• Asian Pacific Journal of Cancer Prevention
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• 제16권13호
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• pp.5253-5256
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• 2015

Background: A number of randomized trials addressing alternative operative and multimodality approaches to gastric cancer have characterized early postoperative morbidity and mortality rates. The aim of this study was to compare mortality and morbidity and disease free survival after D1 and D2 gastrectomy for adenocarcinomas of the stomach Materials and Methods: From June 2006 to January 2012, patients were selected according to information of the cancer administrator center of Ahvaz Jundishapur Medical University. The inclusion criteria were age between 20-85 years and histologically proven adenocarcinoma of the stomach without evidence of distant metastasis. Patients were excluded if they had previous or coexisting cancer or disability disease. In this research, D1 was compared to D2 gastrectomy. Results: 131 patients were randomised, 49 allocated to D1 and 82 to D2 gastrectomy. The two groups were comparable for age, sex, site of tumors, and type of resection performed. The overall post-operative morbidity rate was 17.5%. Complications developed in 14.2% of patients after D1 and in 19.5% of patients after D2 gastrectomy (p=0.07). Postoperative mortality rate was 0.8% (one death); it was 2% after D1 and 0% after D2 gastrectomy. In this research disease free-survival after 3 years was 71.2 % with 63.2% after D1 and 76.8% after D2 gasterctomy. Conclusions: This study indicates that D2 gastrectomy with pancreas preservation is not followed by significantly higher morbidity and mortality than D1 resection. Based on the results of present study, D2 resection should be recommended as the standard surgical approach for resectable gastric cancer.

• Journal of Chest Surgery
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• 제53권2호
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• pp.58-63
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• 2020

Background: Despite progress in treatment, Stanford type A aortic dissection is still a life-threatening disease. In this study, we analyzed surgical outcomes in patients with Stanford type A aortic dissection according to the extent of surgery at Daegu Catholic University Medical Center. Methods: We retrospectively analyzed 98 patients with Stanford type A aortic dissection who underwent surgery at our institution between January 2008 and June 2018. Of these patients, 82 underwent limited replacement (hemi-arch or ascending aortic replacement), while 16 patients underwent total arch replacement (TAR). We analyzed in-hospital mortality, postoperative complications, the overall 5-year survival rate, and the 5-year aortic event-free survival rate. Results: The median follow-up time was 48 months (range, 1-128 months), with a completion rate of 85.7% (n=84). The overall in-hospital mortality rate was 8.2%: 6.1% in the limited replacement group and 18.8% in the TAR group (p=0.120). The overall 5-year survival rate was 78.8% in the limited replacement group and 81.3% in the TAR group (p=0.78). The overall 5-year aortic event-free survival rate was 85.3% in the limited replacement group and 88.9% in the TAR group (p=0.46). Conclusion: The extent of surgery was not related to the rates of in-hospital mortality, complications, aortic events, or survival. Although this study was conducted at a small-volume center, the in-hospital mortality and 5-year survival rates were satisfactory.

• Radiation Oncology Journal
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• 제17권2호
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• pp.120-129
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• 1999

목적 : 방사선치료를 시행한 자궁경부암 환자에서 혈중 SCC항원을 치료 전과 치료 후 추적기간 동안의 수치변화와 치료결과의 상관관계를 조사하기 위하여 자료를 분석하였다. 대상 및 방법 : 순천향대학병원 방사선종양학과에서 방사선치료를 시행한 환자 중에서 1991~1997년 사이에 혈중SCC 검사를 치료 전 시행하였거나 추적관찰 중 시행한 181명의 환자를 대상으로 후향적 분석을 실시하였다. 여러가지 통계방법을 통하여 치료 전 농도와 무병생존기간, 예후인자 등을 비교하고 추적기간 중 수치 변화의 임상적 의미를 조사하였다. 결과 : 혈중 SCC항원의 양성비율은 15ng/ml 기준으로 병기그룹에 따라 71~91%, 2.5ng/ml 기준으로 57~91%로 유의하게 증가하였으며 각 그룹의 5년 무병생존율은 IB-IIA 79.2%, IIB 68.7%, III 33.4%, IV 0% 였다. 그리고 5년 무병생존율은 치료 전 항원농도가 5ng/ml 이상인 경우 34%로 1.5ng/ml 이하, 1.5~5ng/ml의 55~62% 보다 매우 낮았다. 항원 수치 추적검사 결과 임상증상보다 1~13개월(평균 4.8개월) 재발을 빨리 발견할 수가 있었고 항원의 수치와 무병생존기간은 유의한 상관관계를 가졌고(r=-0.266) 다변량 분석상 치료전 SCC항원의 수치는 독립된 예후인자였다. 결론 : 치료 전 혈중 SCC항원 농도는 편평상피 자궁경부암의 예후에 영향을 미치는 인자이며 치료 후 추적기간 중에 하는 검사는 재발을 빨리 발견하는데 유용하다.

• Radiation Oncology Journal
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• 제11권2호
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• pp.337-346
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• 1993

This is a retrospective cohort analysis of 58 patients who treated with postoperative radiation therapy following radical hysterectomy and bilateral pelvic adenectomy for early stage carcinoma of uterine cervix between January 1988 and December 1990 at department of radiation oncology, Keimyoung University Hospital. Sixteen percent of patients (9/58) had chemotherapy. Most patients were FIGO I b (47 patients), and FIGO I a and II a were one and ten patients, respectively. The median follow-up periods were 48.5 months. The indications for radiation therapy included pelvic lymph node metastasis, large tumor size, deep stromal invasion, lymphovascular invasion, positive surgical margin, endometrial invasion and parametrial invasion. Eighty five percent of the patients had more than one risk factor. The actuarial overall five year survival rate (5 YSR) and five year disease free survival rate (5 YDFSR) were $89.5\%,\;and\;87.8\%,$ respectively. Their overall recurrence rate was $12.1\%,$(758). Distant metastasis was the most common cause of treatment failure $(71.4\%:5/7).$ The univariate analysis of prognostic factors affecting to five year survival rate disclosed pelvic lymph node status (negative: $95.5\%,\;positive:69.2\%,$ p=0.006) and hemoglobin level $(\le11 :75\%,>11g/dl:93.3\%,p=0.05)$ as significant factor. The age status was marginally significant $(\le40:96.0\%,\;>\;40:84.3\%p=0.15).$ Multivariate analysis clarified three independent prognostic factors: pelvic lymph node metastasis (p=p.006), hemoglobin level (p=0.015) and age (p=0.035). Multivariate analysis of prognostic factor affecting to five year disease free survival rate disclosed pelvic lymph node status (p=0.0078) and status of surgical margin (p=0.008). Complications relating to radiotherapy were $10.3\%,(6/58).$ There were no severe major complication requiring surgical intervention or a long hospital stay. It is our opinion that the benefit of postoperative pelvic radiotherapy may be gained in such a high risk patient population with acceptible morbidity.

• Journal of Chest Surgery
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• 제44권2호
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• pp.169-177
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• 2011

Background: Video-assisted thoracic surgery (VATS) lobectomy has been performed with increasing frequency over the last decade. However, there is still controversy as to its indications, safety, and feasibility. Especially regarding lung cancer surgery, it is not certain whether it can reduce local recurrences and improve overall survival. Materials and Methods: We retrospectively reviewed 1,067 cases of VATS lobectomy performed between 2003 and 2009, including the indications, postoperative morbidity, mortality, recurrence, and survival rate. Results: One thousand and sixty seven patients underwent VATS lobectomy for the following indications: non-small cell lung cancer (NSCLC) (n=832), carcinoid tumors (n=12), metastatic lung cancer (n=48), and benign or other diseases (n=175). There were 63 cases (5.9%) of conversion to open thoracotomy during VATS lobectomy. One hundred thirty one (15.7%) of the 832 NSCLC patients experienced pathologic upstaging postoperatively. The hospital mortality rate was 0.84% (9 patients), and all of them died of acute respiratory distress syndrome. One hundred forty-nine patients (14.0%) experienced postoperative complications. The median follow-up was 22.9 months for patients with NSCLC. During follow-up, 120 patients had a recurrence and 55 patients died. For patients with pathologic stage I, the overall survival rate and disease-free survival rate at 3 years was $92.2{\pm}1.5%$ and $86.2{\pm}1.9%$, respectively. For patients with pathologic stage II disease, the overall survival rate and disease-free survival rate at 3 years was $79.2{\pm}6.5%$ and $61.9{\pm}6.6%$, respectively. Conclusion: Our results suggest that VATS lobectomy is a technically feasible and safe operation, which can be applied to various lung diseases. In patients with early-stage lung cancer, excellent survival can be also achieved.

• Radiation Oncology Journal
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• 제11권2호
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• pp.285-294
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• 1993

A total of forty patients with resected N2 stage non-small cell lung cancer treated with postoperative adjuvant radiation therapy between Jan. 1975 and Dec. 1990 at the Department of Radiation Oncology, Yonsei University College of Medicine, Yonsei Cancer Center were retrospectively analysed to evaluate whether postoperative radiation therapy improves survival. Patterns of failure and prognostic factors affecting survival were also analysed. The 5 year overall and disease free survival rate were $26.3\%,\;27.3\%$ and median survival 23.5 months. The 5 year survival rates by T-stage were $T1\;66.7\%,\;T2\;25.6\%\;and\;T3\;12.5\%.$ Loco-regional failure rate was $14.3\%$ and distant metastasis rate was $42.9\%$ and both $2.9\%.$ Statistically significant factor affecting distant failure rate was number of postitive lymph nodes(>=4). This retrospective study suggests that postoperative radiation therapy in resected N2 stage non-small cell lung cancer can reduce loco-regional recurrence and may improve survival rate as compared with other studies which were treated by surgery alone. Further study of systemic control is also needed due to high rate of distant metastasis.

• Journal of Gastric Cancer
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• 제18권3호
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• pp.274-286
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• 2018

Purpose: The aim of this study was to investigate the impact of preoperative low body mass index (BMI) on both the short- and long-term outcomes in patients with gastric cancer. Materials and Methods: A total of 510 patients with gastric cancer were divided into the following 3 groups: low BMI group (${\leq}18.5kg/m^2$, n=51), normal BMI group ($18.6-24.9kg/m^2$, n=308), and high BMI group (${\geq}25.0kg/m^2$, n=151). Results: There were significantly more stage III/IV patients in the low BMI group than in the other groups (P=0.001). Severe postoperative complications were more frequent (P=0.010) and the survival was worse (P<0.001) in the low BMI group. The subgroup analysis indicated that survival was worse in the low BMI group of the stage I/II subgroup (P=0.008). The severe postoperative complication rate was higher in the low BMI group of the stage III/IV subgroup (P=0.001), although the recurrence rate and survival did not differ in the stage III/IV subgroup among all the BMI groups. Low BMI was an independent poor prognostic factor in the stage I/II subgroup (disease-free survival: hazard ratio [HR], 13.521; 95% confidence interval [CI], 1.186-154.197; P=0.036 and overall survival: HR, 5.130; 95% CI, 1.644-16.010; P=0.005), whereas low BMI was an independent risk factor for severe postoperative complications in the stage III/IV subgroup (HR, 17.158; 95% CI, 1.383-212.940; P=0.027). Conclusions: Preoperative low BMI in patients with gastric cancer adversely affects survival among those with stage I/II disease and increases the severe postoperative complication rate among those with stage III/IV disease.

• 대한두경부종양학회지
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• 제12권1호
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• pp.26-31
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• 1996

Radiation therapy in T1 glottic cancer offers an excellent cure rate with preservation of voice. From 1983 to 1992 eighty nine patients with TNM staged T1N0M0 invasive squamous cell carcinoma of the glottis were treated at the Dept. of Radiation Oncology, Yonsei Cancer Center, Yonsei University. There were 84 men and 5 women with median age of 59 years. All patients were treated either with Co-60 teletherapy unit or 4MV linear accelerator with an median dose of 6400 cGy(6000-7000 cGy), 200 cGy per day, 5 days in a week. Fourteen local failures have been observed and the median time to local recurrence was 17 months. There were no nodal failure without local recurrence or distant metastases. The 5 year local control rate was 84.3%. The 5 year actuarial surivival rate and the 5 year disease free survival rate were 89.2%, 87.5%, respectively. The 5 year actuarial survival rate and the 5 year disease free survival rate of the nineteen patients with anterior commissure involvement were 77.8% and 74.5% which were lower than those of seventy patients without anterior commissure involvement(91.6%, 90.6%)(p < 0.05). Among the several influencing factors, anterior commissure involvement was the significant prognostic foctor. Final local control rate, taking into account the salvage surgery, was 89.9% at 5 years.

• Journal of Medicine and Life Science
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• 제16권1호
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• pp.6-9
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• 2019

Adjuvant fluorouracil, leucovorin, and oxaliplatin (FOLFOX) chemotherapy for 6 months is the standard treatment of stage III colon cancer to improve patient survival. Recent studies have shown that restricting the treatment to 3 months to reduce toxicity negatively affects the outcome. However, the effect of FOLFOX treatment for a duration of between 3 and 6 months(7~11 cycles) on survival is not known. The effect of a reduced duration of FOLFOX chemotherapy on the prognosis of stage III colon cancer was examined. The 5-year disease-free survival in patients receiving 7~11 cycles of FOLFOX was lower than those receiving 12 cycles(72.9% vs. 87%, respectively). Patients receiving 7~11 cycles who had a bowel obstruction at diagnosis had a significantly higher recurrence rate (66.7% vs. 15.0%) and shorter median disease-free survival (24.7 months vs. not reached) than those receiving 12 cycles. Among patients receiving 12 cycles of FOLFOX, there was no difference in the outcome between those with and those without intestinal obstructions at diagnosis. These results suggest that the completion of 12 cycles FOLFOX chemotherapy is important to improve the patient's prognosis, especially for with intestinal obstructions at diagnosis.

• 대한골관절종양학회지
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• 제9권2호
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• pp.131-138
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• 2003

서론: 악성 말초 신경막 종양(Malignant peripheral nerve sheath tumor, MPNST)에 대하여 수술, 항암제 투여, 방사선 치료 등을 시행하고 이에 따른 종양학적 결과를 분석하여 보다 합리적인 치료 방법을 알아보고자 하였다. 재료 및 방법: 1986년 2월부터 1996년 11월까지 본원에 등록된 MPNST 환자 34례를 대상으로 하였다. 남자가 17례, 여자가 17례였고 평균연령은 41세(18세~74세)였다. 종양의 위치는 하지가 17례, 상지 11례, 체간부 4례, 후복막 2례였다. AJC(American Joint Committee on Cancer) 분류에 의한 종양의 병기는 stage IA가 2례, stage IIA 2례, stage IIB 6례, stage III 16례, 그리고 stage IV가 8례였다. 치료 방법으로는 26례에서 수술과 항암제 투여 그리고 때에 따라서 방사선치료를 시행하였고 3례에서는 수술만, 3례에서는 항암제 투여나 방사선 치료만 시행하였다. 평균 추시 기간은 33.5개월(5.6개월~141.1개월)이었다. Kaplan-Meiyer 법으로 생존율을 구하였고, log rank test로 비교 분석 하였다. 결과: 최종 추시상 질병 상태는 14례에서 CDF(continuous disease free)였고, 2례가 NED(no evidence of disease), 2례 AWD(alive with disease), 그리고 14례가 DOD(died of disease)였다. 실제(actuarial) 5년 생존율과 10년 생존율 은 53.5 %와, 35.7%였다. 수술 후의 국소 재발율은 24.1%였다. 병기별 5년 실질 생존율은 stage I이 100%, stage II 85.7%, stage III 55.9%였고 stage IV의 경우 2년 실질 생존율이 14.3%였다(p=0.04). Stage II, III에서 수술한 경우 21례에서, 광범위 이상의 절제연을 얻었던 경우가 15례로 5년 실질생존율이 76.0%였고 병소내이거나 변연부 절제연의 경우는 6례로 40.0%였다(p=0.26). 4회차 이상의 항암화학요법제를 투여한 군(8례)의 5년 실질생존율은 71.4%였고 3회차 이하의 불충분한 항암제투여를 시행한 군(6례)의 3년 실질생존율은 83.3%였다(p=0.96). Stage II, III 중 방사선 치료 없이 수술 받은 19례에서 병소내 절제나 변연부 절제를 시행했던 5례는 3례가 국소 재발하였고(60.0%) 광범위 절제를 시행한 14례는 4례가 국소 재발하였다(28.6%). 수술 전 또는 후에 방사선치료를 시행하였던 8례에서는 국소재발이한 예도 없었다. 결론: 외과적 절제연(surgical margin)이 국소 재발에는 중요한 요인이었고, 통계적으로 의미있는 수치는 아니었지만 생존율에도 영향을 주는 경향이 있는 것으로 생각된다. 기존의 항암제 투여는 국소 재발이나 생존율상에 통계적으로 의미있는 차이를 보이지 못하였다. 수술전과 수술후 시행하였던 방사선치료는 국소 재발을 줄이는데 어느 정도의 효과를 보였다.