• 건강소식
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• v.30 no.5 s.330
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• pp.16-17
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• 2006

모든 암 사망률의 30%가 흡연으로 밝혀졌다. 담배 연기가 직접 접촉하는 부위에 생기는 암인 구강암, 혀암, 식도암, 기관지암, 폐암은 흡연이 원인의 90%를 차지한다. 담배 연기가 직접 접촉하지 않는 부위에 생기는 암인 자궁경부암, 췌장암, 방광암, 신장암, 위암, 혈액암의 위험은 흡연으로 인하여 1.5~3.0배 정도 증가하게 된다.

• Journal of Chest Surgery
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• v.42 no.3
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• pp.396-400
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• 2009

Operations using the da Vinci robot have performed in for many surgeries, but the adoption of robotics to general thoracic surgery has been slow. The patient (age 74, male) visited our hospital complaining of hiccups and dysphagia. The CT scan and endoscopic biopsy revealed esophageal cancer (squamous cell carcinoma). We performed transthoracic esophagectomy using a da Vinci robot and this was followed by gastric tube mobilization via laparoscopy. Cervical esophago-gastric anastomosis was done using the hand-sewn method. The gastric tube was brought into the neck through the retrosternal route. The patient was discharged without any complications. We report here on a case of successful da Vinci robotic esophgagectomy.

• Journal of Chest Surgery
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• v.34 no.2
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• pp.156-161
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• 2001

배경: 식도암의 절제술에 있어 식도 위 문합술은 중대한 합병증, 즉 문합부 누출, 양성협착, 종양의 재발 등을 유발한다. 수술 후 재원기간동안 환자가 느끼는 주관적인 증상과 합병증이 식도와 위장관의 문합부 위치에 따라 달라질 수 있으므로 서로간에 비교분석할 필요가 있겠다. 대상 및 방법: 1995년 1월부터 1999년 5월까지 식도암 근치술로 식도 위 문합술을 시행 받은 55명의 환자를 대상으로 문합위치에 따라 경부문합한 23명의 환자와 흉부문합을 한 32명의 환자를 비교 분석하였다. 절제술 후 AJCC분류에 따라 I기 5명, II기 27명, III기 23명으로 판정되었으며, 종양이 상흉부에 위치한 경우 3명, 중흉부 34명, 하흉부 18명이었다. 조직학적으로 55명의 환자 2명의 선암을 제외하고 53명이 편평상피세포암이었다. 55명 전원이 남자였으며 평균연령은 경부문합의 경우 59세였고, 흉부문합은 55세였다. 경부 문합의 경우 1명의 staple봉합을 제외하고 나머지 22명이 수봉합을 하였으며, 흉부문합술의 경우는 9명이 수봉합, 23명이 staple봉합을 하였다. 결과: 수술 후 사망자는 경부문합 1명, 흉부문합 2명이었다. 경부 문합환자의 경우 23명 중 15명에서 호흡기, 소화기등의 합병증 46례가 발생하였고, 흉부 문합환자의 경우 32명중 13명에서 합병증 37례가 발생하였다. 경부문합환자는 중등도 혹은 심한 연하곤란을 나타내는 경우가 11명에서 있었으며, 흉부문합환자는 2명에서 나타났다. 또한 수술 후 20일 이후까지 재원한 경우는 경부문합환자 18명, 흉부문합환자는 13명이었다. 결론: 식도암에서 식도 위 문합술의 경우 호흡기, 소화기, 감염등의 합병증이 발생하였으며, 특히 호흡기 합병증에 의한 사망률이 높았다. 문합부 누출은 staple봉합보다 수봉합에서, 흉부문합보다 경부문합에서 빈도가 높았다. 경부문합의 경우 문합부 누출률이 높고, 연하곤란을 많이 호소하며 재원기간이 의미있게 길었다.

• Journal of Chest Surgery
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• v.36 no.11
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• pp.866-869
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• 2003

Less than 2% of patients with primary esophageal cancers have synchronous primary lung cancers and many patients with these synchronous tumors are deemed ineligible for radical resection by surgeons due to the poor prognoses of both the diseases. However, we believe that carefully selected patients could benefit from one stage curative resection for these synchronous tumors. We experienced a case of synchronous double cancer of the lung and esophagus and performed bilobectomy and Ivor Lewis operation simultaneously. To the best of our knowledge, this is the first report on the good result of one stage curative resection for these synchronous serious tumors in Korea.

• Journal of Chest Surgery
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• v.37 no.4
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• pp.356-363
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• 2004

Esophageal cancer is an aggressive disease with a poor prognosis. Recently, every effort has been made to improve the long term survival, but the general prognosis for patients with this disease remains poor. In this study, we reviewed 8 years of experiences with esophageal cancer patients managed in our department at Dong-A University Hospital and evaluated the effectiveness of cervical lymph node dissection performed selectively. Material and Method: From January 1995 to August 2003, 70 patients underwent esophagectomy for esophageal cancer in our department. Among them, 51 patients who underwent curative resection, had no double primary tumors and no neoadjuvant therapy were analyzed retrospectively. In most patients, intrathoracic esophagectomy and cervical esophago-gastrostomy was performed. Since 1997, 3-field lymph node dissection was performed selectively. Result: There were 46 men and 15 women. The median age was 60 years. The tumor was located in the upper third part in 10 patients (19%), middle third in 21 (41%), and lower third in 20 (40%). Majority of the patients (90%) had squamous cell carcinoma. Cervical anastomosis was made in 41 patients, and intrathoracic anastomosis in 10. 2-field lymph node dissection was done in 40 patients, and 3-field lymph node dissection in 11. The pathologic staging were as follows: stage I in 9 patients (17.6%), IIA in 20 (39.2%), IIIB in 7 (13.7%), III in 11 (21.6%), IVA in 2 (3.9%), and IVB in 2 (3.9%). The in-hospital mortality was 3.9% (2 patients) and complications occurred in 24 patients (47%). Overall actuarial 1, 3, and 5-year survival rates were 74.4%, 48.4%, and 48.4% including operative mortality. The 4-year survival rate did not differ significantly between 3-field lymph node dissection group (50.5%) and 2-field lymph node dissection group (48.9%). In 3-field lymph node dissection group, the respiratory complications were more frequent and operative time was significantly longer. Conclusion: We think that curative resection for esophageal cancer can be performed with acceptable mortality, and aggressive surgical approach may improve the long term survival. even for advanced stages. Effectiveness of 3-field lymph node dissection needs further investigations.

• Journal of Chest Surgery
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• v.37 no.2
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• pp.184-187
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• 2004

The synchronous double cancer of the esophagus and lung is rare. Right lower lobectomy and Ivor Lewis procedure were performed simultaneously in a 75 year-old male patient who had synchronous double primary squamous cell carcinoma of the thoracic esophagus and right lower lobe of the lung, Left upper lobectomy was performed in a 69 year-old male patient who had squamous cell carcinoma of the left upper lobe of the lung, and four months later we performed Ivor Lewis procedure for the squamous cell carcinoma that occurred in the thoracic esophagus. The above two patients were doing well 10 months and 24 months after the operation respectively without recurrence. We treated the two cases of synchronous double cancer of the esophagus and lung with complete resection, and report this with review of literature.

• Journal of Chest Surgery
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• v.38 no.11 s.256
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• pp.791-794
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• 2005

After esophagectomy, the stomach is used most commonly for the method of reconstruction. However, the stomach may not be large enough to be reached the site of anastomosis when it is above the pharynx. We experienced a double primary cancer of the lower esophagus and the larynx. Total laryngectomy and total esophagectomy were done with cervical pharyngojejunogastrostomy for reconstruction. Free jejunal graft is interposed between the oropharyngeal stump and the stomach is pulled-up. We could restore the alimentary track without tension at the anastomotic site and obtain sufficient blood supply.

• Journal of Digestive Cancer Reports
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• v.8 no.1
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• pp.71-75
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• 2020

Esophageal cancer is easy to infiltrate and metastasize because esophagus does not have serosa, and is difficult to remove it because esophagus is in the middle of the chest. Because of this, treatments of esophageal cancer do not always follow the guideline. In this situation, efforts to increase treatment efficiency and improve survival rate through multidisciplinary treatment are increasing. In this case, we report the patient with three superficial esophageal cancers (one in cervical esophagus and two in thoracic esophagus). The patient was treated with concurrent chemoradiotherapy instead of surgery through multidisciplinary discussion. The patient reached a complete remission through this discussion. This case is intended to inform the usefulness of multidisciplinary treatment in patients with esophageal cancer.

• Korean Journal of Bronchoesophagology
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• v.9 no.1
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• pp.54-59
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• 2003

• Radiation Oncology Journal
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• v.26 no.1
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• pp.17-23
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• 2008

Purpose: The best treatment for advanced esophageal cancer is chemoradiotherapy followed by surgery. In spite of the advance of multimodality therapy, most patients with esophageal cancer are treated with radiation therapy alone. This study reports the outcome of the use of conventional external beam radiotherapy alone for the treatment of esophageal cancer. Materials and Methods: Between January 1998 and December 2005, 30 patients with squamous cell carcinoma of the esophagus were treated with external beam radiotherapy using a total dose exceeding 40 Gy. Radiotherapy was delivered with a total dose of 44-60 Gy(median dose, 57.2 Gy) over $36{\sim}115$ days(median time, 45 days). Thirteen patients(43.3%) had a history of disorders such as diabetes, hypertension, tuberculosis, lye stricture, asthma, cerebral infarct, and cancers. Four patients metachronously had double primary cancers. The most common location of a tumor was the mid-thoracic portion of the esophagus(56.7%). Tumor lengths ranged from 2 cm to 11 cm, with a median length of 6 cm. For AJCC staging, stage III was the most common (63.3%). Five patients had metastases at diagnosis. Results: The median overall survival was 8.3 months. The survival rates at 1-year and 2-years were 33.3% and 18.7%, respectively. The complete response rate $1{\sim}3$ months after radiotherapy was 20%(6/30) and the partial response rate was 70%(21/30). Sixteen patients(53.3%) had an improved symptom of dysphagia. Significant prognostic factors were age, tumor length, stage, degree of dysphagia at the time of diagnosis and tumor response. Cox regression analysis revealed the aim of treatment, clinical tumor response and tumor length as independent prognostic factors for overall survival. Twenty-eight patients had local failure and another four patients had metastases. Three patients were detected with double primary cancers in this analysis. A complication of esophageal stricture was observed in three patients(10%), and radiation pneumonitis occurred in two patients(6.7%). Conclusion: The prognosis of esophageal cancer remains poor, in spite of advances in radiotherapy techniques. Radiotherapy is one of the main treatment modalities for the relief of dysphagia and treatment related complications are minimal. It is expected that the addition of chemotherapy or another systemic modality to radiotherapy will improve tumor control and increase the survival rate in advanced esophageal cancer.