• Annals of Hepato-Biliary-Pancreatic Surgery
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• v.28 no.2
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• pp.220-228
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• 2024

Backgrounds/Aims: Postoperative pancreatic fistula is the key worry in the ongoing debate about the safety and effectiveness of total laparoscopic pancreaticoduodenectomy (TLPD). Laparoscopic-assisted pancreaticoduodenectomy (LAPD), a hybrid approach combining laparoscopic resection and anastomosis with a small incision, is an alternative to TLPD. This study compares the short-term outcomes and oncological efficacy of LAPD vs. open pancreaticoduodenectomy (OPD). Methods: A retrospective analysis of data of all patients who underwent LAPD or OPD for periampullary carcinoma at a tertiary care center in Northeast India from July 2019 to August 2023 was done. A total of 30 LAPDs and 30 OPDs were compared after 1:1 propensity score matching. Demographic data, intraoperative and postoperative data (30 days), and pathological data were compared. Results: The study included a total of 93 patients, 30 underwent LAPD and 62 underwent OPD. After propensity score matching, the matched cohort included 30 patients in both groups. The LAPD presented several advantages over the OPD group, including a shorter incision length, reduced postoperative pain, earlier initiation of oral feeding, and shorter hospital stays. LAPD was not found to be inferior to OPD in terms of pancreatic fistula incidence (Grade B, 30.0% vs. 33.3%), achieving R0 resection (100% vs. 93.3%), and the number of lymph nodes harvested (12 vs. 14, p = 0.620). No significant differences in blood loss, short-term complications, pathological outcomes, readmissions, and early (30-day) mortality were observed between the two groups. Conclusions: LAPD has comparable safety, technical feasibility, and short-term oncological efficacy.

• Annals of Hepato-Biliary-Pancreatic Surgery
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• v.26 no.2
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• pp.159-167
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• 2022

Backgrounds/Aims: The optimal timing of percutaneous transhepatic gallbladder drainage (PTGBD) and subsequent laparoscopic cholecystectomy (LC) according to the severity of acute cholecystitis (AC) has not been established yet. Methods: This single-center, retrospective study included 695 patients with grade I or II AC without common bile duct stones who underwent PTGBD and subsequent LC between January 2010 and December 2019. Difficult surgery (DS) (open conversion, subtotal cholecystectomy, adjacent organ injury, transfusion, operation time ≥ 90 minutes, or estimated blood loss ≥ 100 mL) and poor postoperative outcome (PPO) (postoperative hospital stay ≥ 7 days or Clavien-Dindo grade ≥ II postoperative complication) were defined to comprehensively evaluate intraoperative and postoperative outcomes, respectively. Results: Of 695 patients, 403 had grade I AC and 292 had grade II AC. According to the receiver operating characteristic curve and multivariate logistic regression analyses, an interval from symptom onset to PTGBD of > 3.5 days and an interval from PTGBD to LC of > 7.5 days were significant predictors of DS and PPO, respectively, in grade I AC. In grade II AC, the timing of PTGBD and subsequent LC were not statistically related to DS or PPO. Conclusions: In grade I AC, performing PTGBD within 3.5 days after symptom onset can reduce surgical difficulties and subsequently performing LC within 7.5 days after PTGBD can improve postoperative outcomes. In grade II AC, early PTGBD cannot improve the surgical difficulty. In addition, the timing of subsequent LC is not correlated with surgical difficulties or postoperative outcomes.

• Clinical and Experimental Reproductive Medicine
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• v.39 no.1
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• pp.22-27
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• 2012

Objective: To evaluate the effectiveness of GnRH antagonist multiple dose protocol applied during early and late follicular phase (MDP-EL) in comparison with standard GnRH agonist luteal long protocol (LP) in each non-obese and obese polycystic ovary syndrome (PCOS) women undergoing IVF. Methods: Two hundred eleven infertile women with PCOS were recruited and randomized to undergo either GnRH antagonist MDP-EL (antagonist group) or standard GnRH agonist luteal LP (agonist group). IVF cycle outcomes were compared between the two groups. Results: Total dose and days of recombinant human follicle stimulating hormone (rhFSH) administered were significantly fewer in the antagonist group than in the agonist group. Incidence of severe ovarian hyperstimulation syndrome was significantly lower in the antagonist group. However, IVF and pregnancy outcomes were similar in the two groups. When all subjects were divided into non-obese and obese subgroups, in non-obese PCOS subgroup, IVF and pregnancy outcomes were comparable in the antagonist and agonist groups but total dose and days of rhFSH were also significantly fewer in the antagonist group. Similar findings were also observed in obese PCOS subgroup. Conclusion: GnRH antagonist MDP-EL is at least as effective as GnRH agonist LP and may be a more patient-friendly alternative in controlled ovarian stimulation for PCOS patients undergoing IVF, independent of body mass index.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.20
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• pp.8993-9004
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• 2014

Background: The incidence rate and the treatment costs of hepatocellular carcinoma (HCC) are high, especially in Thailand. Previous studies indicated that early detection by a surveillance program could help by down-staging. This study aimed to compare the costs and health outcomes associated with the introduction of a HCC surveillance program with no program and to estimate the budget impact if the HCC surveillance program were implemented. Materials and Methods: A cost utility analysis using a decision tree and Markov models was used to compare costs and outcomes during the lifetime period based on a societal perspective between alternative HCC surveillance strategies with no program. Costs included direct medical, direct non-medical, and indirect costs. Health outcomes were measured as life years (LYs), and quality adjusted life years (QALYs). The results were presented in terms of the incremental cost-effectiveness ratio (ICER) in Thai THB per QALY gained. One-way and probabilistic sensitivity analyses were applied to investigate parameter uncertainties. Budget impact analysis (BIA) was performed based on the governmental perspective. Results: Semi-annual ultrasonography (US) and semi-annual ultrasonography plus alpha-fetoprotein (US plus AFP) as the first screening for HCC surveillance would be cost-effective options at the willingness to pay (WTP) threshold of 160,000 THB per QALY gained compared with no surveillance program (ICER=118,796 and ICER=123,451 THB/QALY), respectively. The semi-annual US plus AFP yielded more net monetary benefit, but caused a substantially higher budget (237 to 502 million THB) than semi-annual US (81 to 201 million THB) during the next ten fiscal years. Conclusions: Our results suggested that a semi-annual US program should be used as the first screening for HCC surveillance and included in the benefit package of Thai health insurance schemes for both chronic hepatitis B males and females aged between 40-50 years. In addition, policy makers considered the program could be feasible, but additional evidence is needed to support the whole prevention system before the implementation of a strategic plan.

• Radiation Oncology Journal
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• v.26 no.1
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• pp.10-16
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• 2008

Purpose: To compare the treatment outcomes and to analyze prognostic factors between the use of a breast-conserving treatment(BCT) and a mastectomy for early stage breast cancer. Materials and Methods: We retrospectively reviewed 1,200 patients with pathological stage T1-2N0 breast cancer who received surgery between September 1994 and December 2002 at Samsung Medical Center. We compared the patient characteristics and treatment outcomes between the two treatment groups. Results: Among the 1,174 eligible patients, 601(51.2%) patients received a BCT and the remaining 573(48.8%) patients received a mastectomy. The mastectomy group of patients had significantly more cases with a larger tumor size, multicentricity, extensive intraductal component, and estrogen- and progester-one-receptor negativity. The ten-year overall survival rates(OS) of the BCT and mastectomy groups were 91.96% and 91.01%, respectively(p=0.1274). The ten-year disease-free survival rates(DFS) were 80.48% for the BCT group of patients and 84.95% for the mastectomy group of patients, respectively(p=0.8795). Conclusion: Our study shows some differences in patient characteristics between the two treatment groups. However, these differences did not result in significant survival differences.

• Journal of Chest Surgery
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• v.45 no.2
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• pp.85-90
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• 2012

Background: At present, many surgeons prefer axillary artery cannulation because it facilitates antegrade cerebral perfusion and may diminish the risk of cerebral embolization. However, axillary artery cannulation has not been established as a routine procedure because there is controversy about its clinical advantage. Materials and Methods: We examined 111 patients diagnosed with acute type A aortic dissection between January 2000 and December 2009. The right axillary artery was cannulated in 58 patients (group A) and the femoral artery was cannulated in 53 (group F). The postoperative outcomes were retrospectively reviewed and compared between the two groups. Results: There were 46 male and 65 female patients with a mean age of $58.9{\pm}13.1$ years (range, 26 to 84 years). The extent of aortic replacement in both groups did not differ. There were 8 early deaths (7.2%) and 2 late deaths (1.8%). The mean follow-up duration was $46.0{\pm}32.6$ months (range, 1 month to 10 years). Transient neurologic dysfunction was observed in 11 patients (19.0%) in group A and 14 patients (26.4%) in group F. A total of 11 patients (9.9%) suffered from a permanent neurologic dysfunction. Early and delayed stroke were observed in 6 patients (10.3%) and 2 patients (3.4%), respectively, in group A as well as 2 patients (3.8%) and 1 patient (1.9%), respectively, in group F. There were no statistical differences in the cannulation-related complications between both groups (3 in group A vs. 0 in group F). Conclusion: There were no differences in postoperative neurologic outcomes and cannulation-related complications according to the cannulation sites. The cannulation site in an aortic dissection should be carefully chosen on a case-by-case basis. It is important to also pay attention to the possibility of intraoperative malperfusion syndrome occurring and the subsequent need to change the cannulation site.

• Clinical and Experimental Reproductive Medicine
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• v.45 no.3
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• pp.122-128
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• 2018

Objective: To determine whether fragment removal on in vitro fertilization (IVF) day 2 improved the subsequent development and pregnancy outcomes of fragmented embryos compared to similar-grade embryos without fragment removal. Methods: This study was a retrospective analysis involving 191 IVF cycles in which all embryos had over 10% fragmentation (grade 3 or 4) on day 2 of the IVF-embryo transfer cycle from March 2015 to December 2017. IVF cycles were divided into the fragment removal group (n = 87) and the no fragment removal group (n = 104) as a control cohort. Before fragment removal, embryos with fragmentation on day 2 were incubated in $Ca^{2+}$- and $Mg^{2+}$-free biopsy medium under paraffin oil for 30 minutes. Microsurgical fragment removal was performed with later-assisted hatching and a handmade suction micropipette that had an outer diameter of $30{\mu}m$. Results: There were no significant differences in the characteristics of the patients between the control and the fragment removal groups. After fragment removal and subsequent in vitro culture for 24 hours, the number of blastomeres ($7.1{\pm}1.7$ vs. $6.9{\pm}1.6$) was comparable between the transferred embryos in the two groups, but the morphological grade of the embryos in the fragment removal group ($1.9{\pm}0.7$) was significantly higher than that of the control group ($3.1{\pm}0.5$, p< 0.01). The clinical pregnancy (43.7%) and implantation rates (25.8%) in the fragment removal group were significantly higher than those in the control group (28.8% and 14.0%, respectively; p< 0.05). Conclusion: Early fragment removal on day 2 significantly improved the subsequent development and pregnancy outcomes of fragmented embryos.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.47 no.3
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• pp.175-182
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• 2021

Objectives: In this prospective randomized controlled trial, we measured the primary and secondary stability of two surface-treated implants placed in the posterior maxilla, applied 3-month loading protocols, and compared and analyzed the short-term outcomes of the implants. Patients and Methods: From June 2018 to June 2019, patients with a residual bone height of 4 mm in the posterior maxilla were enrolled and randomly divided into two groups to place SA implants (Osstem Implants, Korea) in Group A and NH implants (Hiossen, USA) in Group B. Finally, 14 implants placed in 13 patients in Group A and 17 implants placed in 14 patients in Group B were analyzed. The measured primary and secondary stability of each implant was represented by implant stability quotient (ISQ), and treatment outcomes were evaluated. Results: Group A consisted of patients with an average age of 62.2 years (range, 48-80 years), and Group B consisted of patients with an average age of 58.1 years (range, 35-82 years). Primary stability was 73.86±6.40 and 71.24±5.32 in Groups A and B, respectively (P=0.222). Secondary stability was 79.07±5.21 in Group A and 78.29±4.74 in Group B (P=0.667). A steep increase in ISQ during the healing period was observed in Group B, though it was not significant (P=0.265). The mean follow-up period was 378.5±164.6 days in Group A and 385.3±167.9 days in Group B. All implants in each group met the success criteria, and the success rate was 100%. Conclusion: Two surface-treated implants placed in the posterior maxilla with greater than 4 mm alveolar bone height exhibited successful one-year treatment outcomes if a primary stability of 65 or higher ISQ was obtained and a 3-month early loading protocol was applied.

• Journal of Gastric Cancer
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• v.21 no.1
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• pp.93-102
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• 2021

Purpose: With advances in surgical techniques, reduced-port laparoscopic surgery is increasingly being performed for the treatment of gastric carcinoma. Many studies have reported satisfactory short-term outcomes after reduced 3-port laparoscopic gastrectomy (LG). The aim of this study was to investigate the long-term oncological outcomes of 3-port LG in patients with gastric carcinoma. Materials and Methods: We reviewed the medical records of 1,117 patients who underwent LG for gastric carcinoma in three major institutions between 2012 and 2015. The data showed that 460 patients underwent 3-port LG without assistance, and 657 underwent conventional 5-port LG. We compared the overall and disease-free survival rates between the 2 groups. Results: There were 642 male and 475 female patients with a mean age of 56.1 years. Among them, 1,028 (92.0%) underwent distal gastrectomy and 89 (8.0%) underwent total gastrectomy. In the final pathologic examination, 1,027 patients (91.9%) were stage I, 73 (6.5%) were stage II, and 17 (1.5%) were stage III, and there were no significant difference in the pathologic stage between groups. The 3- and 5-port LG groups showed no significant differences in the 5-year overall survival (94.3% vs. 96.7%, P=0.138) or disease-free survival (94.3% vs. 95.9%, P=0.231). Stratified analyses according to pT and pN stages also showed no significant differences in overall or disease-free survival between the two groups. Conclusions: Long-term survival after 3- and 5-port LG was comparable in patients with early-stage gastric carcinoma. The 3-port technique requiring limited surgical assistance may be an appropriate surgical option for this patient population.

• Journal of Trauma and Injury
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• v.34 no.1
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• pp.3-12
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• 2021

Purpose: To evaluate the severity of trauma, many scoring systems and predictive models have been presented. The quick Sequential Organ Failure Assessment (qSOFA) is a simple scoring system based on vital signs, and we expect it to be easier to apply to trauma patients than other trauma assessment tools. Methods: This study was a cross-sectional study of trauma patients who visited the emergency department of Jeju National University Hospital. We excluded patients under the age of 18 years and unknown outcomes. We calculated the qSOFA, the Modified Early Warning Score (mEWS), Revised Trauma Score (RTS), and Injury Severity Score (ISS) based on patients' initial vital signs and assessments performed in the emergency department (ED). The primary outcome was mortality within 14 days of trauma. We analyzed qSOFA scores using multivariate logistic regression analysis and compared the predictive accuracy of these scoring systems using the area under the receiver operating characteristic curve (AUROC). Results: In total, 27,764 patients were analyzed. In the multivariate logistic regression analysis of the qSOFA, the adjusted odds ratios with 95% confidence interval (CI) for mortality relative to a qSOFA score of 0 were 27.82 (13.63-56.79) for a qSOFA score of 1, 373.31 (183.47-759.57) for a qSOFA score of 2, and 494.07 (143.75-1698.15) for a qSOFA score of 3. In the receiver operating characteristic (ROC) curve analysis for the qSOFA, mEWS, ISS, and RTS in predicting the outcomes, for mortality, the AUROC for the qSOFA (AUROC [95% CI]; 0.912 [0.871-0.952]) was significantly greater than those for the ISS (0.700 [0.608-0.793]) and RTS (0.160 [0.108-0.211]). Conclusions: The qSOFA was useful for predicting the prognosis of trauma patients evaluated in the ED.