• Title/Summary/Keyword: 수술 후 예후

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Trestment Results and Prognostic Factors in Localized Gastrointestinal Non-Hodgkin's Lymphoma (국소적 위장관 악성 림프종의 치료성적 및 예후인자 분석)

  • Oh, Young-Taek;Suh, Chang-Ok;Kim, Gwi-Eon
    • Radiation Oncology Journal
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    • v.12 no.3
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    • pp.349-359
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    • 1994
  • Purpose: The primary gastrointestinal non-Hodgkin's lymphoma(GI-NHL) is the most common extranodal NHL. Surgery with postoperative radiotherapy or chemotherapy was tried with some success, but proper management guidelines have not been estabilished in localized GI-NHL due to its rarity and the lack of randomized trials. So we designed this study to evaluate treatment results and the lack of randomized trials. So we designed this study to evaluate treatment results and prognostic factors in localized GI-NHL, and to assess proper treatment mdality after surgical resection accordig to risk factors by survival analysis. Method: Seventy three patients who received surgical resection due to localized GI-NHL from Jan. 1916 to Apr. 1991 were reviewed in this study. Prognostic factors were analyzed by multivariate analysis program including postoperative treatment methods, and treatment results were compared according to prognostic factors and treatment modalities. Results: Overall 5-year survival rate was 62.3%, for all patients. The 5-year survival rate was 80.0% for patients with stage I GI-NHL and 45.7% for those with stage II. Chemotherapy or not, stage and residuum or not after surgical resection were significant independent prognositic factors. Postoperative adjuvant treatments showed significant survival benefit. In patients with high risk factors such as stage II or residuum after surgical resection, postoperative combined chemotherapy and radiotherapy showed better survival than those treated with single modality. Conclusions: Chemothrapy or not, stage, and residuum or not were important prognostic factors of patients with localized GI-NHL after surgical resection. Either chemotherapy or radiation therapy alone after surgical resection is recommanded for patients without high risk factors(stage II or residuum after surgical resection) but the postoperative combined chemotherapy and radiotherapy seems to be beneficial for patients with high risk factors.

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Prognostic Factors Influencing the Result of Postoperative Radiotherapy in Endometrial Carcinoma (자궁내막암의 수술 후 방사선치료 결과에 영향을 미치는 예후인자)

  • Ki Yong-Kan;Kwon Byung-Hyun;Kim Won-Taek;Nam Ji-Ho;Yun Man-Su;Lee Hyung-Sik;Kim Dong-Won
    • Radiation Oncology Journal
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    • v.24 no.2
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    • pp.110-115
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    • 2006
  • Purpose: This study was performed to determine the prognostic factors influencing relapse pattern, overall and disease-free survival in patients treated with postoperative radiotherapy for endometrial carcinoma. Materials and Methods: The records of 54 patients with endometrial adenocarcinoma treated postoperative radiotherapy at Pusan National University Hospital between April 1992 and May 2003 were reviewed retrospectively. Median age of the patients was 55 (range $35{\sim}76$). The distribution by surgical FIGO stages were 63.0% for 0Stage I, 14.8% for Stage II, 22.2% for Stage III. All patients received postoperative external radiotherapy up to $41.4{\sim}54Gy$ (median: 50.4 Gy). Additional Intravaginal brachytherapy was app led to 20 patients (37.0% of all). Median follow-up time was 35 months ($5{\sim}115$ months). Significant factors of this study: histologic grade, Iymphovascular space invasion and myometrial invasion depth were scored (GLM score) and analyzed. Survival analysis was peformed using Kaplan-Meier method. The log-rank test was used for univariate analysis and the Cox regression model for multivariate analysis. Results: 5-year overall and disease-free survival rates were 87.7% and 871%, respectively. Prognostic factors related with overall and disease-free survival were histologic grade, Iymphovascular space invasion and myometrial invasion according to the univariate analysis. According to the multivariate analysis, Iymphovascular space invasion was associated with decreased disease-free survival. GLM score was a meaningful factor affecting overall and disease-free survival (p=0.0090, p=0.0073, respectively) and distant recurrence (p=0.0132), which was the sum of points of histologic grade, Iymphovascular space Invasion and myometrial invasion. Total failure rate was 11% with 6 patients. Relapse sites were 2 para-aortic Iymph nodes, 2 lungs, a supraclavicular Iymph node and a vagina. Conclusion: The prognosos in patients with endometrial carcinoma treated by postoperative radiotherapy was closely related with surgical histopathology. If further explorations confirm the system of prognostic factors in endometrial carcinoma, it will help us to predict the progression pattern and to manage.

Clinical Experience of Small-cell Carcinomas of the Stomach (위에 발생한 소세포암의 임상 경험)

  • Kim, Hyoung-Ju;Park, Moon-Hyang;Kwon, Sung-Joon
    • Journal of Gastric Cancer
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    • v.5 no.4 s.20
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    • pp.252-259
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    • 2005
  • To clarify the clinicopathologic features of small-cell carcinomas (SCC) of the stomach, we reviewed three cases of surgically treated SCC. The first case was a pure SCC, with severe pancreatic invasion and peritoneal seeding. A gastro-jejunostomy was performed. Postoperative chemotherapy was performed with CDDP and VP-16 (8 cycles) but showed disease progression (PD); a consecutive chemotherapy with CDDP and irinotencan (2 cycles) also showed PD. A third line with CDDP, VP16, ifosfamide, and mesna was followed by a 4th line (CDDP and Taxol). The male patient died with liver metastasis and peritoneal seeding 14 months after the operation. The second case was a SCC mixed with a poorly differentiated adenocarcinoma. Profound lymphadenopathy and liver metastasis were found. Two cycles of preoperative chemotherapy with TS-1 and CDDP were performed, which showed nearly complete remission for lymphadenopathy and partial response for the primary tumor site and liver metastatic lesion. A total gastrectomy and extended lymphadenectomy was performed. There were no viable cancer cells in 35 retrieved lymph nodes. Postoperative chemotherapy using the same regimen was performed for 4 cycles. Enlarged liver metastasis was found at the follow-up CT scan, so a posterior segmentectomy of liver was performed. After liver surgery, the chemotherapy regimen was changed to irinotecan and cisplatin. This male patient has been in good health for the f4 months since gastric surgery. The third case was a pure SCC, and a subtotal gastrectomy was performed curatively. That male patient received 5 cycles of TS-1 and is still in good health 14 months after operation.

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Traumatic Brachial Plexus Injury: Preoperative Evaluation and Treatment Principles (상완 신경총 손상에서의 수술 전 평가와 치료 계획)

  • Yoo, Jae-Sung;Park, Sung-Bae;Kim, Jong-Phil
    • Archives of Hand and Microsurgery
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    • v.22 no.3
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    • pp.137-146
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    • 2017
  • Brachial plexus injury is regarded as one of the most devastating injuries of the upper extremity. Accurate diagnosis is important to obtain the successful results. Basic preoperative evaluation includes simple radiography, cervical myelography. Magnetic resonance imaging, angiography, electrophysiologic studies and intraoperative studies. Furthermore, proper timing of surgery, surgical indication, plan and sufficient understanding of patients about the prognosis are the key for the satisfactory outcomes. This article provides an overview of the evaluation, diagnosis, intraoperative monitoring, and proper surgical planning for the treatment of posttraumatic brachial plexus injuries.

Informational Needs of Postoperative Gastric Cancer Patients (위암 수술 후 환자의 정보 요구)

  • Kim, Ae-Ran;Choi, Min-Gew;Noh, Jae-Hyung;Sohn, Tae-Sung;Bae, Jae-Moon;Kim, Sung
    • Journal of Gastric Cancer
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    • v.9 no.3
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    • pp.117-127
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    • 2009
  • Purpose: Adequate health-related information provided by health professionals may help cancer patients overcome their uncertain situation and manage their healthcare. To provide information effectively, there is a need to understand the content of the patients' essential information. The purpose of this study was to identify recent informational needs of postoperative gastric cancer patients. Materials and Methods: Data were collected from 190 postoperative gastric cancer patients who attended the Stomach Cancer Patients' Day ceremony (18 November 2008) held by the Stomach Cancer Center of Samsung Medical Center with the use of a questionnaire which measured informational needs. A questionnaire with 37 items was comprised of domains of diagnostic tests, cancer therapy, prognosis, follow-up, sexual activity, stomach cancer-related information, and 7 single items. Results: The priorities of informational needs were the domains of prognosis, ways of healthcare during treatment (a single item), follow-up, stomach cancer-related information, cancer therapy, and diagnostic tests (in descending order). Items related to prognosis, diet, and management of their healthcare ranked in the top 10 informational need scores. As age decreased, the degree of informational needs about diagnostic tests, cancer therapy, sexual activity, and stomach cancer-related information increased. Conclusion: We suggest that prognosis-related information based on the accumulated institutional therapeutic outcomes and objective prognosis data should be incorporated in the current education program. Health professionals should provide comprehensible information content to cancer patients and caregivers and encourage patients to participate in their therapy with a more positive attitude.

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Preoperative Concurrent Radiochemotherapy for Locally Advanced Esophageal Cancer: Treatment Outcome and Prognostic Factors (국소 진행된 식도암에 대한 수술 전 동시병용 방사선-항암 화학요법: 치료 성적과 예후인자에 대한 연구)

  • Kim, Hae-Young;Kim, Kwan-Min;Kim, Jhin-Gook;Shim, Young-Mog;Im, Young-Hyuck;Ahn, Yong-Chan
    • Radiation Oncology Journal
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    • v.25 no.3
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    • pp.160-169
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    • 2007
  • Purpose: This study reports the results of the use of preoperative concurrent radiochemotherapy (CRCT) for the treatment of locoregionally advanced esophageal cancer. Materials and Methods: From 1998 through 2005, 61 patients with intrathoracic esophageal cancer at stages II-IVB (without distant organ metastasis and presumed to be respectable) received preoperative CRCT. CRCT consisted of radiotherapy (45 Gy /25 fractions /5 weeks) and FP chemotherapy (5-FU 1 g/$m^{2}$/day, days 1-4 and 29-32, Cisplatin 60 mg/$m^{2}$/day, days 1 and 29). An esophagectomy was planned in $4{\sim}6$ weeks after the completion of CRCT. Results: There were two treatment-related deaths. Among the 61 patients, 53 patients underwent surgery and 17 patients achieved a pathological complete response (pCR). The overall survival (OS) rates of all 61 patients at 2 and 5 years were 59.0% and 38.0%, respectively. The rates of OS and disease-free survival (DFS) of the surgically resected patients at 2 and 5 years were 61.6%, 40.1 % and 53.3%, 41.8%, respectively. By univariate analysis, achieviement of pCR and a clinically uninvolved distant lymph node (cMO) were favorable prognostic factors for OS and DFS. There were 27 patients that experienced a relapse-a locoregional relapse occurred in 5 patients, a distant metastasis occurred in 12 patients and combined failure occurred in 10 patients. Conclusion: The results of the current study are favorable. pCR and an uninvolved distant lymph node were found to be favorable prognostic factors.

Treatment of Cerebral Arteriovenous Malformations by Preoperative Embolization and Microsurgery (술전 색전술과 미세수술을 이용한 뇌동정맥기형의 치료)

  • Kim, Kyu Hong;Rho, Myung Ho;Lee, Woon Gi;Choi, Jeong Hoon;Lee, In Chang;Bae, Sang Do
    • Journal of Korean Neurosurgical Society
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    • v.29 no.4
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    • pp.500-506
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    • 2000
  • Objective : To determine the role of preoperative embolization on postoperative neurological outcome in the treatment of cerebral AVMs, we retrospectively evaluated an effectiveness of combining preoperative embolization and microsurgery for arteriovenous malformations(AVM) of the brain. Method : Two groups(10 patients who underwent preoperative superselective embolization and surgery versus 27 patients who underwent surgery only) were compared and categorized by Spetzler-Martin grade, the size of AVM and postoperative clinical outcome using Glasgow Outcome Scale. The 37 patients included 23 males and 14 females, ranging in age from 11 to 74 years(mean 36 years). Results : The arteriovenous malformations in preoperative embolization and surgery group had a larger average greatest diameter(4.45cm versus 3.83cm) and were of higher Spetzler-Martin grade(80% versus 52% grade III through V). At 1 week after surgery, the preoperative embolization and surgery group represented a better outcome(60% versus 44% with Glasgow Outcome Scale score of 5). And over 6 months after surgery, the embolization and surgery group displayed more favorable clinical outcome(80% versus 63% with Glasgow Outcome Scale score of 5). Conclusion : Combined treatment with superselective preoperative embolization using N-butyl cyanoacrylate and direct surgery may help neurosurgeon treating the high grade AVMs thus improving the postsurgical outcome.

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Autogenous Free Gingival Graft (유리치근 자가이식술의 방법 및 증례보고)

  • Son, Seoung-Heui;Lee, Jae-Hyun;Kim, Woo-Sung;Kim, Choong-Gun;Lee, Chung-Ho
    • The Journal of the Korean dental association
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    • v.11 no.10
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    • pp.675-679
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    • 1973
  • 저자들은 Vestibular fornix의 연장, 노출된 치근의 치근회복 또는 부착치근의 폭경을 증가시켜주기 위해서 유리치근 자가이식수술을 6례는 하악전치부에, 2례는 하악구치부에 시행하여 성공하였다. 수술후 3개월 6개월에 완전치유결과를 나타냈으며 수술후의 후유증으로 이식부위의 조직의 색조가 인접조직과 비교해서 약간 차이가 있을 뿐이다. 본 수술은 비교적 간단하고 또한 치유가 빠르며 예후가 양호하므로 치주영역에 추천할만한 수술법이다.

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Treatment Outcome and Analysis of the Prognostic Factors of High Grade Glioma Treated by Postoperative Radiotherapy (고악성도 신경아교종의 수술 후 방사선 치료 성적과 예후인자 분석)

  • Lee, Sun-Min;Park, Young-Je;Yoon, Won-Sup;Lee, Suk;Yang, Dae-Sik;Jeong, Yong-Gu;Kim, Chul-Yong
    • Radiation Oncology Journal
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    • v.28 no.3
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    • pp.117-124
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    • 2010
  • Purpose: To analyze the postoperative radiotherapy results and prognostic factors in patients with WHO grade 3 and 4 gliomas. Materials and Methods: A total of 99 patients with malignant gliomas who underwent postoperative radiotherapy between 1988 and 2007 were enrolled in this study. Total resections, subtotal resections ($\geq$50%), partial resections (<50%), and biopsies were performed in 16, 38, 22, and 23 patients, respectively. In total there were 32, 63 and 4 WHO grade 3, 4, and unspecified high grade gliomas, respectively. The biologically equivalent dose was in the range of 18.6 to $83.3\;Gy_{10}$ (median dose, $72.2\;Gy_{10}$). We retrospectively analyzed survival rate, patterns of failure, prognostic factors, and adverse effects. Results: The median follow-up time was 11 months and there were 54 patients (54.5%) with local failure. The one and 2-year survival rates were 56.6% and 29.3%, respectively, and the median survival duration was 13 months. The one and 2-year progression-free survival rates (PFS) were 31.3% and 18.2%, respectively, and the median PFS was 7 months. The prognostic factors for overall survival were age (p=0.0001), surgical extents (subtotal resection, p=0.023; partial resection, p=0.009; biopsy only, p=0.002), and enhancement of tumor in postoperative imaging study (p=0.049). The factors affecting PFS were age (p=0.036), tumor enhancement of the postoperative imaging study (p=0.006). There were 3 patients with grade 3 and 4 side effects during and after radiotherapy. Conclusions: In addition to age and surgical extents, tumor enhancement of the postoperative imaging study was included in the prognostic factors. The most common relapse patterns were local failures and hence, additional studies are needed to improve local control rates.