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Lee KG, Shin CI, Kim SG, Choi J, Oh SY, Son YG, Suh YS, Kong SH, Lee HJ, Kim SH, Lee KU, Kim WH, Yang HK. Can endoscopic ultrasonography (EUS) improve the accuracy of clinical T staging by computed tomography (CT) for gastric cancer? Eur J Surg Oncol 2021; 47:1969-1975. [PMID: 33741246 DOI: 10.1016/j.ejso.2021.02.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/05/2021] [Accepted: 02/28/2021] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION With the introduction of new therapeutic options for gastric cancer treatment, more precise preoperative staging of gastric cancer is needed. The purpose of this study was to evaluate the role of endoscopic ultrasonography (EUS) for improving the accuracy of clinical T staging by computed tomography (CT) for gastric cancer. MATERIALS AND METHODS A total of 2636 patients underwent stomach protocol CT (S-CT) and EUS, followed by gastrectomy for primary gastric adenocarcinoma between September 2012 and February 2018 at Seoul National University Hospital. The results of preoperative S-CT and EUS were compared to the postoperative pathologic staging. RESULTS The overall accuracy of S-CT and EUS for T staging were 69.4% and 70.4%, respectively. When T staging was divided into T1-2 and T3-4 for clinically advanced gastric cancer (AGC), the positive predictive value for T3-4 using S-CT, EUS, and a combination of both modalities was 73.8%, 79.3%, and 85.6%, respectively. In 114 cases of indeterminate lesions between cT1 and cT2 by S-CT, EUS had a better prediction rate than the final decision based on endoscopy or the agreement between the two experts (Match rate: EUS vs. final decision, 69.3% vs. 58.8%). CONCLUSION EUS can be a complementary diagnostic tool to clinical T staging of gastric cancer by CT for selecting T3-4 lesion.
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Affiliation(s)
- Kyung-Goo Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea; Department of Surgery, Myongji Hospital, Hanyang University College of Medicine, Goyang, South Korea
| | - Cheong-Il Shin
- Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea
| | - Sang Gyun Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Jeongmin Choi
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, South Korea; Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea
| | - Seung-Young Oh
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea; Critical Care Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Young-Gil Son
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea; Department of Surgery, Dongsan Hospital, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Yun-Suhk Suh
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Seong-Ho Kong
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyuk-Joon Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Se Hyung Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea
| | - Kuhn Uk Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea; Department of Surgery, Myongji Hospital, Hanyang University College of Medicine, Goyang, South Korea
| | - Woo Ho Kim
- Department of Pathology, Seoul National University College of Medicine, Seoul, South Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Han-Kwang Yang
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea.
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Lee KG, Lee HJ, Oh SY, Yang JY, Ahn HS, Suh YS, Kong SH, Kim TY, Oh DY, Im SA, Lee KU, Kim WH, Bang YJ, Yang HK. Is There Any Role of Adjuvant Chemotherapy for T3N0M0 or T1N2M0 Gastric Cancer Patients in Stage II in the 7th TNM but Stage I in the 6th TNM System? Ann Surg Oncol 2016; 23:1234-1243. [DOI: 10.1245/s10434-015-4980-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Yang JY, Kong SH, Ahn HS, Lee HJ, Jeong SY, Ha J, Yang HK, Park KJ, Lee KU, Choe KJ. Prognostic factors for reoperation of recurrent retroperitoneal sarcoma: The role of clinicopathological factors other than histologic grade. J Surg Oncol 2014; 111:165-72. [DOI: 10.1002/jso.23783] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 08/09/2014] [Indexed: 12/12/2022]
Affiliation(s)
- Jun-Young Yang
- Department of Surgery; Seoul National University College of Medicine; Seoul Korea
| | - Seong-Ho Kong
- Department of Surgery; Seoul National University College of Medicine; Seoul Korea
| | - Hye Seong Ahn
- Department of Surgery; Seoul National University College of Medicine; Seoul Korea
| | - Hyuk-Joon Lee
- Department of Surgery; Seoul National University College of Medicine; Seoul Korea
- Cancer Research Institute; Seoul National University College of Medicine; Seoul Korea
| | - Seung-Yong Jeong
- Department of Surgery; Seoul National University College of Medicine; Seoul Korea
| | - Jongwon Ha
- Department of Surgery; Seoul National University College of Medicine; Seoul Korea
| | - Han-Kwang Yang
- Department of Surgery; Seoul National University College of Medicine; Seoul Korea
- Cancer Research Institute; Seoul National University College of Medicine; Seoul Korea
| | - Kyu Joo Park
- Department of Surgery; Seoul National University College of Medicine; Seoul Korea
| | - Kuhn Uk Lee
- Department of Surgery; Seoul National University College of Medicine; Seoul Korea
| | - Kuk Jin Choe
- Department of Surgery; Seoul National University College of Medicine; Seoul Korea
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Cho YB, Lee WY, Choi SJ, Kim J, Hong HK, Kim SH, Choi YL, Kim HC, Yun SH, Chun HK, Lee KU. CC chemokine ligand 7 expression in liver metastasis of colorectal cancer. Oncol Rep 2012; 28:689-94. [PMID: 22614322 DOI: 10.3892/or.2012.1815] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 04/10/2012] [Indexed: 11/06/2022] Open
Abstract
The main cause of death for colorectal cancer (CRC) patients is the development of metastatic lesions at sites distant from the primary tumor. Therefore, it is important to find biomarkers that are related to the metastasis and to study the possible mechanisms. Recent data have shown that soluble attractant molecules called chemokines support the metastasis of certain cancers to certain organs. To identify molecular regulators that are differentially expressed in liver metastasis of CRC, PCR array analysis was performed and CC chemokine ligand 7 (CCL7) showed remarkable overexpression in liver metastatic tumor tissues. To validate the results of the PCR array, 30 patients with primary CRC and liver metastases were selected. Immunohistochemistry and real-time PCR analysis showed that CCL7 was expressed in normal colonic epithelium and the expression was higher in liver metastases compared to primary CRC (p<0.001). Real-time PCR showed that the expression of CCR1, CCR2 and CCR3 was also higher in liver metastases compared to primary CRC (p=0.001, p=0.033 and p<0.001, respectively). In conclusion, correlation of CCL7 overexpression and its receptor expression with colon cancer liver metastasis suggests that CCL7 as a novel target in liver metastasis of CRC may be of potential clinical value for the prevention of hepatic recurrences.
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Affiliation(s)
- Yong Beom Cho
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul National University Hospital, Seoul 135-710, Republic of Korea
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Song Y, Kang MJ, Jang JY, Lee KU, Suh KS, Kim SW. Clinical outcome and long term results after surgical treatment of biliary cystadenoma and cystadenocarcinoma. Korean J Hepatobiliary Pancreat Surg 2012; 16:24-8. [PMID: 26388902 PMCID: PMC4575011 DOI: 10.14701/kjhbps.2012.16.1.24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 11/26/2011] [Accepted: 12/20/2011] [Indexed: 12/26/2022]
Abstract
Backgrounds/Aims Biliary cystadenoma (BCA) and cystadenocarcinoma (BCCA) are rare cystic hepatic neoplasms. Prior reports concerning the proper surgical treatment and long-term survival are scarce. We report our experience and survival outcome of 30 patients over the last 25 years. Methods We retrospectively reviewed the clinicopathologic data of the pathologically confirmed 18 BCA and 12 BCCA patients, who underwent operations from 1983 to 2006, at the Seoul National University Hospital. Results The patients consisted of 8 men and 22 women with a mean age of 51 years. With abdominal computed tomography scans, 73.3% (n=22) were preoperatively diagnosed as BCA or BCCA, and differentiating BCCA from BCA was accurate in 58.3% patients. R0 resection was achieved in 90% (n=27). The differentiating factors included the presence of mural nodule (4/18 vs. 8/12; p=0.009) and mucinous content (2/9 vs. 8/1; p=0.005), and tumor size tending to be larger in BCCA (11.7 cm vs. 7.9 cm; p=0.067). Overall 5-year and 10-year survival rates of BCCA were 72.9% and 60.9%, respectively. Of patients with BCCA, 4 experienced recurrence. In case of recurrence, patients tended to be younger than 50 years (p=0.061) and the lesions tended to be larger than those without recurrence (p=0.088). Conclusions Preoperative differentiations of BCA from simple cyst, and BCCA from BCA are still difficult. Complete removal of the tumor, via major hepatectomy, should be considered, especially in the younger age group with large tumor.
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Affiliation(s)
- Youngpeck Song
- Department of Surgery & Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Mee Joo Kang
- Department of Surgery & Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jin-Young Jang
- Department of Surgery & Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Kuhn Uk Lee
- Department of Surgery, Konkuk University College of Medicine, Seoul, Korea
| | - Kyung Suk Suh
- Department of Surgery & Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Sun-Whe Kim
- Department of Surgery & Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Affiliation(s)
- Nam-Joon Yi
- Division of HBP Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kwang-Woong Lee
- Division of HBP Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung-Suk Suh
- Division of HBP Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kuhn Uk Lee
- Division of HBP Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Soo Tae Kim
- Division of HBP Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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Jung H, Lee KU, Shin WY, Ahn H. Treatment outcomes of surgical resection for hepatocellular carcinoma with inferior vena cava invasion and/or thrombosis. ACTA ACUST UNITED AC 2011; 58:1694-9. [PMID: 21940334 DOI: 10.5754/hge10653] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND/AIMS Advanced hepatocellular carcinoma with either an invasion of the inferior vena cava or thrombosis is rare, and its prognosis is extremely poor. There is no established treatment. The purpose of this study was to evaluate the efficacy of surgical resection and its prognosis in 5 recent cases. METHODOLOGY From January 2005 to December 2008, 5 patients diagnosed with advanced hepatocellular carcinoma with inferior vena cava invasion and/or thrombosis underwent surgical resection. These patients were retrospectively reviewed. RESULTS The mean age at diagnosis was 54 years. There were 4 men and 1 woman. According to the Child-Pugh classification, all patients were class A. One case had 2 hepatic masses, and the others had a solitary hepatic mass. The mean tumor size was 5.53cm. All 5 patients underwent partial hepatectomy and inferior vena cava resection or thrombosis removal. Among these, 4 cases needed a cardiopulmonary bypass. Four patients survived and 1 patient expired at the point of analyzing. Four cases experienced recurrences. The mean disease-free survival time was 19.6 months. One patient has been followed-up for 43 months without any recurrences up to now. CONCLUSIONS Concurrent en-bloc resection of the liver and inferior vena cava for progressive HCC accompanying IVC invasion or thrombosis can be considered as a curative treatment.
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Affiliation(s)
- Hyemin Jung
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
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Kim JW, Kong SH, Kim MA, Kim WH, Lee HJ, Lee KU, Yang HK. Transverse mesocolon invasion in advanced gastric cancer: should we reconsider current T staging? Ann Surg Oncol 2011; 18:1274-81. [PMID: 21369743 DOI: 10.1245/s10434-010-1485-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND According to the AJCC/UICC TNM classification, T mesocolon invasion in AGC is classified as T2b or T3 according to the presence or the absence of serosa invasion. However, many authors have considered T mesocolon invasion in AGC as T4. This study was performed to evaluate the appropriate T stage for T mesocolon invasion in AGC. MATERIALS AND METHODS From 1996 to 2008, 90 patients underwent curative gastrectomy with T mesocolon excision at the authors' institute under the suspicion of T mesocolon invasion based on surgical findings and without pathologic invasion to any other organ. Histopathologic findings were reviewed to determine whether tumors had invaded the T mesocolon. Survival data of AGC patients registered in the SNUH database (N = 9998, from 1986 to 2007) was used as reference data for comparative purposes. RESULTS A total of 27 patients (30%) had proven histopathological invasion of the T mesocolon, and a significant difference in survival rates was found between these 27 and the remaining 63 (P = .012). As compared with the SNUH database population, the survival rate of T mesocolon invasion patients differed from those of T2b (P < .001) and T3 (P = .043) patients, but was similar to that of T4 patients (P = .218). Furthermore, for N1 stage patients, the survival rate differed from those of T2b (P = .001) and T3 (P = .046) patients, but was similar to that of T4 patients (P = .744). CONCLUSIONS The T stage of T mesocolon invasion in AGC should be revised to AJCC/UICC stage T4, because the survival rate of T mesocolon invasion AGC is lower than that of stage T2b or T3.
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Affiliation(s)
- Jong Won Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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Tae WS, Kim SS, Lee KU, Nam EC, Choi JW, Park JI. Hippocampal shape deformation in female patients with unremitting major depressive disorder. AJNR Am J Neuroradiol 2011; 32:671-6. [PMID: 21372170 DOI: 10.3174/ajnr.a2367] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND PURPOSE The hippocampal atrophy of MDD has been known, but the region shape contractions of the hippocampus in MDD were inconsistent. Spheric harmonic shape analysis was applied to the hippocampus in female patients with unremitting MDD to evaluate morphometric changes of the hippocampus. MATERIALS AND METHODS Shape analysis was performed by using T1-weighted MR imaging in 21 female patients with MDD and 21 age- and sex-matched healthy controls. Manually segmented hippocampi were parameterized, and the point-to-point-based group difference was compared by using the Hotelling T-squared test. The partial correlation analyses were tested between clinical variables and shape changes. RESULTS Both hippocampal volumes were small in patients with MDD compared with healthy controls, and the right hippocampal volume was negatively correlated with the number of episodes at marginal significance. Regional shape contractions were found in the ambient gyrus, basal hippocampal head, posterior subiculum, and dorsal hippocampus of the left hemisphere. The right hippocampus showed a similar pattern but was less atrophic compared with the left hippocampus. A negative correlation was found between the HDRS and shape deformation in the CA3, ambient gyrus, posterior subiculum, and gyrus fasciolaris of the left hippocampus. CONCLUSIONS We showed atrophy and regional shape contractions in the hippocampi of patients with MDD, which were more dominant on the left side. The causes of hippocampal damage could be the hypersecretion of glucocorticoids contributing to neuronal death or the failing of adult neurogenesis in the dentate gyrus.
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Affiliation(s)
- W S Tae
- Neuroscience Research Institute, Kangwon National University School of Medicine, Chuncheon, Korea
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Ahn HS, Lee HJ, Yoo MW, Jeong SH, Park DJ, Kim HH, Kim WH, Lee KU, Yang HK. Changes in clinicopathological features and survival after gastrectomy for gastric cancer over a 20-year period. Br J Surg 2011; 98:255-60. [PMID: 21082693 DOI: 10.1002/bjs.7310] [Citation(s) in RCA: 147] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The pattern of gastric cancer in the Western world is changing, with an increased proportion of tumours in the upper stomach. The aim of this study was to investigate changes in clinicopathological features and survival of patients with resected gastric cancer at a single institution, in an area of high incidence in the Far East. METHODS Clinical features and pathological findings were compared in patients with gastric cancer who underwent gastrectomy at Seoul National University Hospital during four consecutive periods (1986-1990, 1991-1995, 1996-2000 and 2001-2006). RESULTS There were 12 026 patients. The mean age increased from 53·4 years in the first period to 57·4 years in the last (P < 0·001). The proportion of patients aged 70 years or older also increased, reaching 16·1 per cent in the final period. Upper-third cancer increased from 5·3 per cent in the first period to 14·0 per cent in the fourth (P < 0·001). Early gastric cancer (pathological T1) increased continuously over the four time intervals, from 24·8 to 48·9 per cent (P < 0·001). The overall 5-year survival rate increased from 64·0 per cent in the first period to 73·2 per cent at the end (P < 0·001), and this survival improvement was apparent in patients aged 40 years or more. CONCLUSION The mean age of patients with gastric cancer has increased during the past 20 years. The proportion of early gastric cancer and overall survival have gradually increased, especially in patients aged over 40 years.
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Affiliation(s)
- H S Ahn
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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Lee JH, Chung GE, Yu SJ, Hwang SY, Kim JS, Kim HY, Yoon JH, Lee HS, Yi NJ, Suh KS, Lee KU, Jang JJ, Kim YJ. Long-term prognosis of combined hepatocellular and cholangiocarcinoma after curative resection comparison with hepatocellular carcinoma and cholangiocarcinoma. J Clin Gastroenterol 2011; 45:69-75. [PMID: 20142755 DOI: 10.1097/mcg.0b013e3181ce5dfa] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
GOAL In this study, we attempted to evaluate the prognosis of combined hepatocellular and cholangiocarcinoma (cHCC-CC) with comparison to hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (CC). BACKGROUND The prognosis of cHCC-CC has not been fully elucidated. In this study, we attempted to evaluate the prognosis of cHCC-CC with comparison to HCC and CC. STUDY Consecutive patients who underwent curative resection for cHCC-CC at a single tertiary care center in Korea and their age, sex, and Child-Turcotte-Pugh class matched HCC and CC patients were included. We evaluated time-to-recurrence (TTR) and overall survival (OS) of cHCC-CC cases and compared them with HCC and CC patients. RESULTS Thirty cHCC-CC, 60 HCC, and 60 CC patients were included. For cHCC-CC group, the median TTR and OS were 5.4 and 18.0 months. After adjustment for confounding factors, the cHCC-CC group had a shorter TTR than did HCC group [relative risk (RR), 2.76; P<0.001] and CC group (RR, 2.00; P=0.013), and a shorter OS than HCC group (RR, 4.70; P<0.001). Compared with the each stage I diseases, cHCC-CC had shorter TTR than HCC (RR, 4.59; P=0.001) and CC (RR, 2.74, P=0.015) and shorter OS than HCC (RR, 9.35; P=0.001). CONCLUSIONS The results of this study indicated that cHCC-CC had a significantly poorer prognosis than HCC and CC even after curative resection.
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Affiliation(s)
- Jeong-Hoon Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul, Republic of Korea
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Jang JH, Beron RI, Ahn HS, Kong SH, Lee HJ, Kim WH, Lee KU, Yang HK. Clinicopathological Features of Upper Third Gastric Cancer during a 21-Year Period (Single Center Analysis). J Gastric Cancer 2010; 10:212-8. [PMID: 22076188 PMCID: PMC3204506 DOI: 10.5230/jgc.2010.10.4.212] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Accepted: 10/12/2010] [Indexed: 12/11/2022] Open
Abstract
Purpose The aim of this study was to determine proportions of upper third gastric cancer (UTG) among all gastric cancers and analyze clinicopathological features of the disease. Materials and Methods The medical records of 12,300 patients who underwent gastric surgery between 1986 and 2006 at Seoul National University Hospital (SNUH) were retrospectively reviewed. Clinicopathological features of 1,260 patients with UTG and 9,929 patients with middle or lower third gastric cancer (MLG) were compared, and annual proportions of UTG were evaluated. Results The proportion of patients with UTG rapidly increased from 2.6% in 1986 to 12.5% in 1992. However, linear regression analysis showed that the rate of increase was reduced (0.21%/year) after 1992 (12.5% to 14.2% from 1992 to 2006). Compared with the MLG group, the UTG group had a lower proportion of (22.3% vs. 39.7%, P<0.001) and a greater proportion of stage III/IV disease (39.4% vs. 31.7%, P<0.001). The UTG group also had larger tumors than the MLG group in stages I/II and III (3.5 cm/5.3 cm/6.5 cm vs. 3.2 cm/5.0 cm/5.8 cm, P=0.020/0.028 /<0.001), a higher proportion of undifferentiated cancer (63.1% vs. 53.7%, P<0.001), and less intestinal Lauren's type (38.8% vs. 47.4%, P<0.001). The 5-year survival rate of the UTG group was significantly lower than that of the MLG group in stages I/II and III (85.6%/63.1%/34.2% vs. 91.6%/ 69.2%/44.7%, P<0.001/0.028/0.006). Conclusions The proportion of UTGs has increased over the last two decades at SNUH, but the rate of increase has been greatly reduced since 1992. The UTG group showed a poorer prognosis compared with the MLG group in stages I/II and III.
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Affiliation(s)
- Je-Ho Jang
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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Roh H, Lee KU, Lee YS, Kim OJ, Kim SW, Choi JW. Effect of patient safety education in surgical clerkship to develop competencies for managing and preventing medical errors. Korean J Med Educ 2010; 22:303-311. [PMID: 25814133 DOI: 10.3946/kjme.2010.22.4.303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Accepted: 08/13/2010] [Indexed: 06/04/2023]
Abstract
PURPOSE The aims of this study were to define the necessity and effectiveness of patient safety education during surgical clerkship to develop competency for managing and preventing medical errors. METHODS Fifty 3rd-year students participated in the patient safety education program during a 4-week surgical clerkship. The students were divided into 4 groups: control group, pretest-only group, education-only group, and pretest and education group. Students were assessed using short essays and an oral exam for reasoning skills, clinical performance exams for patient education and communication skills, and multisource feedback and direct observation of error reporting for real-world problem-solving skills. The results were analyzed with SPSS 14.0K. The reliability (Cronbach alpha) of the entire assessment was 0.893. RESULTS There was no difference in scores between early and late clerkship groups. Reasoning skills were improved by the pretest. Reasoning, patient education, and error reporting skills were much more developed by patient safety education. Real-world error identification, reporting, and communication did not change after the 4-week course. CONCLUSIONS Patient safety education during surgical clerkship is necessary and effective. Error prevention and competency management in the real world should developed.
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Affiliation(s)
- HyeRin Roh
- Department of Surgery, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Kuhn Uk Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Yoon Seong Lee
- Department of Forensic Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ock Joo Kim
- Department of Medical History, Seoul National University College of Medicine, Seoul, Korea
| | - Sun Whe Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Woon Choi
- Department of Surgery, Chungbuk National University College of Medicine, Cheongju, Korea
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Kong SH, Yoo MW, Kim JW, Lee HJ, Kim WH, Lee KU, Yang HK. Validation of limited lymphadenectomy for lower-third gastric cancer based on depth of tumour invasion. Br J Surg 2010; 98:65-72. [PMID: 20954197 DOI: 10.1002/bjs.7266] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2010] [Indexed: 12/13/2022]
Abstract
BACKGROUND This study aimed to determine the appropriate extent of lymph node (LN) dissection in gastric cancer by analysing LN metastasis patterns from prospectively collected topographical data on nodal status at Seoul National University Hospital, Korea. METHODS The metastasis rate for each LN station was analysed according to the depth of tumour invasion in patients with primary lower-third gastric cancer who underwent curative gastrectomy. The Maruyama Index of unresected disease (MI) was calculated using the WinEstimate(®) program with simulation of various extents of LN dissection. RESULTS LN metastasis in mucosal cancer was rare; 2·6 per cent of patients had a MI of more than 5 with simulation of D1 plus station 7 dissection, whereas 0·9 per cent had a MI above 5 with D1 plus stations 7 and 8a. In submucosal cancer, 3·3 per cent of tumours metastasized to level 2 LN stations outside the range of D1 plus stations 7, 8a and 9. The proportion of patients with a MI above 5 was 9·0 per cent with D1 plus stations 7, 8a and 9 dissection. The nodal metastasis rate was higher at level 1 and 2 for muscularis propria or deeper cancers. CONCLUSION D1 dissection plus stations 7 and 8a for mucosal cancer, and D2 dissection for cancers of the muscularis propria or deeper seems appropriate. For submucosal cancer, an expanded dissection to the D2 level should be considered to ensure complete removal of metastatic LNs.
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Affiliation(s)
- S-H Kong
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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Lee JH, Lee MS, Kim HH, Park DJ, Lee KH, Hwang JY, Lee HJ, Yang HK, Lee KU. Feasibility of laparoscopic partial gastrectomy with sentinel node basin dissection in a porcine model. Surg Endosc 2010; 25:1070-5. [PMID: 20835727 DOI: 10.1007/s00464-010-1318-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2010] [Accepted: 08/07/2010] [Indexed: 12/20/2022]
Abstract
BACKGROUND This study aimed to evaluate the technical feasibility and safety of laparoscopic partial full-thickness gastrectomy with extensive sentinel node basin (SB) dissection in a porcine model before its application to gastric cancer without lymph node metastasis. METHODS A series of 10 pigs (30-37 kg) were used for a survival study approved by an animal use committee. The imaginary lesions were located in the greater curvature (n = 2), lesser curvature (n = 2), anterior wall (n = 2), posterior wall (n = 2), cardia (n = 1), and angle of the stomach (n = 1). The SBs were assumed to be located around each lesion in question. Laparoscopic partial gastrectomy and SB dissection were performed. Upper gastrointestinal series (UGIS) studies were performed with gastrograffin 5 days after the operation to detect possible stricture, leakage, and passage problems. The pigs were kept alive for 3 weeks, then killed. RESULTS The procedure was completed for all the pigs. Nine gastric wedge resections and one segmental resection of the stomach with several SB dissections were performed. The mean operation time was 102 min (70-150 min). The postoperative mean weight gain was 3.19 kg. There was no perioperative morbidity or mortality. The UGIS studies failed to detect leakage and stricture, but all the pigs exhibited delayed gastric emptying. Necropsies did not detect procedure-related complications. CONCLUSIONS As shown by a pig model, laparoscopic limited gastrectomy with SB dissection appears to be safe and technically feasible.
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Affiliation(s)
- Ju-Hee Lee
- Department of Surgery, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, South Korea
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16
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Ahn HS, Lee HJ, Hahn S, Kim WH, Lee KU, Sano T, Edge SB, Yang HK. Evaluation of the seventh American Joint Committee on Cancer/International Union Against Cancer Classification of gastric adenocarcinoma in comparison with the sixth classification. Cancer 2010; 116:5592-8. [PMID: 20737569 DOI: 10.1002/cncr.25550] [Citation(s) in RCA: 167] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2010] [Revised: 06/15/2010] [Accepted: 06/30/2010] [Indexed: 12/23/2022]
Abstract
BACKGROUND The seventh TNM staging system for gastric cancer of the American Joint Committee on Cancer/International Union Against Cancer (AJCC/UICC) had a more detailed classification than the sixth TNM staging system for both the tumor (T) and lymph nodes (N). The authors compared survival rates assessed by the seventh staging system with those by the sixth system. METHODS The authors analyzed the prospectively collected database on patients with gastric cancer who underwent surgery at Seoul National University Hospital between 1986 and 2006, and calculated the survival rates of 9998 cases with primary cancer, R0 resection, and >14 retrieved lymph nodes. RESULTS The 5-year cumulative survival rates (5YSR) according to the seventh edition T or N classifications were significantly different. The 5YSR according to seventh edition of the TNM staging system were 95.1% (stage IA), 88.4% (stage IB), 84.0% (stage IIA), 71.7% (stage IIB), 58.4% (stage IIIA), 41.3% (stage IIIB), and 26.1% (stage IIIC), which were significantly different from each other. The 5YSR of the seventh edition T2 and T3 classifications had significant differences in patients with every N classification, and the 5YSR of seventh edition N1 and N2 classifications had significant differences in T2 patients, T3 patients, and T4 patients. Each stage in the sixth edition was divided into the seventh edition stage with different survival rates. In addition, the number of homogenous groupings in seventh edition TNM stages was increased from 1 to 2. CONCLUSIONS The seventh system provided a more detailed classification of prognosis than the sixth system, especially between T2 and T3 tumors and N1 and N2 tumors, although further studies were found to be needed for the N3a and N3b classification.
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Affiliation(s)
- Hye Seong Ahn
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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17
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Shin WY, Suh KS, Kim T, Jeon YM, Yi NJ, Lee KU. [Could patients who underwent hepatic resection due to hepatocellular carcinoma with high alpha-fetoprotein be monitored for recurrence by alpha-fetoprotein level?]. Korean J Hepatol 2010; 16:168-75. [PMID: 20606501 DOI: 10.3350/kjhep.2010.16.2.168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND/AIMS The follow-up strategy after hepatectomy for hepatocellular carcinoma (HCC) usually depends on the experience of physician, resulting in frequent imaging studies, which leads to increased cost. Hence, we investigated the role of monitoring alpha-fetoprotein (AFP) levels after hepatectomy in patients with preoperative high AFP. METHODS From January 2000 to December 2004, 66 patients who underwent curative hepatectomy due to HCC with preoperative AFP level > 400 ng/mL were reviewed. Changes in AFP level after the operation were investigated. The recurrence was suspected in case of two consecutive increase of AFP over cut-off value. Cut-off value was determined by ROC curve. All patients were divided into 2 groups: patients who met the definition (Group S) and those who didn't (Group D). RESULTS AFP level of 20 ng/ml was proposed as the cut-off value for diagnosis of recurrence by ROC curve. Thirty two patients who didn't have the AFP level decreased below 20 ng/ml after the resection had HCC recurred, whereas 16 out of 34 patients who had AFP decreased had tumor recurrence. The AFP level of patients without recurrence was kept below 20 ng/ml during the follow-up. The AFP level of 44 out of 48 recurred patients increased over 20 ng/ml upon recurrence. By definition, group D were 5 patients. In 4 patients of group D, the AFP level didn't increase above 20 ng/ml upon recurrence. These patients had HCC and they recurred 1 year after the surgery. CONCLUSIONS In patients with preoperative AFP level > 400 ng/ml, the AFP level tended to increase above 20 ng/ml at recurrence mostly within 1 year. Hence, we proposed that these patients could be monitored by only AFP until 1 year after surgery.
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Affiliation(s)
- Woo Young Shin
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
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18
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Abstract
BACKGROUND Proximal gastrectomy is a surgical option for proximally located early gastric cancer. We present a new double-stapling method for proximal gastrectomy and esophagogastrostomy. METHODS We examined the safety of proximal gastrectomy by analyzing the lymph node metastasis rate in 53 patients who underwent total gastrectomy due to proximally located early gastric cancer from January 2004 to December 2008. We applied the double-stapling method used in distal gastrectomy reversely to proximal gastrectomy and esophagogastrostomy in 15 patients. RESULTS Retrospective analysis showed that proximal early gastric cancer metastasizes to only lymph node station 2, 3 and 7 which were completely removed during proximal gastrectomy. Fifteen patients underwent proximal gastrectomy using a new method which left no gastrostomy wound for the insertion of a circular stapler in the remaining stomach. The median operation time was 156.5 min and median postoperative hospital stay was 8.0 days. There were only 2 cases of wound complications during hospital stay. Two cases of anastomosis site strictures which developed after discharge were successfully treated with balloon dilatation. CONCLUSION We presented a new 'reverse double-stapling method' for proximal gastrectomy, which seems to be a fast and feasible method that leaves no gastrostomy wound in the remaining stomach.
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Affiliation(s)
- Seong-Ho Kong
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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Kim J, Yi NJ, Shin WY, Kim T, Lee KU, Suh KS. Platelet transfusion can be related to liver regeneration after living donor liver transplantation. World J Surg 2010; 34:1052-8. [PMID: 20151125 DOI: 10.1007/s00268-010-0464-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although liver regeneration is a fundamental aspect of living donor liver transplantation (LDLT), the factors that affect liver regeneration during the early post-transplantation period have not been thoroughly investigated. Recently it was suggested that platelets contribute to liver regeneration. The aim of the present study was to identify the major factors that affect liver graft regeneration during the early post-transplantation period. MATERIALS AND METHODS Eighty-seven right liver grafted, adult-to-adult LDLT patients were retrospectively analyzed. Liver regeneration was assessed by volumetry from computed tomographic (CT) scans obtained between the 9th and 11th postoperative days. The authors investigated relationships between clinical variables and liver graft regeneration rates, and they conducted multiple regression analysis on factors found to be significant by univariate analysis. RESULTS Mean graft weight at operation was 722.9 +/- 109.7 g, and mean graft volume assessed by follow-up CT was 1,042.2 +/- 155.6 ml, reflecting a mean liver graft regeneration of 45.9 +/- 22.3%. The graft regeneration was found to correlate inversely with graft-to-recipient weight ratio (GRWR, r = -0.406, p < 0.001) and directly with portal flow velocity (cm/s; r = 0.307; p = 0.004) and splenic index (cm(3); r = 0.282; p = 0.009). Moreover, the total amount (units) of platelets transfused was found to be significantly associated with graft regeneration (r = 0.293; p = -.006). Stepwise regression analysis showed that GRWR (beta = -33.124; p = 0.001), total amount of platelets transfused (beta = 0.771; p = 0.012), and splenic index (beta = -0.010; p = 0.049) were independently associated with graft regeneration. CONCLUSIONS The results of the present study suggest that platelets play a significant role in human liver regeneration after LDLT.
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Affiliation(s)
- Joohyun Kim
- Department of Surgery, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, 1 Hoegi-Dong, Dongdaemun-Gu, Seoul, 130-702, Republic of Korea
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Hwang DW, Lim CS, Jang JY, Lee SE, Yoon SO, Jeon YK, Uk Lee K, Kim SW. Primary hematolymphoid malignancies involving the extrahepatic bile duct or gallbladder. Leuk Lymphoma 2010; 51:1278-87. [PMID: 20572800 DOI: 10.3109/10428194.2010.483300] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Primary hematolymphoid malignancies of the extrahepatic biliary tract are rare tumors. We report five cases of primary hematolymphoid malignancies involving the extrahepatic biliary tract. One is a granulocytic sarcoma of the extrahepatic bile duct, another is an extramedullary plasmacytoma of the gallbladder, and the others are two non-Hodgkin lymphomas of the extrahepatic bile duct and one of the gallbladder. The clinical presentations, radiographic studies, and gross findings at surgery have not been a significant help in differential diagnosis. Although a preoperative diagnosis of primary hematolymphoid malignancy is very difficult to reach because of the rarity of this disease, it should be considered, because, if an accurate diagnosis is made before surgical intervention, chemotherapy is the most appropriate treatment. In limited cases mimicking cholangiocarcinoma and gallbladder cancer, surgical resection followed by chemotherapy has a valid role as reasonable treatment for patients.
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Affiliation(s)
- Dae Wook Hwang
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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21
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Lee HW, Suh KS, Kim J, Shin WY, Yi NJ, Jae HJ, Chung JW, Oh SW, Kang KW, Lee KU. Pulmonary artery embolotherapy in a patient with type I hepatopulmonary syndrome after liver transplantation. Korean J Radiol 2010; 11:485-9. [PMID: 20592935 PMCID: PMC2893322 DOI: 10.3348/kjr.2010.11.4.485] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Accepted: 02/01/2010] [Indexed: 12/31/2022] Open
Abstract
Although liver transplantation (LT) is the only effective treatment option for hepatopulmonary syndrome (HPS), the post-LT morbidity and mortality have been high for patients with severe HPS. We performed post-LT embolotherapy in a 10-year-old boy who had severe type I HPS preoperatively, but he failed to recover early from his hypoxemic symptoms after an LT. Multiple embolizations were then successfully performed on the major branches that formed the abnormal vascular structures. After the embolotherapy, the patient had symptomatic improvement and he was discharged without complications.
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Affiliation(s)
- Hae Won Lee
- Department of Surgery, Konkuk University School of Medicine, Seoul 143-729, Korea
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22
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Kim JW, Yoon H, Kong SH, Kim JS, Paeng JC, Lee HJ, Lee KU, Yang HK. Analysis of esophageal reflux after proximal gastrectomy measured by wireless ambulatory 24-hr esophageal pH monitoring and TC-99m diisopropyliminodiacetic acid (DISIDA) scan. J Surg Oncol 2010; 101:626-33. [PMID: 20461772 DOI: 10.1002/jso.21560] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND OBJECTIVES Reflux is one of the most common sequela after proximal gastrectomy (PG). The aim of this study was to find a predicting factor related to the character of esophageal reflux after PG. METHODS Wireless ambulatory 24-hr pH monitoring (for acid reflux, AR) and diisopropyliminodiacetic acid hepatobiliary scan (for bile reflux, BR) were performed on 24 patients who had reflux symptoms after PG with esophagogastrostomy from July 2008 to March 2009. Endoscopic examination was done and the length of remnant stomach (LoRS) was measure by postoperative UGI series. RESULTS Eleven patients (45.8%) had only BR, 7 (29.2%) had AR only, Two patients (8.3%) had both acid and BR, and 3 (12.5%) had neither. The LoRS along greater curvature was significantly shorter in patients with only BR (16.11 +/- 2.87 cm) than in patients with only AR (23.69 +/- 6.15 cm, P = 0.003). Severity of symptoms or esophagitis was not significantly correlated with the content of acid or BR. CONCLUSION Reflux symptom after PG is caused by either bile or acid rather than both. Character of reflux was related to the LoRS.
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Affiliation(s)
- Jong Won Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
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Yoo MW, Park DJ, Ahn HS, Jeong SH, Lee HJ, Kim WH, Kim HH, Lee KU, Yang HK. Evaluation of the adequacy of lymph node dissection in pylorus-preserving gastrectomy for early gastric cancer using the maruyama index. World J Surg 2010; 34:291-5. [PMID: 20012611 DOI: 10.1007/s00268-009-0318-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The Maruyama computer program predicts the percentage likelihood of disease in lymph node stations left undissected by a surgeon, according to the age and sex of the patient and the gross type, size, location, depth of invasion, and histology of the tumor. The Maruyama index (MI) is defined as the sum of the predictions of the percentage likelihood of disease in undissected regional lymph node station (station 1-12). It has been shown that an MI < 5 is a strong predictor of survival and that the MI is an independent predictor of overall survival and relapse risk. We used the MI to evaluate the adequacy of lymph nodes dissection in pylorus-preserving gastrectomy (PPG) for early gastric cancer (EGC) performed at Seoul National University Hospital. METHODS From March 2003 to September 2007, PPG was performed for patients with EGC of the middle third of the stomach when the distal resection margin was greater than 2 cm and preservation of 3 cm antral segment was possible. MIs and pathologic data such as TNM stage and the presence of metastatic lymph node for each station were reviewed. RESULTS PPG were performed on 24 patients. The mean age of the patients was 55 years. The median tumor size was 2.1 cm. The median and mean MI were 0 and 0.8, respectively. There were 23 cases of T1N0M0 tumor and one case of T2N0M0 tumor postoperatively. There were no recurrences (mean follow-up period: 27.2 months). CONCLUSIONS The MI indicates that lymph node dissection during PPG performed in these 24 patients was adequate.
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Affiliation(s)
- Moon-Won Yoo
- Department of Surgery, Seoul National University College of Medicine, 101 Daehakno, Jongno-Gu, Seoul, 110-744, Korea
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Shin WY, Suh KS, Lee HW, Kim J, Kim T, Yi NJ, Lee KU. Prognostic factors affecting survival after recurrence in adult living donor liver transplantation for hepatocellular carcinoma. Liver Transpl 2010; 16:678-84. [PMID: 20440777 DOI: 10.1002/lt.22047] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Liver transplantation is regarded as an effective treatment for early hepatocellular carcinoma (HCC). However, some patients experience recurrence and subsequently rapid progression of the disease. We investigated prognostic factors affecting survival after recurrence in patients who underwent adult living donor liver transplantation (LDLT) for HCC. From October 1992 to December 2005, 138 adult patients underwent LDLT for HCC. Among these, 28 patients (20.3%) who suffered recurrence were retrospectively reviewed. Univariate and multivariate analyses were performed to analyze factors affecting survival after recurrence. The median time to recurrence was 7.9 months. The median survival time after recurrence was 11.7 months, and the 1- and 3-year survival rates after recurrence were 52.8% and 15.8%, respectively. Initially, 7 patients (25%) showed multiorgan involvement; however, in the follow-up, 21 patients (75%) had multiorgan involvement. On univariate analysis, a pretransplant alpha-fetoprotein level >1000 ng/mL, major vascular invasion, a poorly differentiated tumor, a time to recurrence < or =6 months, unresectable disease, and bony metastases were related to shorter survival after recurrence. The independent prognostic factors by multivariate analysis were major vascular invasion [hazard ratio (HR) = 7.6], a poorly differentiated tumor (HR = 4.3), unresectable disease (HR = 10.4), and bony metastases (HR = 3.2). Two patients survived more than 36 months. One of them underwent retransplantation and survived for 45 months without additional recurrences. In conclusion, after transplantation, recurrent HCC has a tendency to involve multiple organs, and the prognosis is very poor. However, some patients have a good prognosis, and the appropriate treatment can prolong their survival. If the recurrent lesion is locally controllable, surgical resection should be considered.
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Affiliation(s)
- Woo Young Shin
- Department of Surgery, Seoul National University College of Medicine, Chongno-Gu, Seoul, Korea
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Woo HG, Lee JH, Yoon JH, Kim CY, Lee HS, Jang JJ, Yi NJ, Suh KS, Lee KU, Park ES, Thorgeirsson SS, Kim YJ. Identification of a cholangiocarcinoma-like gene expression trait in hepatocellular carcinoma. Cancer Res 2010; 70:3034-41. [PMID: 20395200 DOI: 10.1158/0008-5472.can-09-2823] [Citation(s) in RCA: 147] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC) are the major adult liver cancers. The existence of combined hepatocellular-cholangiocarcinoma (CHC), a histopathologic intermediate form between HCC and CC, suggests phenotypic overlap between these tumors. Here, we applied an integrative oncogenomic approach to address the clinical and functional implications of the overlapping phenotype between these tumors. By performing gene expression profiling of human HCC, CHC, and CC, we identified a novel HCC subtype, i.e., cholangiocarcinoma-like HCC (CLHCC), which expressed cholangiocarcinoma-like traits (CC signature). Similar to CC and CHC, CLHCC showed an aggressive phenotype with shorter recurrence-free and overall survival. In addition, we found that CLHCC coexpressed embryonic stem cell-like expression traits (ES signature) suggesting its derivation from bipotent hepatic progenitor cells. By comparing the expression of CC signature with previous ES-like, hepatoblast-like, or proliferation-related traits, we observed that the prognostic value of the CC signatures was independent of the expression of those signatures. In conclusion, we suggest that the acquisition of cholangiocarcinoma-like expression traits plays a critical role in the heterogeneous progression of HCC.
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Affiliation(s)
- Hyun Goo Woo
- Department of Internal Medicine, Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Kong SH, Kim JW, Lee HJ, Kim WH, Lee KU, Yang HK. The safety of the dissection of lymph node stations 5 and 6 in pylorus-preserving gastrectomy. Ann Surg Oncol 2010; 16:3252-8. [PMID: 19639365 DOI: 10.1245/s10434-009-0646-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Indexed: 12/18/2022]
Abstract
BACKGROUND This study was intended to examine the safety of possibly incomplete dissection of lymph node stations (LNS) 5 and 6 in pylorus-preserving gastrectomy (PPG) for gastric cancer. MATERIALS AND METHODS We reviewed the medical information from 1802 gastric cancer patients who underwent curative gastrectomy and whose lymph nodes were topographically classified according to LNS between March 2003 and December 2008. We divided the patients who underwent subtotal gastrectomy into 2 groups according to the distance between the distal resection margin (DRM) and primary tumor: those with a distance of < 6 cm (the < 6 DRM group) and those with a distance of >or= 6 cm (the >or= 6 DRM group). We analyzed the lymph node metastasis rate to LNS 5 and 6 according to T stage and the location. The number of retrieved lymph nodes according to LNS was compared between subtotal gastrectomy (STG) and PPG. RESULTS The metastasis rate to LNS 5 was very rare in >or= 6 DRM group: T1a, 0% (0 of 105); T1b, 0.9% (1 of 113); and T2a, 0% (0 of 56), although the number of retrieved LNS 5 was significantly lower in PPG than in STG. The metastasis rate to LNS 6 in the >or= 6 DRM group was significantly lower than in the < 6 DRM group, but higher than that of LNS 5: T1a, 0% (0 of 107); T1b, 1.8% (2 of 114); and T2a, 3.6% (2 of 56). The number of retrieved LNS 6 was not significantly different between STG and PPG. CONCLUSIONS PPG seems to be safe for early gastric cancer located >or= 5 cm from the pylorus in terms of LNS 5 and 6.
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Affiliation(s)
- Seong-Ho Kong
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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27
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Kang MJ, Jang JY, Lee SE, Lim CS, Lee KU, Kim SW. Comparison of the long-term outcomes of uncinate process cancer and non-uncinate process pancreas head cancer: poor prognosis accompanied by early locoregional recurrence. Langenbecks Arch Surg 2010; 395:697-706. [PMID: 20652784 DOI: 10.1007/s00423-010-0593-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Accepted: 01/07/2010] [Indexed: 12/22/2022]
Abstract
PURPOSE The embryologic and anatomic peculiarity of the uncinate process may result in distinct clinical features, but few studies have addressed the uncinate process cancer. The purpose of this study was to compare the clinicopathologic characteristics and identify the prognostic factors that affect the survival and recurrence of pancreatic head cancer by tumor location. METHODS Between January 2002 and December 2008, 453 patients (161 with uncinate and 292 with non-uncinate process cancer) were treated for pancreatic head cancer. Clinicopathologic variables were analyzed by tumor location. RESULTS Invasion into the superior mesenteric artery (SMA) occurred more frequently (p < 0.001), and overall resectability (p = 0.003), curative resection (p < 0.001), and R0 resection rates (22.3% vs 35.6%; p = 0.003) were lower for uncinate process cancer. Furthermore, overall survival after R0 resection was lower for uncinate process cancer (median 21 vs 26 months; p = 0.018), and this was accompanied by more frequent (p = 0.038) and earlier (median 13 vs 52 months; p < 0.001) locoregional recurrence. Concurrent chemoradiation increased overall (median, 26 vs 13 months; p < 0.001) and disease-free survival (median, 15 vs 6 months; p < 0.001) of uncinate and non-uncinate process cancer, respectively, after curative-intended resection. CONCLUSION In uncinate process cancer, frequent invasion into the SMA led to lower resectability. Furthermore, lower survival after R0 resection was accompanied with frequent and early locoregional recurrence. Strategies to improve surgical and perioperative locoregional control are required for uncinate process cancer.
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Affiliation(s)
- Mee Joo Kang
- Department of Surgery, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, South Korea
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Kwon J, Lee JH, Jee YS, Park DJ, Kim HH, Lee HJ, Yang HK, Lee KU, Lee HS. Overexpression of p53, Mutation of hMLH1and Microsatellite Instability in Gastric Carcinomas: Clinicopathologic Implications and Prognosis. J Korean Surg Soc 2010. [DOI: 10.4174/jkss.2010.79.2.94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Junsik Kwon
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ju-Hee Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ye Seob Jee
- Department of Surgery, Dankook University Hospital, Seoul, Korea
| | - Do-Jung Park
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyung-Ho Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hyuk-Joon Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Han-Kwang Yang
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kuhn Uk Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hye Seung Lee
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea
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Lee SE, Jang JY, Hwang DW, Lee KU, Kim SW. Clinical efficacy of organ-preserving pancreatectomy for benign or low-grade malignant potential lesion. J Korean Med Sci 2010; 25:97-103. [PMID: 20052354 PMCID: PMC2800014 DOI: 10.3346/jkms.2010.25.1.97] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2008] [Accepted: 03/01/2009] [Indexed: 11/20/2022] Open
Abstract
The clinical usefulness of organ-preserving pancreatectomy is not well established due to technical difficulty and ambiguity of functional merit. The purpose of this study is to evaluate the clinical efficacy of organ-preserving pancreatectomy such as duodenum-preserving resection of the head of the pancreas (DPRHP), pancreatic head resection with segmental duodenectomy (PHRSD), central pancreatectomy (CP) and spleen-preserving distal pancreatectomy (SPDP). Between 1995 and 2007, the DPRHP were performed in 14 patients, the PHRSD in 16 patients, the CP in 13 patients, and the SPDP in 45 patients for preoperatively diagnosed benign lesions or tumors with low-grade malignant potential. The clinical outcomes including surgical details, postoperative complications and long-term functional outcomes were compared between organ-preserving pancreatectomy and conventional pancreatectomy group. Major postoperative complications constituted the following: bile duct stricture (7.1% [1/14]) in DPRHP, delayed gastric emptying (31.2% [5/16]) in PHRSD, pancreatic fistula (21.4% [3/14]) in CP. There were no significant differences in postoperative complications and long-term functional outcomes between two groups. Organ-preserving pancreatectomy is associated with tolerable postoperative complications, and good long-term outcome comparing to conventional pancreatectomy. Organ-preserving pancreatectomy could be alternative treatment for benign or low-grade malignant potential lesion of the pancreas or ampullary/parapapillary duodenum.
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Affiliation(s)
- Seung Eun Lee
- Department of Surgery, Seoul National University, College of Medicine, Seoul, Korea
| | - Jin-Young Jang
- Department of Surgery, Seoul National University, College of Medicine, Seoul, Korea
| | - Dae Wook Hwang
- Department of Surgery, Seoul National University, College of Medicine, Seoul, Korea
| | - Kuhn Uk Lee
- Department of Surgery, Seoul National University, College of Medicine, Seoul, Korea
| | - Sun-Whe Kim
- Department of Surgery, Seoul National University, College of Medicine, Seoul, Korea
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Cho JY, Suh KS, Shin WY, Lee HW, Yi NJ, Kim MA, Jang JJ, Lee KU. Expansion of hepatic progenitor cell in fatty liver graft after living donor liver transplantation. Transpl Int 2009; 23:530-7. [PMID: 20003044 DOI: 10.1111/j.1432-2277.2009.01020.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Although it is known that steatotic livers have a reduced ability to regenerate, most individuals with steatosis show generally benign prognosis. We hypothesized that a proliferative blockade in steatotic hepatocytes results in the compensatory expansion of hepatic progenitor cells (HPC) during fatty liver regeneration. Fifty-four cases of living donor liver transplantation (LDLT) with a liver biopsy performed at the postoperative 10th day were examined. HPC were counted by immunofluorescence histochemical dual-staining technique using cytokeratin 7 and Ki-67, and the replicative arrest of hepatocytes was assessed by p21 immunohistochemistry. The degree of ductular proliferation during regeneration 10 days after LDLT correlated both with the degree of steatosis and the number of HPC (P < 0.001). There was no difference in the average number of HPC and the replicative arrest index between donors with or without steatosis before LDLT (P = 0.111 and P = 0.062). However, degree of steatosis correlated with both the expansion of HPC and the replicative arrest index during liver regeneration 10 days after LDLT (P < 0.001 and P < 0.001, respectively). Moreover, increased replicative arrest was strongly associated with HPC expansion (P < 0.001). In conclusion, the compensatory expansion of HPC as a result of impaired hepatocyte replication occurred during steatotic liver regeneration after LDLT.
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Affiliation(s)
- Jai Young Cho
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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Jee YS, Hwang SH, Rao J, Park DJ, Kim HH, Lee HJ, Yang HK, Lee KU. Safety of extended endoscopic mucosal resection and endoscopic submucosal dissection following the Japanese Gastric Cancer Association treatment guidelines. Br J Surg 2009; 96:1157-61. [PMID: 19705373 DOI: 10.1002/bjs.6686] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are widely performed. Indications for these procedures have been extended in Korea and Japan. The aim was to evaluate whether these extended indications are safe. METHODS All patients who had surgery for early gastric cancer at Seoul National University Bundang Hospital between May 2003 and December 2007 were identified from a prospective database. Lymph node status was examined in patients who met extended indications for EMR and had undergone surgical resection. RESULTS Of patients with mucosal cancers, 129 met extended indications for EMR or ESD and three (2.3 per cent) had lymph node metastasis. Of the 52 submucosal cancers meeting extended indications for EMR or ESD, two (4 per cent) had lymph node metastasis. Differentiated mucosal cancers without ulcer formation did not have lymph node metastasis, irrespective of size. CONCLUSION Extending the indications for EMR and ESD according to the Japanese Gastric Cancer Association guidelines carries an increased risk of lymph node metastasis. For cancers meeting these criteria, treatment by gastric resection with lymph node dissection should still be considered. A well differentiated mucosal cancer of any size without ulceration may be considered as an extended indication for EMR or ESD.
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Affiliation(s)
- Y S Jee
- Department of Surgery, Seoul National University Bundang Hospital, Seoul, Korea
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Ahn HY, Cho YM, Yi NJ, Suh KS, Lee KU, Park KS, Kim SY, Lee HK. Predictive factors associated with the reversibility of post-transplantation diabetes mellitus following liver transplantation. J Korean Med Sci 2009; 24:567-70. [PMID: 19654934 PMCID: PMC2719195 DOI: 10.3346/jkms.2009.24.4.567] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2008] [Accepted: 08/23/2008] [Indexed: 11/20/2022] Open
Abstract
Post-transplantation diabetes mellitus (PTDM) is reversible in a considerable number of patients. We examined the prevalence and predictive factors of transient PTDM following liver transplantation. Forty-two of 74 PTDM patients showed the clinical features of transient PTDM. Compared with the persistent PTDM patients, they were characterized by younger age at the time of transplantation (49+/-7 vs. 53+/-8 yr, P<0.05), longer time before the development of PTDM (44+/-59 vs. 13+/-20 days, P<0.05), lower rate of hepatitis c virus seropositivity (0.0 vs. 9.4%, P<0.05), and use of mycophenolate mofetil (59.5 vs. 28.1%, P<0.05). Among these risk factors, age at the time of transplantation is the single independent predictive factor associated with the reversibility of PTDM.
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Affiliation(s)
- Hwa Young Ahn
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Young Min Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Nam-Joon Yi
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung Suk Suh
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kuhn Uk Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kyong Soo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Seong Yeon Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hong Kyu Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Hwang SH, Park DJ, Jee YS, Kim MC, Kim HH, Lee HJ, Yang HK, Lee KU. Actual 3-year survival after laparoscopy-assisted gastrectomy for gastric cancer. ACTA ACUST UNITED AC 2009; 144:559-64; discussion 565. [PMID: 19528390 DOI: 10.1001/archsurg.2009.110] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To analyze 3-year actual disease-free survival after laparoscopy-assisted gastrectomy for gastric cancer on the assumption that 3-year disease-free survival may represent 5-year overall survival. DESIGN Retrospective analysis. SETTING Department of surgery of a university hospital. PATIENTS A total of 197 patients who underwent laparoscopy-assisted gastrectomy for gastric cancer from May 1998 to September 2007 and who were followed up for more than 3 years. MAIN OUTCOME MEASURES Feasibility and long-term survival rate with survival analysis by the Kaplan-Meier method. RESULTS Subtotal and total gastrectomies were performed in 178 and 19 patients, respectively. The scope of the lymph node dissections were D1 + beta (n = 152) and D2 (n = 45). There were 153, 28, 8, 6, 1, and 1 patients in stages Ia, Ib, II, IIIa, IIIb, and IV, respectively. The median follow-up was 45 months (range, 1-113 months), and there were 7 recurrences. Multivariate analysis of disease-specific survival showed that depth of invasion and lymph node metastasis influenced the prognosis independently. The actual 3-year disease-free survival rate for all patients was 96.9%. The 173 patients with early gastric cancer and 24 with advanced gastric cancer showed 98.8% and 79.1% actual 3-year disease-free survival rates, respectively. CONCLUSIONS Laparoscopy-assisted gastrectomy is acceptable oncologically in early gastric cancer if 3-year disease-free survival represents 5-year overall survival. Laparoscopy-assisted gastrectomy may also play an important role in the treatment of advanced gastric cancer.
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Affiliation(s)
- Sun-Hwi Hwang
- Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi, Korea
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Yi NJ, Suh KS, Lee HW, Shin WY, Kim J, Kim W, Kim YJ, Yoon JH, Lee HS, Lee KU. Improved outcome of adult recipients with a high model for end-stage liver disease score and a small-for-size graft. Liver Transpl 2009; 15:496-503. [PMID: 19399732 DOI: 10.1002/lt.21606] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Although adult-to-adult living donor liver transplantation (ALDLT) has shown comparable outcomes to deceased donor liver transplantation, the outcome of patients with a high MELD score (>25) and a small-for-size graft (SFSG<0.8% of graft-to-recipient weight ratio) is not known. For 7 years, 167 consecutive hepatitis B virus-infected recipients underwent ALDLT at our institution. Based on their MELD score without additional score for hepatocellular carcinoma (HCC), the recipients were divided into Group L (low MELD score, n = 105) or Group H (high MELD score, n = 62). To analyze the risk of the graft size, the patients were further stratified as follows: Group Hs (high MELD score and SFSG, n = 11), Hn (high MELD score and normal size graft, n = 51), Ls (low MELD score and SFSG, n = 18), and Ln (low MELD score and normal size graft, n = 87). The primary endpoint was one-year patient survival rate (1-YSR). The mean follow-up period was 32.6 months. The mean MELD scores were 17.1 in Group L and 32.6 in Group H. Group H had more patients with the complications of cirrhosis but less patients with HCC than Group L (p < 0.05). However, major morbidity rates and 1-YSR were similar in comparisons between Group L (46.7% and 86.7%) and H (59.7% and 83.8%) (p > 0.05). 1-YSR was similar among Group Hs (72.7%), Hn (86.3%), Ls (83.3%), and Ln (88.5%) groups (p = 0.278). The multivariate analysis revealed accompanying HCC and the year of transplant were risk factors for poor 1-YSR. However, 1-YSR without HCC patients was also similar in comparisons between group L (90.2%) and H (91.7%) (p = 0.847), and among Group Hs (80.0%), Hn (94.7%), Ls (72.7%), and Ln (96.7%) (p = 0.072). In conclusion, high MELD score (>25) didn't predict 1-YSR in ALDLT. Improvement of the 1-YSR might be affected by center's experience as well as the selection of patients with low risk of recurrence of HCC.
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Affiliation(s)
- Nam-Joon Yi
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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Suh KS, Yi NJ, Kim J, Shin WY, Lee HW, Han HS, Lee KU. Laparoscopic hepatectomy for a modified right graft in adult-to-adult living donor liver transplantation. Transplant Proc 2009; 40:3529-31. [PMID: 19100430 DOI: 10.1016/j.transproceed.2008.07.134] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2008] [Accepted: 07/22/2008] [Indexed: 11/15/2022]
Abstract
BACKGROUND We performed a modified right hepatectomy completely by laparoscopic techniques preserving the middle hepatic vein (MHV) branches in adult-to-adult living donor liver transplantation (LDLT). PATIENTS AND METHODS Two young women (24 and 25 years old) volunteered to be live donors for their parents who had hepatocellular carcinomas. As the donors expressed concerns about scarring, we performed a laparoscopic procedure using a hand port device. Mobilization of the right liver and the hepatic parenchymal transection were performed under pneumoperitoneum. Parenchymal transection was performed using a laparoscopic ultrasonic aspirator without the Pringle maneuver. During parenchymal transection, major MHV branches >5 mm were preserved using Hem-o-lock clips. The graft was extracted through the hand port site. On the back table, the 3 MHV branches were reconstructed using an artificial vascular graft. The livers were transplanted without complications. RESULTS The operative times for the donors were 765 and 898 minutes. The donors did not require transfusions or reoperation; they were discharged on postoperative days 10 and 14 with normal liver functions. CONCLUSION A hepatectomy performed completely by laparoscopic techniques for a right graft with preservation of the MHV branches was technically feasible.
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Affiliation(s)
- K S Suh
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
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Lee HJ, Lee IK, Kim JW, Lee KU, Choe KJ, Yang HK. Clinical characteristics of gastric cancer associated with pregnancy. Dig Surg 2009; 26:31-6. [PMID: 19153493 DOI: 10.1159/000193330] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2008] [Accepted: 10/18/2008] [Indexed: 12/10/2022]
Abstract
BACKGROUND/AIMS This study was conducted to evaluate the clinical features and treatment outcome of gastric cancer associated with pregnancy. METHODS Clinicopathologic characteristics of 15 patients who were diagnosed as having gastric cancer during pregnancy or within 1 year after delivery (the P-related group) were compared with those of 53 age-matched pregnancy-unrelated gastric cancer patients (the control group). RESULTS Significant differences were found in tumor stage and surgical curability; the numbers of stage IV disease were 12 (80%) and 21 (40%; p = 0.006), and those of curative resection were 4 (27%) and 20 (62%; p = 0.02) in the P-related and the control group, respectively. Three-year survival rate was significantly lower in the P-related group (23.3%) than in the control group (52.8%; p = 0.007). In the P-related group, only 3 patients, including one patient diagnosed using endoscopy, survived without recurrences. In the multivariate analysis, pregnancy was not identified as an independent risk factor associated with poor outcome. CONCLUSION Gastric cancer associated with pregnancy is discovered at its advanced stage and consequently shows a dismal prognosis. Considering that the patients who underwent curative resection have a favorable prognosis, primary efforts should be focused on early diagnosis.
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Affiliation(s)
- Hyuk-Joon Lee
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
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Ahn HS, Lee HJ, Yoo MW, Kim SG, Im JP, Kim SH, Kim WH, Lee KU, Yang HK. Diagnostic accuracy of T and N stages with endoscopy, stomach protocol CT, and endoscopic ultrasonography in early gastric cancer. J Surg Oncol 2009; 99:20-7. [PMID: 18937292 DOI: 10.1002/jso.21170] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Preoperative accurate diagnosis of the T and N stages in early gastric cancer (EGC) is important in determining the application of various limited treatments. The aim of this study is to analyze the accuracy of T and N staging of EGC with esophagogastroduodenoscopy (EGD), Stomach protocol CT (S-CT), and endoscopic ultrasonography (EUS), and the factors influencing the accuracy. METHODS Four hundred and thirty-four patients preoperatively diagnosed as EGC using EGD or S-CT and undergoing curative gastrectomy at Seoul National University Hospital in 2005 were included. The T and N stage reviewed by experienced personnel were compared with the surgical pathology. RESULTS The predictive values for EGC of EGD, S-CT, and EUS were 87.4%, 92.2%, and 94.1%, respectively. The predictive values for node negativity of S-CT, and EUS were 90.1% and 92.6%, respectively. The factors leading to underestimation of T stage with EGD were the upper third location, the size greater than 2 cm, and diffuse type of tumor. Those with S-CT were female sex, the upper third location and lesion size greater than 2 cm. CONCLUSIONS Before applying limited treatment for EGC, a surgeon should consider the risk factors of underestimation of T stage with EGD or S-CT.
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Affiliation(s)
- Hye Seong Ahn
- Department of Surgery, Seoul National University College of Medicine, Jongno-Gu, Seoul, Korea
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Yang SH, Yin YH, Jang JY, Lee SE, Chung JW, Suh KS, Lee KU, Kim SW. Establishment of a Guideline for the Safe Management of Anatomical Hepatic Artery Variations While Performing Major Hepato-pancreatico-biliary Surgery. J Korean Surg Soc 2009. [DOI: 10.4174/jkss.2009.76.2.100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Sung Hoon Yang
- Department of Surgery, Incheon Medical Center, Incheon, Korea
| | - Yong Hu Yin
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jin-Young Jang
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Eun Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Wook Chung
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung-Suk Suh
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kuhn Uk Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sun-Whe Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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Hwang SH, Park DJ, Jee YS, Kim HH, Lee HJ, Yang HK, Lee KU. Risk factors for operative complications in elderly patients during laparoscopy-assisted gastrectomy. J Am Coll Surg 2008; 208:186-92. [PMID: 19228529 DOI: 10.1016/j.jamcollsurg.2008.10.023] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2008] [Revised: 10/20/2008] [Accepted: 10/27/2008] [Indexed: 02/07/2023]
Abstract
BACKGROUND We evaluated the feasibility of laparoscopy-assisted gastrectomy in elderly patients with gastric cancer. STUDY DESIGN We performed a retrospective analysis of 632 patients who underwent laparoscopy-assisted gastrectomy from May 2003 to December 2007 at Seoul National University Bundang Hospital. Postoperative complication rates were compared between patients older and younger than 70 years of age. RESULTS Of the 632 patients, 515 (81.5%) were younger than 70 years and 117 (18.5%) were aged 70 years or older. Significant differences in the prevalence of cardiovascular disease and hypertension were observed in patients older than 70 years (p < 0.05). Although the overall complication rates of the patients younger and older than 70 years were 12.6% and 17.9%, respectively, there was no statistically significant difference between groups (p=0.12). Multiple logistic regression analysis revealed that comorbidities with hypertension or with liver cirrhosis were the only variables that correlated independently with postoperative complications. CONCLUSIONS Complications after laparoscopy-assisted gastrectomy for patients older than 70 years of age with gastric cancer were similar to those of younger patients. But a careful approach is required when patients older than 70 years of age have hypertension or liver cirrhosis.
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Affiliation(s)
- Sun-Hwi Hwang
- Department of Surgery, Seoul National University Bundang Hospital, Gyeonggi, Korea
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Abstract
The spleen may be preserved during distal pancreatectomy (DP) for benign disease. The aim of this study was to compare the perioperative and postoperative courses of patients with conventional DP and spleen-preserving distal pancreatectomy (SPDP) for benign lesions or tumors with low-grade malignant potential occurred at the body or tail of the pancreas. A retrospective analysis was performed for the hospital records of all the patients undergoing DP and SPDP between January 1995 and April 2006. One-hundred forty-three patients underwent DP and 37 patients underwent SPDP. There were no significant differences in age, sex, indications of operation, estimated blood loss, operative time, and postoperative hospital stay between the two groups. Pancreatic fistula occurred in 21 (13.3%) patients following DP and in 3 (8.1%) following SPDP without a significant difference (p=0.081). Portal vein thrombosis occurred in 4 patients after DP. Splenic infarction occurred in one patient after SPDP. Overwhelming postosplenectomy infection was observed in one patient after DP. SPDP can be achieved with no increase in complication rate, operative time, or length of postoperative hospitalization as compared to conventional DP. Additionally, it has the advantage of reducing the risk of overwhelming postsplenectomy infection and postoperative venous thrombosis.
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Affiliation(s)
- Seung Eun Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jin-Young Jang
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kuhn Uk Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sun-Whe Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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Yang SH, Yin YH, Jang JY, Lee SE, Chung JW, Suh KS, Lee KU, Kim SW. Assessment of Hepatic Arterial Anatomy in Keeping with Preservation of the Vasculature While Performing Pancreatoduodenectomy: An Opinion. World J Surg 2008. [DOI: 10.1007/s00268-008-9751-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Han SS, Jang JY, Lee KU, Kim SW. Actual long-term outcome of Klatskin's tumor after surgical resection. Hepatogastroenterology 2008; 55:1986-1992. [PMID: 19260464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND/AIMS To analyze the actual long-term outcome of Klatskin's tumor after surgical resection and to identify the factors affecting long-term survival. METHODOLOGY We reviewed the records of 145 Klatskin's tumor cases who underwent operation from 1991 to 1999 and analyzed the actual outcome and prognostic factors. We also compared the clinicopathologic characteristics of long-term and short-term survivors. RESULTS Seventy-six patients underwent resection (resection rate 52.4%). Twenty-one of the 76 patients survived more than 5 years, an actual 5-year survival rate of 28%, and of these survivors, 4 had recurrent disease at 5 years and 3 developed recurrence after 5 years. Five patients with well-known poor prognostic factors, such as, lymph node metastasis and resection margin involvement survived more than 5 years. Lymph node metastasis was identified as a significant prognostic factor, and long-term survivors were found to have more favorable T and N stages than short-term survivors. CONCLUSIONS The actual 5-year survival rate after resection was 28%, and lymph node metastasis was identified as a significant prognostic factor. Long-term follow-up is mandatory, because recurrence occurs beyond 5 years after surgery. An aggressive surgical approach should be used to give patients with poor prognostic factors a chance of survival.
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Affiliation(s)
- Sung-Sik Han
- Center for Liver Cancer, National Cancer Center, Goyang, Gyeonggi, Korea
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Park DJ, Lee HJ, Jung HC, Kim WH, Lee KU, Yang HK. Clinical outcome of pylorus-preserving gastrectomy in gastric cancer in comparison with conventional distal gastrectomy with Billroth I anastomosis. World J Surg 2008; 32:1029-36. [PMID: 18256877 DOI: 10.1007/s00268-007-9441-4] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Pylorus-preserving gastrectomy (PPG) was originally a treatment option in gastric ulcer surgery and is now being performed as a limited surgery in some early gastric cancer cases. This study was designed to evaluate the postoperative functional characteristics of PPG versus conventional distal gastrectomy with Billroth I anastomosis (BI). METHODS Patients who underwent PPG (study group) between November 1999 and April 2003 were enrolled and BI patients (control group) were matched for number, gender, age, weight, height, stage, and follow-up period. We evaluated postprandial symptoms and nutritional status. Gastric emptying studies with a 99mTc gamma camera, follow-up endoscopies with random biopsies of remnant gastric mucosa to evaluate bile reflux gastritis, and ultrasonography to detect gallbladder stones were performed. Recurrence and survival also were investigated. RESULTS Twenty-two PPG patients (study group) and 17 BI patients (control group) were enrolled. Overall modified Visick scores of postprandial symptoms were lower in PPG patients than in BI patients (0.9 +/- 0.7 vs. 2.3 +/- 1.4; p = 0.018). Gastric emptying was delayed in PPG patients versus BI patients for solids (p < 0.05). Moderate gastritis, bile reflux, and gallbladder stone were observed only in BI patients. Remnant stomach pathologic findings corresponding to bile reflux gastritis in the two groups were similar, except for Helicobacter pylori colonization. No recurrence occurred in either group (mean follow-up period = 41 +/- 9.5 months). CONCLUSIONS PPG patients had fewer subjective postprandial symptoms than BI patients. The present study also suggests that PPG has advantages over BI in terms of the avoidance of bile reflux and gallbladder stones.
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Affiliation(s)
- Do Joong Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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Abstract
BACKGROUND AND OBJECTIVES The purpose of this study is to investigate characteristics of synchronous and metachronous cancer in gastric cancer and to suggest appropriate methods of treatment management. METHODS We reviewed 4,593 patients who underwent operations for gastric cancer at Seoul National University Hospital from 1999 to 2005. We selected those patients who had also been diagnosed with another primary cancer and classified patients into three groups according to the date of detection of another primary cancer. We analyzed their clinicopathological features. RESULTS The incidence of synchronous or metachronous cancer in addition to gastric cancer was 3.4%. The most common another primary cancer was colorectal cancer (20.1%), followed by lung cancer and liver cancer. The majority of synchronous cancers were operated on at the same time as gastric cancer. Eighty-five percent of the synchronous group and 45% of the post-metachronous group were detected by a routine checkup, without prior symptoms. There was no postoperative mortality and the overall 5-year survival rate was 69.4%. CONCLUSION Synchronous cancer should be considered in the preoperative workup and combined resection should be applied whenever possible. Periodic examination for metachronous cancer is necessary during the postoperative period.
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Affiliation(s)
- Bang Wool Eom
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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Yang HK, Park DJ, Lee HJ, Kim HH, Kim WH, Lee KU. Clinicopathologic characteristics of gastrointestinal stromal tumor of the stomach. Hepatogastroenterology 2008; 55:1925-1930. [PMID: 19102424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND/AIMS This study was undertaken to investigate a surgical role in treating gastrointestinal stromal tumors (GISTs) of the stomach and to find their behavior and prognostic factors. METHODOLOGY The clinicopathologic results of 112 patients with gastric GISTs who underwent surgery from December 1999 to August 2006 were reviewed. RESULTS Forty (35.7%) patients had no symptoms. Of a total of 112 patients, curative resections were performed on 105 (93.8%). There were 41 (36.6%) high-risk patients. The mean follow-up period was 34.3 months (1-82 months) and there were two deaths. Six (5.7%) of the 105 patients who received curative resections had recurrences and all recurrences occurred only in high-risk patients. Univariate analysis showed that tumor size and mitotic count were prognostic for disease-free survival of GIST patients (p=0.0004 and p<0.0001, respectively), but multivariate analysis identified mitotic count as the only prognostic factor for disease-free survival of GIST patients (p=0.039). CONCLUSIONS The curative resection rate was high in GISTs of the stomach and they were treated using various surgical procedures. Patient survival after curative resection was good. Mitotic count was the independent prognostic factor for disease-free survival and only high-risk patients had recurrences.
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Affiliation(s)
- Han-Kwang Yang
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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Abstract
BACKGROUND It is known that hypophosphatemia can frequently develop after hepatectomy and may result from an increased renal phosphate leak. However, its clinical significance has not been well defined in live donor right hepatectomy (LDRH). The purpose of this study was to investigate the correlation between postoperative hypophosphatemia and both donor morbidity and the degree of hepatic resection in LDRH. METHODS In all, 88 live liver donors were enrolled, who had undergone right hemihepatectomy between January 2002 and December 2005. Based on the severity of the postoperative hypophosphatemia, we divided the donors into 3 groups: mild (1.5-2.5 mg/dL, n = 30), moderate (1.0-1.5 mg/dL, n = 41), and severe (<1.0 mg/dL, n = 17), and we compared the incidence of complications among these groups. In addition, we investigated the possible correlation between the nadir phosphorus levels and both remnant liver volume and alkaline phosphate (ALP) levels. RESULTS All donors developed hypophosphatemia postoperatively. The mean value of the nadir phosphorus levels was 1.4 +/- 0.04 mg/dL. However, no significant difference was observed in the incidence of postoperative complications among the hypophosphatemia groups. The phosphorus level was positively correlated with the remnant liver volume (r = 0.389, P < 0.001), but it was negatively correlated with a postoperative increase in the ALP (r = -0.276, P = 0.014). CONCLUSIONS Hypophosphatemia developed very frequently after LDRH. However, transient hypophosphatemia was unlikely to lead to severe complications in healthy donors. Therefore, based on the serum level, oral or intravenous phosphorus replacement treatment might be more appropriate than routine aggressive replacement by TPN. In addition, although the factors responsible for posthepatectomy hypophosphatemia have not been identified, they might be substances that are associated with hepatic regeneration.
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Affiliation(s)
- Hae Won Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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Woo HG, Park ES, Cheon JH, Kim JH, Lee JS, Park BJ, Kim W, Park SC, Chung YJ, Kim BG, Yoon JH, Lee HS, Kim CY, Yi NJ, Suh KS, Lee KU, Chu IS, Roskams T, Thorgeirsson SS, Kim YJ. Gene expression-based recurrence prediction of hepatitis B virus-related human hepatocellular carcinoma. Clin Cancer Res 2008; 14:2056-64. [PMID: 18381945 DOI: 10.1158/1078-0432.ccr-07-1473] [Citation(s) in RCA: 131] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE The poor prognosis of hepatocellular carcinoma (HCC) is, in part, due to the high rate of recurrence even after "curative resection" of tumors. Therefore, it is axiomatic that the development of an effective prognostic prediction model for HCC recurrence after surgery would, at minimum, help to identify in advance those who would most benefit from the treatment, and at best, provide new therapeutic strategies for patients with a high risk of early recurrence. EXPERIMENTAL DESIGN For the prediction of the recurrence time in patients with HCC, gene expression profiles were generated in 65 HCC patients with hepatitis B infections. RESULT Recurrence-associated gene expression signatures successfully discriminated between patients at high-risk and low-risk of early recurrence (P=1.9 x 10(-6), log-rank test). To test the consistency and robustness of the recurrence signature, we validated its prognostic power in an independent HCC microarray data set. CD24 was identified as a putative biomarker for the prediction of early recurrence. Genetic network analysis suggested that SP1 and peroxisome proliferator-activated receptor-alpha might have regulatory roles for the early recurrence of HCC. CONCLUSION We have identified a gene expression signature that effectively predicted early recurrence of HCC independent of microarray platforms and cohorts, and provided novel biological insights into the mechanisms of tumor recurrence.
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Affiliation(s)
- Hyun Goo Woo
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Cho JY, Suh KS, Shin WY, Lee HW, Yi NJ, Lee KU. Thrombosis Confined to the Portal Vein Is Not a Contraindication for Living Donor Liver Transplantation. World J Surg 2008; 32:1731-7. [DOI: 10.1007/s00268-008-9651-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Hwang SH, Park DJ, Kim YH, Lee KH, Lee HS, Kim HH, Lee HJ, Yang HK, Lee KU. Laparoscopic surgery for submucosal tumors located at the esophagogastric junction and the prepylorus. Surg Endosc 2008; 23:1980-7. [PMID: 18470554 DOI: 10.1007/s00464-008-9955-3] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2007] [Revised: 02/18/2008] [Accepted: 04/05/2008] [Indexed: 02/06/2023]
Abstract
BACKGROUND Laparoscopic partial gastric resection is widely accepted as a treatment for gastric submucosal tumors (SMTs). However, SMTs of either end of the stomach are generally managed by subtotal gastrectomies or total gastrectomies. This study was conducted to evaluate surgical techniques for management of SMTs located at the ends of the stomach. METHODS Among 63 patients who were diagnosed and underwent laparoscopic surgery for gastric SMTs at Seoul National University Bundang Hospital from May 2003 to May 2007, 11 SMTs located at the ends of the stomach were identified. The clinicopathologic results of these 11 SMTs were analyzed. RESULTS Laparoscopic partial wedge resections or tumor excisions were successfully performed on all patients except for those who had prepyloric tumors. Six men and five women had SMTs at the ends of the stomach. The patients ranged in age from 21-63 years (mean 43.4 +/- 13.5 years). Of six esophagogastric junctional tumors that showed low, homogeneous contrast enhancement on computed tomography (CT) scans, five were treated by laparoscopic transgastric enucleation and one by tumor-everting resection. One esophagogastric junctional tumor that leaned toward the fundus and showed a 6-cm-diameter endophytic mass with heterogeneous enhancement on CT scan was resected by laparoscopic wedge resection. The mean operation time was 100 min (range 60-210 min). Three laparoscopy-assisted distal gastrectomies and one laparoscopic wedge resection were performed on SMTs located near the prepyloric antrum. There were no intra- or postoperative complications. Duration of postoperative hospital stay ranged from 4-7 days. CONCLUSION Laparoscopic local resection is an effective treatment for SMTs located at the esophagogastric junction and can be used instead of a total or proximal gastrectomy. However, gastrectomies should be considered for SMTs located near the pylorus because of the small volume of the lower third of the stomach.
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Affiliation(s)
- Sun-Hwi Hwang
- Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi, Korea
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Ahn HS, Kim JW, Yoo MW, Park DJ, Lee HJ, Lee KU, Yang HK. Clinicopathological features and surgical outcomes of patients with remnant gastric cancer after a distal gastrectomy. Ann Surg Oncol 2008; 15:1632-9. [PMID: 18379851 DOI: 10.1245/s10434-008-9871-8] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2007] [Revised: 01/25/2008] [Accepted: 01/31/2008] [Indexed: 02/06/2023]
Abstract
BACKGROUND The incidence of gastric cancer in the remnant stomach after distal gastrectomy is increasing. The aim of this study was to evaluate the clinicopathological features and surgical outcomes of remnant gastric cancer (RGC). METHODS We reviewed the medical records of 58 patients who underwent laparotomy for RGC at Seoul National University Hospital between 2000 and 2005. RESULTS The mean interval between the first and second operations was 12.5 years, and the rate of RGC diagnosis by tests included the follow-up program was 41.4%. The 45 RGCs occurring after distal gastrectomy for initial gastric cancer had a shorter interval and were more frequently located at the non-anastomotic site than those following benign lesions (P <0.001 and P = 0.010). Of all patients, 41 (70.7%) underwent, and the overall 3-year survival rate was 62.4%. An early stage of the initial gastric cancer, no symptoms at diagnosis, curative resection, tumor size smaller than 6 cm, and an early TNM stage of the RGC were associated with longer survival; the initial gastric disease, the interval and the location of RGC were not. CONCLUSION The successful curative resection and an early stage of the RGC led to good outcomes. In considering the different latency periods of the two initial gastric diseases, appropriate follow-up programs should be developed.
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Affiliation(s)
- Hye Seong Ahn
- Department of Surgery, College of Medicine, Seoul National University, 28 Yeongeon-dong, Jongno-gu, Seoul 110-744, Korea
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