• Journal of Chest Surgery
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• 제38권1호
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• pp.76-79
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• 2005

식도에서 간엽세포 종양과 상피성세포 종양의 공존은 매우 드물다 저자들은 식도 평활근종의 점막표면에 위치한 편평상피세포암 수술 치험 1예를 보고한다. 내원 3개월 전부터 음식 섭취시 연하통을 주소로 내원한 76세 남자 환자에서 수술 전 검사로 석회화를 동반한 식도 점막하종양을 의심하였고, 종양을 덮고 있는 불규칙한 점막의 식도내시경 조직검사로 편평상피세포암의 공존을 수술 전에 진단하였다. 우측 개흥과 개복으로 흉부 식도절제술 후 식도-위 문합을 시행하였다. 수술 25개월이 경과한 현재까지 재발의 소견 없이 정상 생활을 하고 있다. 두 종양 사이의 관계의 가능성과 빈도에 대해 문헌 고찰을 한다.

• Journal of Chest Surgery
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• 제31권3호
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• pp.324-328
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• 1998

식도에 발생하는 혈관종은 식도에 드물게 발생하는 양성종양의 2% 내지 3% 정도 차지할 정도로 매우 희귀하여 세계적으로 보고된 증례수가 많지 않다. 저자들은 식도에 발생한 매우 희귀한 해면혈관종 1례를 수술치험하였기에 문헌고찰과 더불어 보고하고자 한다. 환자는 40세 남 米\ulcorner경미한 연하장애를 주소로 내원하여 식도조영술, 식도 내시경검사, 조영제를 이용한 흉부 전산화 단층촬영등을 시행하여 하부 식도의 점막하층에서 발생하여 근육층 밖으로 돌출되어 나온 식도 종양이 추정되어 수술을 시행하였다. 수술소견상 하부 식도 및 식도-위 문합부에 걸쳐 과혈관성의 7x7x3.5cm 크기의 거대한 종괴가 식도점막하층과 식도근육층 그리고 주위조직으로의 침범이 심하게 되어 있어 종양을 포함한 식도절제술 및 식도-위 문합술을 시행하여 병리 조직학적으로 해면 혈관종으로 확진되었으며 환자는 특별한 문제없이 술후 제14일째 건강한 상태로 퇴원하였다.

• 대한기관식도과학회지
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• 제5권2호
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• pp.143-152
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• 1999

Background : the technical modality of esophagogastric anastomosis plays an important part in the factors leading to anastomotic leakage and stricture. Objective : The objective of this study was to compare the leakage and stricture rates between the different anastomosis techniques. Materials and Methods : A retrospective study was undertaken in the patients with esophageal cancer who underwent a esophagectomy. Hand-sewn anastomosis was performed in one layer with interrupted sutures(Manual group). The stapler group was divided into two subgroups, such as PCEEA group and Endo-GIA group. Results : The differences of preoperative patient profiles between the groups were not significant. Overall mortality fates were 5% in manual group, 5% in PCEEA group and 11.5% in Endo-GIA group. Fewer anastomotic leakage occurred in manual group(5%) than in PCEEA group(10%) or in Endo-GIA group(15.4%). The postoperative stricture rate was higher in PCEEA group(35%) than in manual group(5%) or in Endo-GIA group(0%) Conclusion : Statistically, there were no significant differences in the anastomotic leakage and stricture rates between the hand-sewn and mechanical anastomosis. But the stricture rate was lower in the group using the linear stapling device and the leakage rate was lower in the hand-sewn group than the other groups.

• Asian Pacific Journal of Cancer Prevention
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• 제14권5호
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• pp.3183-3186
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• 2013

Purpose: The 7th edition of the American Joint Committee on Cancer Staging Manual for esophageal cancer (EC) categorizes N stage according to the number of metastatic lymph nodes (LNs), irrespective of the site. The aim of this study was to determine the prognostic value of subcarinal LN metastasis in patients undergoing esophagectomy for esophageal squamous cell carcinoma (ESCC). Methods: A retrospective analysis of 507 consecutive patients with ESCC was conducted. Potential clinicopathological factors that could influence subcarinal LN metastasis were statistically analyzed. Univariate and multivariate analyses were also performed to evaluate the prognostic parameters for survival. Results: The frequency of subcarinal LN metastasis was 22.9% (116/507). Logistic regression analysis showed that tumor length (>3cm vs ${\leq}3cm$; P=0.027), tumor location (lower vs upper/middle; P=0.009), vessel involvement (Yes vs No; P=0.001) and depth of invasion (T3-4a vs T1-2; P=0.012) were associated with 2.085-, 1.810-, 2.535- and 2.201- fold increases, respectively, for risk of subcarinal LN metastasis. Multivariate analyses showed that differentiation (poor vs well/moderate; P=0.001), subcarinal LN metastasis (yes vs no; P=0.033), depth of invasion (T3-4a vs T1-2; P=0.014) and N staging (N1-3 vs N0; P=0.001) were independent prognostic factors. In addition, patients with subcarinal LN metastasis had a significantly lower 5-year cumulative survival rate than those without (26.7% vs 60.9%; P<0.001). Conclusions: Subcarinal LN metastasis is a predictive factor for long-term survival in patients with ESCC.

• Journal of Chest Surgery
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• 제25권12호
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• pp.1530-1536
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• 1992

From January 1984 to December 1991, One hundred sixty five patients with carcinomoa of the esophagus were treated surgically at the department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital. Among them, hospital records were available in 121 patients and were included in this study. There were 115 men and 6 women, with ages ranging from 40 years to 79 years[mean age of 59.2 years]. The most frequent preoperative symptoms included dysphagia[72.7%], weight loss[60.3%], chest pain or discomfort[14.9%], general malaise[13.2%]. All were treated surgically: 100 patients were managed by curative or palliative resection with reconstruction, and 6 by palliative bypass surgery. In 15 patients, explorative thoracotomy or laparotomy was only done due to unresectability. [operability: 87.6%, resectability: 82.6%] All specimens[those from resectable 100 cases] were sent to pathology, and histopathologic examinations were done; squamous cell carcinomas were found in 95 cases, adenocarcinoma in l. Adenosquamous carcinomas were found in 3, and malignant melanoma in l. Postoperative complications occurred in 34 cases; anastomotic site leakage[10], which was followed by empyema in 9 of them, wound problem[7], hepatic failure[6], pneumonia [3], post-operative bleeding[3], chylothorax[2], post-operative stricture[2], sepsis[1], and tracheobronchial fistula[1]. Hospital deaths were in 6 cases[Hospital mortality: 5.0%]. During the follow up period, 26 patients were proven to be recurrence of cancer locally or distantly. The one, two, and five-year actuarial survival raf.es were 71.3$\pm$4.5%, 57.4$\pm$5.6%, 34.7$\pm$8.9%, respectively. The data from this study suggested that esophagectomy with reconstruction of gastrointestinal tract could be performed with a low operative mortality and a few serious postoperative complications and achieved reasonable long term palliation for carcinoma of the esophagus.

• Journal of Chest Surgery
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• 제38권7호
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• pp.514-517
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• 2005

위장관 간질 종양은 위장관 전역에서 발생하며 그 중 위와 소장 등에 많이 생기며 식도에서도 발생한다. 44세 남성이 연하곤란과 체중감소를 주소로 내원하여 시행한 상부 위장관 내시경 검사 및 흉부 전산화 단층 촬영에서 식도 하부의 완전폐쇄, 위의 전방 편위 소견과 중앙부 괴사를 동반하는 최대 직경 15cm 정도의 저음영의 거대 종괴를 보여 흉복부 절개를 이용하여 하부 식도 및 위전적출술을 시행하였다 종양은 CDl17 (c-kit)와 CD34에서 양성을 보여 악성 위장관 간질 종양으로 확진되었으며 현재 외래 추적관찰 중이다.

• Journal of Gastric Cancer
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• 제14권1호
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• pp.58-62
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• 2014

We report an extremely rare case of primary squamous cell carcinoma of the stomach. A 69-year-old man was admitted to our hospital with a 2-month history of dysphagia and tarry stools. Endoscopic examination revealed a cauliflower-shaped protruding mass along the lesser curvature of the gastric cardia. Biopsy of the lesion revealed squamous cell carcinoma of the stomach. Computed tomography revealed a thickened stomach wall and a mass protruding into the gastric lumen. Total gastrectomy with splenectomy, distal pancreatectomy, and Roux-en-Y reconstruction was performed, together with a lower thoracic esophagectomy via a left thoracotomy. Histopathological examination of the specimen revealed well-differentiated squamous cell carcinoma of the stomach. Postoperative follow-up was uneventful for the first 18 months. However, multiple liver metastases and para-aortic lymph node metastasis developed subsequently. Despite systemic combination chemotherapy, the patient died because of progression of the recurrent tumors. Here, we review the characteristics of 56 cases of gastric squamous cell carcinoma reported in Japan.

• Journal of Gastric Cancer
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• 제19권4호
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• pp.473-483
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• 2019

Surgical therapy for adenocarcinoma of the esophagogastric junction II requires distal esophagectomy, in which a transhiatal management of the lower esophagus is critical. The 'dorsal track control' (DTC) maneuver presented here facilitates the atraumatic handling of the distal esophagus, in preparation for a circular-stapled esophagojejunostomy. It is based on a ventral semicircular incision in the distal esophagus, with an intact dorsal wall for traction control of the esophagus. The maneuver facilitates the proper placement of the purse-string suture, up to its tying (around the anvil), thus minimizing the manipulation of the remaining esophagus. Furthermore, the dorsally-exposed inner wall surface of the ventrally-opened esophagus serves as a guiding chute that eases anvil insertion into the esophageal lumen. We performed this novel technique in 21 cases, enabling a safe anastomosis up to 10 cm proximal to the Z-line. No anastomotic insufficiency was observed. The DTC technique improves high transhiatal esophagojejunostomy.

• Journal of Chest Surgery
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• 제31권5호
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• pp.549-551
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• 1998

氷복茸兌\ulcorner환자에서 발생하는 연하곤란은 보통 역류성 식도염, 감염성 식도염, 화학요법 및 백혈병의 직접적인 식도 침범에 의해 발생하지만 그중에서도 백혈병 환자의 화학요법의 결과로 발생하는 식도협착중 급성으로 발병하는 경우는 아주 드물다. 본원에서는 40세의 남자환자가 급성 골수성 백혈병으로 화학요법 받은지 1개월 이내에 발생한 급성 식도협착으로 수술위해 입원, 식도 절제술 및 위식도 문합술 과 유문부 성형술을 시행하였다. 병리 조직검사상 단핵구들의 점막 침착 및 점막하조직과 근육층을 침범하는 섬유화소견을 보이고 있다.

• Journal of Gastric Cancer
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• 제19권1호
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• pp.62-71
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• 2019

Purpose: The laparoscopic transhiatal approach (LA) for adenocarcinoma of the esophagogastric junction (AEJ) is advantageous since it allows better visualization of the surgical field than the open approach (OA). We compared the surgical outcomes of the 2 approaches. Materials and Methods: We analyzed 108 patients with AEJ who underwent transhiatal distal esophagectomy and gastrectomy with curative intent between 2003 and 2015. Surgical outcomes were reviewed using electronic medical records. Results: The LA and OA were performed in 37 and 71 patients, respectively. Compared to the OA, the LA was associated with significantly shorter duration of postoperative hospital stay (9 vs. 11 days, P=0.001), shorter proximal resection margins (3 vs. 7 mm, P=0.004), and extended operative times (240 vs. 191 min, P=0.001). No significant difference was observed between the LA and OA for intraoperative blood loss (100 vs. 100 mL, P=0.392) or surgical morbidity rate ($grade{\geq}II$) for complications (8.1% vs. 23.9%, P=0.080). Two cases of anastomotic leakage occurred in the OA group. The number of harvested lymph nodes was not significantly different between the LA and OA groups (54 vs. 51, P=0.889). The 5-year overall and 3-year relapse-free survival rates were 81.8% and 50.7% (P=0.024) and 77.3% and 46.4% (P=0.009) for the LA and OA groups, respectively. Multivariable analyses revealed no independent factors associated with overall survival. Conclusions: The LA is feasible and safe with short- and long-term oncologic outcomes similar to those of the OA.