,Colon, Transverse - Abstract
AIM Laparoscopic anterior resection with natural orifice specimen extraction (NOSE) has favourable short-term outcomes. However, NOSE is rarely adopted for left hemicolectomy procedures. This study aimed to review the feasibility, safety and short-term outcomes of transrectal NOSE in patients undergoing laparoscopic left hemicolectomy. METHOD All consecutive patients who underwent laparoscopic left hemicolectomy surgery with transrectal NOSE in a single institution between January 2018 and December 2020 were reviewed. Transrectal NOSE was performed with an enterotomy at the upper rectum. The specimen was brought out via a transanal endoscopic microsurgery scope inserted through the anus. A supplementary video demonstrates this technique. Surgical outcomes, including complications, postoperative short-term recovery and the level of pain intensity, are presented. RESULTS Twenty patients were reviewed. There were no immediate postoperative complications and no wound infections in these patients. The average time to tolerate a soft diet was 3.6 days, and the average postoperative hospital stay was 4.5 days. The average score on the numerical rating scale of postoperative pain was 3.0 on postoperative day 1. The median follow-up time was 23.5 months. CONCLUSION Laparoscopic left hemicolectomy with transrectal NOSE is a safe and feasible procedure that leads to early postoperative recovery and a short hospital stay.
- Published
- 2021
31. Efficient and Safe Method for Splenic Flexure Mobilization in Laparoscopic Left Hemicolectomy: A Propensity Score–weighted Cohort Study
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Jy-Ming Chiang, Yu-Jen Hsu, Jing-Rong Jhuang, Wen-Sy Tsai, Hsin-Yuan Hung, Yih-Jong Chern, Tzong-yun Tsai, and Jeng-Fu You
- Subjects
medicine.medical_specialty ,Cohort Studies ,03 medical and health sciences ,Gastrointestinal complications ,Postoperative Complications ,0302 clinical medicine ,medicine ,Humans ,Splenic flexure mobilization ,Propensity Score ,Laparoscopy ,minimally invasive surgery ,Colectomy ,Survival analysis ,Retrospective Studies ,left hemicolectomy ,medicine.diagnostic_test ,business.industry ,propensity score weighted ,Original Articles ,Colorectal surgery ,laparoscopic splenic flexure mobilization ,Surgery ,Treatment Outcome ,030220 oncology & carcinogenesis ,standardized procedure ,Colonic Neoplasms ,Propensity score matching ,ComputingMethodologies_DOCUMENTANDTEXTPROCESSING ,030211 gastroenterology & hepatology ,Laparoscopic left hemicolectomy ,business ,Colon, Transverse ,Cohort study - Abstract
Supplemental Digital Content is available in the text., Background: Because methods of performing laparoscopic left hemicolectomy differ between surgeons, standardizing the procedure is crucial to reduce complications and secure good oncologic outcomes. Materials and Methods: This is a retrospective hospital-based cohort study using a propensity score–weighted method. This study was conducted at the department of colorectal surgery in a tertiary teaching hospital between October 2007 and December 2017. The short-term and long-term outcomes of open and laparoscopic left hemicolectomy from 10 years of experience using a standardized 4-step laparoscopic procedure at one institution were compared. Short-term outcomes were postoperative morbidity and mortality. Long-term outcomes were disease-free survival and overall survival. Results: We enrolled 564 patients who underwent open or laparoscopic left hemicolectomy for primary colon adenocarcinoma. The open surgery and laparoscopy groups had 357 and 207 patients, respectively. Compared with the open surgery group, the laparoscopy group had significantly shorter hospital stays (open vs. laparoscopy, 10 vs. 7 d, P
- Published
- 2020
32. Improvement of ulcerative colitis control by searching and restricting of inflammatory trigger factors in daily clinical practice.
- Author
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Kun-Yu Tsai, Jeng-Fu You, Tzong-Yun Tsai, Yih Jong Chern, Yu-Jen Hsu, Shu-Huan Huang, and Wen-Sy Tsai
- Subjects
ULCERATIVE colitis ,COLITIS treatment ,CLINICAL trials - Abstract
Background/Aims: Exacerbating factors of ulcerative colitis (UC) are multiple and complex with individual influence. We aimed to evaluate the efficacy of disease control by searching and restricting inflammation trigger factors of UC relapse individually in daily clinical practice. Methods: Both patients with UC history or new diagnosis were asked to avoid dairy products at first doctor visit. Individual-reported potential trigger factors were restricted when UC flared up (Mayo endoscopy score ≥ 1) from remission status. The remission rate, duration to remission and medication were analyzed between the groups of factor restriction complete, incomplete and unknown. Results: The total remission rate was 91.7% of 108 patients with complete restriction of dairy product. The duration to remission of UC history group was significantly longer than that of new diagnosis group (88.5 days vs. 43.4 days, P= 0.006) in patients with initial endoscopic score 2–3, but no difference in patients with score 1. After first remission, the inflammation trigger factors in 161 relapse episodes of 72 patients were multiple and personal. Milk/ dairy products, herb medicine/Chinese tonic food and dietary supplement were the common factors, followed by psychological issues, non-dietary factors (smoking cessation, cosmetic products) and discontinuation of medication by patients themselves. Factor unknown accounted for 14.1% of patients. The benefits of factor complete restriction included shorter duration to remission (P< 0.001), less steroid and biological agent use (P= 0.022) when compared to incomplete restriction or factor unknown group. Conclusions: Restriction of dairy diet first then searching and restricting trigger factors personally if UC relapse can improve the disease control and downgrade the medication usage of UC patients in daily clinical practice. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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33. Minimally invasive right colectomy with transrectal natural orifice extraction: could this be the next step forward?
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P.-S. Hsieh, J.-M. Chiang, J.-F. You, C.-K. Liao, W.-S. Tsai, H.-Y. Hung, C.-C. Cheng, Y.-R. Hsu, and Yih-Jong Chern
- Subjects
Male ,Natural Orifice Endoscopic Surgery ,Laparoscopic surgery ,medicine.medical_specialty ,medicine.medical_treatment ,Multimedia Article ,Malignancy ,Minimally invasive surgery ,Colon surgery ,medicine ,Humans ,Colectomy ,Nose ,Aged ,Laparotomy ,business.industry ,Mortality rate ,Right colectomy ,Gastroenterology ,Right hemicolectomy ,Length of Stay ,Middle Aged ,medicine.disease ,Colorectal surgery ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Natural orifice specimen extraction (NOSE) ,Right Colectomy ,Laparoscopy ,business ,Abdominal surgery - Abstract
Background The transvaginal natural orifice specimen extraction (NOSE) approach for right-side colon surgery has been proven to exhibit favorable short-term outcomes. However, thus far, no study has reported the advantages of transrectal NOSE for right-side colon surgery. The aim of this study was to compare the technical feasibility, safety, and short-term outcomes of minimally invasive right hemicolectomy using the transrectal NOSE method and those of conventional mini-laparotomy specimen extraction. Methods A study was conducted on consecutive patients who had minimally invasive right hemicolectomy either for malignancy or benign disease at Chang Gung Memorial Hospital, Linkou, Taiwan, between January 2017 and December 2018. The patients were divided into two groups: conventional surgery with specimen extraction using mini-laparotomy and NOSE surgery. Surgical outcomes, including complications, postoperative short-term recovery, and pain intensity, were analyzed. Results We enrolled 297 patients (151 males, mean age 64.9 ± 12.8 years) who had minimally invasive right hemicolectomy. Of these 297 patients, 272 patients had conventional surgery with specimen extraction through mini-laparotomy and 25 patients had NOSE surgery (23 transrectal, 2 transvaginal). The diagnosis of colon disease did not differ significantly between the conventional and NOSE groups. Postoperative morbidity and mortality rates were comparable. The postoperative hospital stay was significantly (p = 0.004) shorter in the NOSE group (median 5 days, range 3–17 days) than in the conventional group (median 7 days, range 3–45 days). Postoperative pain was significantly (p = 0.026 on postoperative day 1 and p = 0.002 on postoperative day 2) greater in the conventional group than in the NOSE group. Conclusions NOSE was associated with acceptable short-term surgical outcomes that were comparable to those of conventional surgery. NOSE results in less postoperative wound pain and a shorter hospital stay than conventional surgery. Larger studies are needed
- Published
- 2020
34. Association of a Preoperative Leisure-Time Physical Activity With Short- and Long-term Outcomes of Patients Undergoing Curative Resection for Stage I to III Colorectal Cancer: A Propensity Score Matching Analysis
- Author
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Jy-Ming Chiang, Hsin-Yuan Hung, Pao-Shiu Hsieh, Yih-Jong Chern, Jeng-Fu You, Chien-Yuh Yeh, Wen-Sy Tsai, and Yu-Jen Hsu
- Subjects
Male ,Curative resection ,medicine.medical_specialty ,Disease free survival ,Colorectal cancer ,Leisure time ,Physical activity ,Disease-Free Survival ,Leisure Activities ,Postoperative Complications ,Metabolic Equivalent ,medicine ,Long term outcomes ,Humans ,Survivors ,Propensity Score ,Exercise ,Aged ,Neoplasm Staging ,Retrospective Studies ,Gynecology ,business.industry ,Gastroenterology ,General Medicine ,Middle Aged ,Prognosis ,medicine.disease ,Chemotherapy, Adjuvant ,Case-Control Studies ,Preoperative Period ,Propensity score matching ,Female ,Colorectal Neoplasms ,business - Abstract
BACKGROUND Physical activity might be directly or indirectly linked to the risk of colorectal cancer and the prognosis of patients with colorectal cancer. OBJECTIVE This study aimed to elucidate whether preoperative physical activity plays a role in reducing short-term postoperative complications and improving long-term survival of patients with colorectal cancer. DESIGN This was a retrospective analysis of prospectively collected data. SETTINGS This study was conducted at a department of colorectal surgery in a tertiary teaching hospital between January 1995 and December 2016. PATIENTS Patients who underwent curative resection for stage I to III primary colorectal cancer were enrolled. According to the preoperative leisure-time weekly metabolic equivalent of task values, patients were divided into 2 groups: the metabolic equivalent of task
- Published
- 2020
35. Improvement of ulcerative colitis control by searching and restricting of inflammatory trigger factors in daily clinical practice
- Author
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Kun-Yu Tsai, Jeng-Fu You, Tzong-Yun Tsai, Yih Jong Chern, Yu-Jen Hsu, Shu-Huan Huang, and Wen-Sy Tsai
- Subjects
Gastroenterology - Abstract
Background/Aims: Exacerbating factors of ulcerative colitis (UC) are multiple and complex with individual influence. We aimed to evaluate the efficacy of disease control by searching and restricting inflammation trigger factors of UC relapse individually in daily clinical practice. Methods: Both patients with UC history or new diagnosis were asked to avoid dairy products at first doctor visit. Individual-reported potential trigger factors were restricted when UC flared up (Mayo endoscopy score ≥1) from remission status. The remission rate, duration to remission and medication were analyzed between the groups of factor restriction complete, incomplete and unknown. Results: The total remission rate was 91.7% of 108 patients with complete restriction of dairy product. The duration to remission of UC history group was significantly longer than that of new diagnosis group (88.5 days vs. 43.4 days, P=0.006) in patients with initial endoscopic score 2–3, but no difference in patients with score 1. After first remission, the inflammation trigger factors in 161 relapse episodes of 72 patients were multiple and personal. Milk/dairy products, herb medicine/Chinese tonic food and dietary supplement were the common factors, followed by psychological issues, non-dietary factors (smoking cessation, cosmetic products) and discontinuation of medication by patients themselves. Factor unknown accounted for 14.1% of patients. The benefits of factor complete restriction included shorter duration to remission (PP=0.022) when compared to incomplete restriction or factor unknown group. Conclusions: Restriction of dairy diet first then searching and restricting trigger factors personally if UC relapse can improve the disease control and downgrade the medication usage of UC patients in daily clinical practice.
- Published
- 2021
36. Deciding the operation type according to mismatch repair status among hereditary nonpolyposis colorectal cancer patients: should a tailored approach be applied, or does one size fit all?
- Author
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Yueh-Chen Lin, Chun-Kai Liao, Yih-Jong Chern, Jy-Ming Chiang, Yu-Jen Hsu, and Jeng-Fu You
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Oncology ,medicine.medical_specialty ,Multivariate analysis ,Tailored approach ,Colorectal cancer ,Metachronous CRC ,medicine.medical_treatment ,HNPCC ,QH426-470 ,Resection ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Overall survival ,Genetics ,Genetics (clinical) ,RC254-282 ,Colectomy ,business.industry ,Research ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Perioperative ,medicine.disease ,Extended colectomy ,MMR status ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,DNA mismatch repair ,business - Abstract
Background Although extended colectomy (EC) was recommended for HNPCC patients, previous studies did not show significantly improved overall survival. Immunohistochemical (IHC) stain of mismatch repair (MMR) gene protein expression is now a feasible and reliable test clinically. Therefore, we tried to investigate whether we could use MMR IHC stain to select operation types in HNPCC patients. Patients and methods Between 1995 and 2013, 186 HNPCC patients were collected. Status of MMR protein expression, perioperative clinic-pathological variables and post-operative follow up status were analyzed by multivariate analyses. Results Sixty-five percent (121 of 186) patients of these HNPCC patients demonstrated loss of at least one MMR protein. There were several significant differences existing between deficient MMR (dMMR) and proficient MMR (pMMR) subgroups in terms of clinic-pathological characteristics. With the average follow-up duration of 93.9 months, we observed significantly high risk of developing metachronous CRC between SC and EC subgroups (crude rate 8.5% vs. 0%, p = 0.035). However, no significant difference was observed among the presence of extra-colonic tumors (12.4% vs. 5.8%, p = 0.284). The positive and negative prediction rate of metachronous CRC in dMMR subgroup was 12.8 and 87.2% while 1.9 and 98.1% in the pMMR subgroup. Survival outcomes were significantly affected by MMR status and resection types by multivariate analysis. Significantly better OS in dMMR subgroup (HR = 0.479, 95% CI: 0.257–0.894, p = 0.021) comparing with pMMR subgroup was observed. However, significant improved DFS (HR = 0.367, 95% CI: 0.172–.0787, p = 0.010) but not significant for OS (HR = 0.510, 95% CI: 0.219–1.150, p = 0.103) for EC subgroup compared with SC subgroup. Differences existing among different subgroups by combing extent of resection and MMR status. In dMMR subgroup, SC, compared with EC, demonstrated significantly worse DFS by multivariate analyses (HR = 3.526, 95% CI: 1.346–9.236, p = 0.010) but not for OS (HR = 2.387, 95% CI: 0.788–7.229, p = 0.124), however, no significantly differences of OS and DFS in pMMR subgroup between SC and EC were found. Conclusions Significantly better overall survival and higher rate of metachronous CRC exist in dMMR subgroup of HNPCC patients comparing with pMMR subgroup. Extended colectomy significantly improved DFS and was thus recommended for dMMR subgroup but not pMMR subgroup of HNPCC patients.
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- 2021
37. Prognostic value of the C-reactive protein to albumin ratio in colorectal cancer: an updated systematic review and meta-analysis
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Yen-Lin Yu, Yih-Jong Chern, Yu-Jen Hsu, Jy-Ming Chiang, Chun-Kai Liao, Yueh-Chen Lin, and Jeng-Fu You
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Male ,Oncology ,medicine.medical_specialty ,RD1-811 ,Disease-free survival ,Colorectal cancer ,Population ,Subgroup analysis ,Review ,Carcinoembryonic antigen ,Internal medicine ,medicine ,Humans ,Overall survival ,education ,Serum Albumin ,RC254-282 ,education.field_of_study ,biology ,business.industry ,C-reactive protein ,Hazard ratio ,C-reactive protein to albumin ratio ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Prognosis ,medicine.disease ,Confidence interval ,Meta-analysis ,C-Reactive Protein ,Colonic Neoplasms ,biology.protein ,Surgery ,Colorectal Neoplasms ,business - Abstract
Backgrounds The inflammatory biomarker “C-reactive protein to albumin ratio (CAR)” has been reported to significantly correlate to a variety of human cancers. However, there are conflicting results regarding the prognostic value of CAR in colorectal cancer. Previous studies mainly assessed patients in Eastern countries, so their findings may not be applicable to the Western population. Therefore, this updated meta-analysis aimed to investigate the prognostic value of pre-treatment CAR and outcomes of patients with colorectal cancer. Methods We conducted a systematic search for eligible literature until October 31, 2020, using PubMed and Embase databases. Studies assessing pre-treatment CAR and outcomes of colorectal cancer were included. Outcome measures included overall survival, disease-free survival, progression-free survival, and clinicopathological features. The pooled hazard ratios (HR) with 95% confidence intervals (CI) were used as effective values. Results A total of 15 studies involving 6329 patients were included in this study. The pooled results indicated that a high pre-treatment CAR was associated with poor overall survival (HR 2.028, 95% CI 1.808−2.275, p < 0.001) and poor disease-free survival/progression-free survival (HR 1.768, 95% CI 1.321–2.365, p < 0.001). Subgroup analysis revealed a constant prognostic value of the pre-treatment CAR despite different study regions, sample size, cancer stage, treatment methods, or the cut-off value used. We also noted a correlation between high pre-treatment CAR and old age, male sex, colon cancer, advanced stage (III/IV), large tumor size, poor differentiation, elevated carcinoembryonic antigen levels, neutrophil-to-lymphocyte ratio, and the modified Glasgow prognostic score. Conclusions High pre-treatment CAR was associated with poor overall survival, disease-free survival, and progression-free survival in colorectal cancer. It can serve as a prognostic marker for colorectal cancer in clinical practice.
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- 2021
38. The risk factors of local recurrence and distant metastasis on pT1/T2N0 mid-low rectal cancer after total mesorectal excision
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Jeng-Fu You, Hsin-Yuan Hung, I-Li Lai, Yu-Jen Hsu, Wen-Sy Tsai, Jy-Ming Chiang, Yih-Jong Chern, and Pao-Shiu Hsieh
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medicine.medical_specialty ,RD1-811 ,Colorectal cancer ,03 medical and health sciences ,0302 clinical medicine ,Carcinoembryonic antigen ,Risk Factors ,Rectal Adenocarcinoma ,Local recurrence ,Medicine ,Humans ,Risk factor ,Rectal cancer ,Lymph node ,RC254-282 ,Neoplasm Staging ,Retrospective Studies ,biology ,business.industry ,Rectal Neoplasms ,Research ,Hazard ratio ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,medicine.disease ,Prognosis ,Radical resection ,Total mesorectal excision ,Surgery ,medicine.anatomical_structure ,Treatment Outcome ,Oncology ,030220 oncology & carcinogenesis ,Distant metastasis ,biology.protein ,Resection margin ,030211 gastroenterology & hepatology ,Neoplasm Recurrence, Local ,business - Abstract
Background Radical resection is associated with good prognosis among patients with cT1/T2Nx rectal cancer. However, still some of the patients experienced cancer recurrence following radical resection. This study tried to identify the postoperative risk factors of local recurrence and distant metastasis separately. Methods This retrospective, single-center study comprised of 279 consecutive patients from Linkou branch of Chang Gung Memorial Hospital in 2005–2016 with rectal adenocarcinoma, pT1/T2N0M0 at distance from anal verge ≤ 8cm, who received curative radical resection. Results The study included 279 patients with pT1/pT2N0 mid-low rectal cancer with median follow-up of 73.5 months. Nineteen (6.8%) patients had disease recurrence in total. Nine (3.2%) of them had local recurrence, and fourteen (5.0%) of them had distant metastasis. Distal resection margin < 0.9 (cm) (hazard ratio = 4.9, p = 0.050) was the risk factor of local recurrence. Preoperative carcinoembryonic antigen (CEA) ≥ 5 ng/mL (hazard ratio = 9.3, p = 0.0003), lymph node yield (LNY) < 14 (hazard ratio = 5.0, p = 0.006), and distal resection margin < 1.4cm (hazard ratio = 4.0, p = 0.035) were the risk factors of distant metastasis. Conclusion For patients with pT1/pT2N0 mid-low rectal cancer, current multidisciplinary treatment brings acceptable survival outcome. Insufficient distal resection margin attracted the awareness of risk factors for local recurrence and distant metastasis as a foundation for future research.
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- 2021
39. Additional file 1 of The risk factors of local recurrence and distant metastasis on pT1/T2N0 mid-low rectal cancer after total mesorectal excision
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I-Li Lai, Jeng-Fu You, Yih-Jong Chern, Wen-Sy Tsai, Jy-Ming Chiang, Pao-Shiu Hsieh, Hsin-Yuan Hung, and Hsu, Yu-Jen
- Abstract
Additional file 1: Supplementary table 1 Patient characteristics
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- 2021
- Full Text
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40. Short- and medium-term outcomes of intracorporeal versus extracorporeal anastomosis in laparoscopic right colectomy: a propensity score-matched study
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Jeng-Fu You, Yu-Jen Hsu, Chun-Kai Liao, Wen-Sy Tsai, Jy-Ming Chiang, Yih-Jong Chern, Pao-Shiu Hsieh, Chien-Yuh Yeh, Yueh-Chen Lin, and Hsin-Yuan Hung
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Laparoscopic surgery ,medicine.medical_specialty ,Resection margin ,Propensity score ,medicine.medical_treatment ,lcsh:Surgery ,Intracorporeal anastomosis ,Anastomosis ,lcsh:RC254-282 ,Extracorporeal ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,medicine ,Humans ,Colectomy ,Retrospective Studies ,business.industry ,Research ,Anastomosis, Surgical ,Postoperative complication ,Right hemicolectomy ,Pain scale ,lcsh:RD1-811 ,Length of Stay ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Prognosis ,Surgery ,Peritoneal recurrence ,Treatment Outcome ,Oncology ,030220 oncology & carcinogenesis ,Propensity score matching ,Right Colectomy ,Colonic Neoplasms ,030211 gastroenterology & hepatology ,Laparoscopy ,business - Abstract
BackgroundsThough better short-term outcomes were frequently reported, differences in specimen parameters and the rate of subsequent peritoneal recurrence between intracorporeal anastomosis (IA) and extracorporeal anastomoses (EA) for laparoscopic right hemicolectomy have not been analyzed. We aimed to compare the pathologic differences and oncological outcomes between these two approaches.MethodsWe retrospectively analyzed 217 consecutive patients who underwent laparoscopic right hemicolectomies from September 2016 to April 2018 and classified them into IA and EA groups, based on the approach used. Propensity score matching analysis was performed, after which 101 patients were included in each group with the patients matched for demographics, tumor stage, and localization.ResultsThe IA group had a longer operative time, shorter length of stay, shorter time to first flatus and tolerating a soft diet, and better pain scale scores at postoperative day 3. No inter-group differences in conversion, postoperative complication, mortality, or readmission rates were found. The IA group had a longer resected colon length (23.67 vs. 19.75 cm,p= 0.010) and nearest resected margin (7.51 vs. 5.40 cm,p= 0.010) for cancer near the hepatic flexure. There are comparable 3-year overall survival (87.7% vs. 89.6%,p= 0.604) and disease-free survival (75.0% vs. 75.7%,p= 0.842) between the IA and EA groups. The rate of peritoneal recurrence was similar between the two groups (5.9% vs. 7.9%,p= 0.580).ConclusionsThe overall survival, disease-free survival, and the rate of peritoneal recurrence were comparable between the IA and EA procedures. IA ensures better recovery and comparable complications to EA and achieved a more precise tumor excision; thus, IA can be considered a safe procedure for patients with right-sided colon lesions.
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- 2021
41. Additional file 2 of The risk factors of local recurrence and distant metastasis on pT1/T2N0 mid-low rectal cancer after total mesorectal excision
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I-Li Lai, Jeng-Fu You, Yih-Jong Chern, Wen-Sy Tsai, Jy-Ming Chiang, Pao-Shiu Hsieh, Hsin-Yuan Hung, and Hsu, Yu-Jen
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Additional file 2: Supplementary table 2 Patient characteristics for non-RT vs. RT
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- 2021
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42. Advantage of laparoscopy surgery for elderly colorectal cancer patients without compromising oncologic outcome
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Jy-Ming Chiang, Yu-Jen Hsu, Wen-Sy Tsai, Jeng-Fu You, Pao-Shiu Hsieh, Yih Jong Chern, and Hsin-Yuan Hung
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Male ,Laparoscopic surgery ,medicine.medical_specialty ,Colorectal cancer ,medicine.medical_treatment ,Elderly ,Laparotomy ,medicine ,Humans ,In patient ,Colorectal adenocarcinoma ,Stage (cooking) ,Laparoscopy ,Colectomy ,Outcome ,Aged ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,General Medicine ,medicine.disease ,Surgery ,Treatment Outcome ,Cohort ,Colorectal Neoplasms ,business ,Research Article - Abstract
Background Laparoscopic surgery has achieved significant results in elderly patients with colorectal cancer (CRC). In this study, we compared the short-term and long-term outcomes of open surgery and laparoscopic surgery in patients with CRC aged above 75 years at a single tertiary medical center. Methods We analyzed 967 patients who underwent curative resection for primary colorectal adenocarcinoma without distant metastasis between January 2009 and December 2015, in a single institution. Of the enrolled patients, 305 underwent laparoscopic surgery, and 662 received open laparotomy surgery. Results Compared to the patients who underwent open surgery, those who received laparoscopic surgery had significantly shorter postoperative stay (10.3 vs. 13.5 days p p = 0.354) and mortality (p = 0.082). In the laparoscopy cohort, six of 305 patients were converted to open surgery and one died. The long-term overall survival, cancer-specific survival, and recurrence rate were similar between both cohorts in each stage. Conclusions Laparoscopic surgery is suitable for elderly patients owing to shorter postoperative stay, similar long-term outcomes with open surgery, and acceptable low conversion rates. For long-term overall and oncological outcomes, the results of laparoscopic surgery were similar to that of open surgery in each TNM stage.
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- 2020
43. Clinicopathological characteristics and outcomes of metachronous rectal cancer in patients with a history of cervical cancer with and without remote radiotherapy: Reports of 45 cases
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Hsin-Yuan Hung, Wen-Sy Tasi, Jeng-Fu You, Sum-Fu Chiang, Cheng-Chou Lai, Jy-Ming Chiang, Yih-Jong Chern, Chien-Yuh Yeh, Pao-Shiu Hsieh, and Yu-Jen Hsu
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Adult ,medicine.medical_specialty ,Neoplasms, Radiation-Induced ,Colorectal cancer ,cervical cancer ,medicine.medical_treatment ,Taiwan ,Observational Study ,Uterine Cervical Neoplasms ,Adenocarcinoma ,03 medical and health sciences ,0302 clinical medicine ,Colostomy ,Cystitis ,Rectal Adenocarcinoma ,Medicine ,Humans ,Rectal Fistula ,Proctitis ,030212 general & internal medicine ,Stage (cooking) ,rectal cancer ,Lymph node ,Aged ,Neoplasm Staging ,Retrospective Studies ,Cervical cancer ,Aged, 80 and over ,Radiotherapy ,business.industry ,Rectal Neoplasms ,Retrospective cohort study ,Neoplasms, Second Primary ,General Medicine ,Middle Aged ,medicine.disease ,Prognosis ,Radiation therapy ,medicine.anatomical_structure ,Treatment Outcome ,030220 oncology & carcinogenesis ,Case-Control Studies ,Lymphatic Metastasis ,Female ,Radiology ,business ,Research Article - Abstract
The purpose of this study was to report the clinicopathological characteristics and treatment outcomes of 45 rectal cancer patients who have a history of cervical cancer with or without remote radiotherapy. Twenty-nine patients (64.4%) with a history of cervical cancer treated with pelvic radiotherapy were classified as group A, 16 (35.6%) patients with a history of cervical cancer not treated with radiotherapy were classified as group B. The median duration between radiotherapy for cervical cancer and rectal adenocarcinoma diagnosis was 18 years. At the time of rectal cancer diagnosis, 5 (17.2%) patients presented stage I disease, 15 (51.7%) had stage II, 1 (3.4%) had stage III, and 8 (27.6%) had stage IV. The patients in group A had older age, higher rates of gross ulcerative lesions, low hemoglobin levels, and a lower rate of lymph node metastases. The patients with secondary rectal cancer developed after radiotherapy for cervical cancer usually presented with abnormal abdominal symptoms, such as proctitis, cystitis, or rectal fistula. Higher colostomy rate was found in this group of patients due to severe pelvic fibrosis or proctitis.
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- 2020
44. Survival analysis of local excision vs total mesorectal excision for middle and low rectal cancer in pT1/pT2 stage and intermediate pathological risk
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Pao-Shiu Hsieh, Sum-Fu Chiang, Jinn-Shiun Chen, Chien-Yuh Yeh, Jeng-Fu You, Cheng-Chou Lai, Hsin-Yuan Hung, Yu-Jen Hsu, I-Li Lai, Wen-Sy Tsai, Reiping Tang, Jy-Ming Chiang, and Yih-Jong Chern
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Male ,medicine.medical_specialty ,Local excision ,Lymphovascular invasion ,Colorectal cancer ,Perineural invasion ,lcsh:Surgery ,Gastroenterology ,lcsh:RC254-282 ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Adjuvant therapy ,Medicine ,Humans ,Neoplasm Invasiveness ,Stage (cooking) ,Rectal cancer ,Survival analysis ,Digestive System Surgical Procedures ,Neoplasm Staging ,Retrospective Studies ,Sphincter-sparing surgery ,business.industry ,Rectal Neoplasms ,Research ,Retrospective cohort study ,lcsh:RD1-811 ,Middle Aged ,medicine.disease ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Total mesorectal excision ,Survival Rate ,Treatment Outcome ,Oncology ,Chemoradiation ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Surgery ,Female ,sense organs ,Neoplasm Recurrence, Local ,business ,Follow-Up Studies - Abstract
Background Local excision (LE) is a feasible treatment approach for rectal cancers in stage pT1 and presents low pathological risk, whereas total mesorectal excision (TME) is a reasonable treatment for more advanced cancers. On the basis of the pathology findings, surgeons may suggest TME for patients receiving LE. This study compared the survival outcomes between LE with/without chemoradiation and TME in mid and low rectal cancer patients in stage pT1/pT2, with highly selective intermediate pathological risk. Methods This retrospective study included 134 patients who received TME and 39 patients who underwent LE for the treatment of intermediate risk (pT1 with poor differentiation, lymphovascular invasion, perineural invasion, relatively large tumor, or small-sized pT2 tumor) rectal cancer between 1998 and 2016. Results Overall survival (OS), disease-free survival (DFS), and cumulative recurrence rate (CRR) were similar between the LE (3-year DFS 92%) and TME (3-year DFS 91%) groups. Following subgrouping into an LE with adjuvant therapy group and a TME without adjuvant therapy group, the compared survival outcomes (OS, DFS, and CRR) were found not to be statistically different. The temporary and permanent ostomy rates were higher in the TME group than in the LE group (p < 0.001). Rates of early and late morbidity following surgery were higher in the TME group (p = 0.005), and LE had similar survival compared with TME. Conclusion For patients who had mid and low rectal cancer in stage pT1/pT2 and intermediate pathological risk, LE with chemoradiation presents an alternative treatment option for selected patients.
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- 2019
45. A Prediction Model for Metachronous Peritoneal Carcinomatosis in Patients with Stage T4 Colon Cancer after Curative Resection
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Pao-Shiu Hsieh, Cheng-Chou Lai, Yu-Jen Hsu, Jing-Rong Jhuang, Yih-Jong Chern, Sum-Fu Chiang, Chien-Yuh Yeh, Wen-Sy Tsai, Reiping Tang, Jeng-Fu You, Jy-Ming Chiang, Hsin-Yuan Hung, and Tzong-Yun Tsai
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Cart ,Cancer Research ,medicine.medical_specialty ,Colorectal cancer ,metachronous peritoneal carcinomatosis ,Article ,03 medical and health sciences ,0302 clinical medicine ,Carcinoembryonic antigen ,immune system diseases ,medicine ,Stage (cooking) ,T4 colon cancer ,RC254-282 ,Framingham Risk Score ,biology ,business.industry ,Area under the curve ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,medicine.disease ,prediction model ,Oncology ,Brier score ,030220 oncology & carcinogenesis ,biology.protein ,T-stage ,030211 gastroenterology & hepatology ,Radiology ,business - Abstract
(1) Background: The aim of this study was to develop a prediction model for assessing individual mPC risk in patients with pT4 colon cancer. Methods: A total of 2003 patients with pT4 colon cancer undergoing R0 resection were categorized into the training or testing set. Based on the training set, 2044 Cox prediction models were developed. Next, models with the maximal C-index and minimal prediction error were selected. The final model was then validated based on the testing set using a time-dependent area under the curve and Brier score, and a scoring system was developed. Patients were stratified into the high- or low-risk group by their risk score, with the cut-off points determined by a classification and regression tree (CART). (2) Results: The five candidate predictors were tumor location, preoperative carcinoembryonic antigen value, histologic type, T stage and nodal stage. Based on the CART, patients were categorized into the low-risk or high-risk groups. The model has high predictive accuracy (prediction error ≤5%) and good discrimination ability (area under the curve >, 0.7). (3) Conclusions: The prediction model quantifies individual risk and is feasible for selecting patients with pT4 colon cancer who are at high risk of developing mPC.
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- 2021
46. Efficient and Safe Method for Splenic Flexure Mobilization in Laparoscopic Left Hemicolectomy: A Propensity Score--weighted Cohort Study.
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Yu-Jen Hsu, Yih-Jong Chern, Jing-Rong Jhuang, Wen-Sy Tsai, Jy-Ming Chiang, Hsin-Yuan Hung, Tzong-yun Tsai, and Jeng-Fu You
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- 2021
- Full Text
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47. The dark side of laparoscopic surgery for colorectal cancer patients aged 75 years or older
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Jinn-Shiun Chen, Chien-Yuh Yeh, Pao-Shiu Hsieh, Hsin-Yuan Hung, Geng-Pin Lin, Cheng-Chou Lai, Jy-Ming Chiang, Sum-Fu Chiang, Yau-Tong You, Jeng-Fu You, Yu-Ren Hsu, Yih-Jong Chern, Reiping Tang, and Wen-Sy Tsai
- Subjects
Laparoscopic surgery ,Male ,medicine.medical_specialty ,Colorectal cancer ,medicine.medical_treatment ,Taiwan ,Anastomotic Leak ,Anastomosis ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Internal medicine ,Medicine ,Humans ,In patient ,Laparoscopy ,Colectomy ,Aged ,Retrospective Studies ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,Open surgery ,Mortality rate ,Patient Selection ,Gastroenterology ,Age Factors ,Hepatology ,Length of Stay ,medicine.disease ,Surgery ,Treatment Outcome ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Female ,Risk Adjustment ,business ,Colorectal Neoplasms - Abstract
The rate of postoperative morbidity and mortality is reportedly high in patients aged ≥ 75 years with colorectal cancer (CRC). In such patients, a comparison of the short-term outcome between open method and laparoscopy has not been clearly defined in Taiwan. We aimed to compare postoperative morbidity and mortality parameters after open method and laparoscopy in CRC patients aged ≥ 75 years. We retrospectively analyzed patients who underwent surgery for CRC from February 2009 to September 2015 at the Linkou Chang Gung Memorial Hospital in Taiwan and analyzed their clinicopathological factors. Postoperative morbidity and mortality were analyzed for evaluating if laparoscopic surgery offers more favorable outcomes than open surgery in the elderly. A total of 1133 patients were enrolled and analyzed in this study; they were divided into two groups (open method vs. laparoscopy = 797 vs. 336). The anastomotic leakage rate was significantly higher in the laparoscopy group than in the open method group (3.3 vs. 0.9%, p = 0.003). Overall postoperative morbidity and mortality rates showed no significant difference between these two groups. Postoperative hospital stay was significantly shorter in the laparoscopy group than in the open method group (10.4 ± 8.7 vs. 13.8 ± 13.5 days, p
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- 2018
48. IDDF2018-ABS-0152 The preoperative cea can be an independent predictive factor for colorectal cancer patients after curative resection in long-term outcome
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Reiping Tang, Yih Jong Chern, Wen Sy Tsai, Hsin Yuan Hung, Jinn Shiun Chen, Yu Jen Hsu, Shu Huan Huang, Chien Yuh Yeh, Sum Fu Chiang, Jeng Fu You, Pao Shiu Hsieh, Cheng Chou Lai, and Jy Ming Chiang
- Subjects
medicine.medical_specialty ,biology ,Colorectal cancer ,business.industry ,Proportional hazards model ,Consecutive case series ,medicine.disease ,Gastroenterology ,digestive system diseases ,Carcinoembryonic antigen ,Internal medicine ,Propensity score matching ,biology.protein ,medicine ,Stage (cooking) ,business ,Survival rate ,Survival analysis - Abstract
Background The preoperative carcinoembryonic antigen (CEA) level as a prognostic factor of colorectal cancer (CRC) has been in debate. Methods A consecutive case series were collected from our database of CRC from 1995 to 2010. Clinicopathological factors were matched by propensity score methods with calliper width of 0.05 and a 1:4 ratio. Long-term overall survival (OS) and disease-specific survival (DSS) were analysed and compared between 3 different serum CEA levels. Results A total number of 9634 patients were included initially. After exclusion and matching, a number of 6099 cases were matched by propensity score matching methods with median follow-up period 86 months. The survival analysis showed poor OS in elevated serum CEA groups than normal CEA level (5 year survival rate: 75% vs. 66% vs. 61%) and was also presented in both subgroups divided by lymph node (LN) stage (LN positive: 69% vs. 56% vs. 50%, LN negative: 83% vs. 77% vs. 72%) but not between elevated groups. In contrast, DSS showed significantly poor outcome between each group and was proportional to serum CEA elevation (5 year survival rate: 83% vs. 76% vs. 69%, p In multivariate Cox regression model after adjusted with TNM stage, smoking, DM, renal insufficiency, liver cirrhosis and other factors, elevated CEA showed higher risk in DSS (5 to 10 ng/ml HR=1.540,>10 ng/ml HR=1.910, both p Conclusions Elevated preoperative serum CEA can be an independent prognostic factor for stage I to III CRC patients after curative resection with poor long-term overall and oncological outcome.
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- 2018
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