• Journal of Chest Surgery
• /
• 제31권11호
• /
• pp.1106-1109
• /
• 1998

식도의 원발성 악성 흑색종은 매우 드문 종양성 질환으로 전세계적으로 약 200례가 보고되어 있다. 저자들은 식도 악성 흑색종의 외과적 치험 1례를 문헌고찰과 함께 보고하였다. 종양은 호두알 크기의 타원형으로 중부 식도에 위치하고 있었으며, 식도-위 경계부위에 2개의 위성병변이 있었다. 종양은 조직학적 검사와 면역조직학적 검사에 의하여 식도원발의 악성 흑색종으로 확진되었다. 개흉적 식도아전절제와 2영역 림프절적출로 근치적 수술을 하였으나, 수술 7개월후 원격전이 재발이 확인되었으며 면역요법에 뚜렷한 효과를 보이지 않고 있다.

• Journal of Chest Surgery
• /
• 제20권2호
• /
• pp.348-352
• /
• 1987

A 51 year-old male was admitted with the chief complaints of swallowing difficulty and pain on neck and upper chest for 2 months prior to admission: He was taken biopsy under esophagoscopy, and the result was squamous cell carcinoma. Preoperatively we studied the esophagogram and chest CT. On these, we found the main appreciable mass at midesophagus easily. But, we missed the upper cervical unexpected mass. So we performed the esophagectomy and lymph node dissection from upper clavicle level to the esophagogastric junction by thoracic approach as wide as possible, and cervical esophagostomy and feeding gastrostomy also. At that evening we reviewed the studied films in detail, and we found another mass lesion at C4-C6 level of cervical esophagus. We performed the 2nd operation e.g. cervical esophagectomy on next morning without hesitation. Between these two masses, there was almostly normally looking skip area grossly. The squamous cell carcinoma of the esophagus could be multicentric in character and may have skip area. But, we heard little reports until now. The two masses could be different in origin or be same probably by submucosal spreading. Anyway, it was an alarming case to the surgeon not to neglect the another possible lesions in squamous cell type. Postoperative course was uneventful, he took G-tube feeding with no problems on 7th postoperative day. Now he took the postoperative irradiation at out patient department.

• Journal of Chest Surgery
• /
• 제27권1호
• /
• pp.72-75
• /
• 1994

The esophageal hiatal hernia is a rare disease in Korea especially in children and infant. We experienced a case of type III esophageal hiatal hernia in 9 months female. She had no specific past history and familial history except recurrent URI and postprandial habitual vomiting. The chest X-ray and Barium swallowing showed herniated stomach in Rt. thoracic cavity and posterior mediastinum. We performed modified Belsey Mark IV procedure with using the 3-0 and 4-0 Pledgeted Ticrons. In operative field, the stomach cardia portion was herniated into the Rt.thoracic cavity and posterior mediastinum with elevation of the esophagogastric junction above the diaphragm. But there was no evidence of short esophagus and combined anomaly. The postoperative courses were uneventful and good without specific complication for about 5 months to this point.

• Journal of Chest Surgery
• /
• 제29권2호
• /
• pp.248-250
• /
• 1996

기관기관지 잔유조직에 의한 선천성 식도협착은 드문 질환으로 주로 중·하부 식도에 혼히 발생한다. 발생원인은 태생기 원시 전장에서 식도와 기도가 정상적인 분리를 못하여 식도벽내에 기관지 연골조직이 존재하며, 이로 인하여 연하곤란이 생후 직후부터 서서히 생기게 된다. 4세의 여아가 최근 2년간 악화된 연하곤란을 주소로 입원하였다. 식도이완 불능증의 진단하에 수술을 시행하였으며, 식도-위 경계부 상방 4cm부위에서 백색의 단단한 결절성의 종괴를 발견하였다. 수술은 종괴를 제거하고 식도의 확장 성형술을 시행하였으며, 술후 조직 소견상 기관연골과 기관지점 막 상피로 밝혀졌다.

• Journal of Gastric Cancer
• /
• 제15권1호
• /
• pp.10-18
• /
• 2015

The purpose of this study was to determine if international guidelines differ in their recommendations concerning additive therapy for advanced, but potentially curable, gastric cancer. A systematic search of the English and German literature was conducted in the databases Medline, Cochrane Database, Embase, and PubMed. The search terms used were 'guidelines gastric cancer,' 'guidelines stomach cancer,' and 'Leitlinien Magenkarzinom.' Six different guidelines published after January 1, 2010, in which the tumors were classified according to the seventh edition of the TNM system (2010), were identified. Although the examined guidelines were based on the same study results, their recommendations concerning accompanying therapy for gastric cancer differ considerably. While perioperative chemotherapy is recommended in Germany, Great Britain, and large parts of Europe, postoperative adjuvant radiochemotherapy or perioperative chemotherapy is recommended in the USA and Canada. In Japan, postoperative adjuvant chemotherapy is recommended. The results of identical studies were interpreted differently in different countries. Since considerable effort is required for each country to separately test relevant studies for their validity and suitability, an international cooperation could simplify the creation of a common basis for guidelines and contribute to improved comparability of international guidelines.

• Journal of Chest Surgery
• /
• 제1권1호
• /
• pp.53-60
• /
• 1968

Achalasia is a functional disorder of a short segment of the lower esophagus showing obstruction of the esophagogastric junction. Dysphagia. regurgitation and weight loss are outstanding features,however, complicated pulmonary troubles aspiration pneumonitis, bronchiectasis, lung abscess etc. --are sometimes more apparent than the disease entity in children though achalasia is rarely encountered in children. During the period of January, 1961, to May, 1968, the authors experienced 9 cases of achalasia of the esophagus in Chest Surgery Department,N.M.C. 1. Seven of nine were male and four were under 5 years of age. 2. So-called symptoms triad noted in almost every case, and 3 of 4 children showed recurrent attacks of pneumonitis. 3. Chest film showed widened superior mediastinum by dilated esophagus in 6 cases, and pulmonary infiltrations in 3 cases of children. 4. Preoperative diagnosis were achalasia,esophageal stricture by rodent-cidal ingestion and suggestive esophageal cancer in 7 cases,one case and remaining one case. respectively. 5. Modified Heller procedure was performed in all cases with definite diagnosis of achalasia at operation table in misdiagnosed 2 cases. 6. Immediate postoperative complications were 2 cases of wound infection and one case of atelectasis and no operative mortality encountered. 7. Seven of nine showed excellent result of operation, and good in one case. Remaining one case failed relieving obstruction and underwent interposition of ileocolonic segment with excellent result.

• Journal of Gastric Cancer
• /
• 제21권2호
• /
• pp.111-121
• /
• 2021

Laparoscopic endoscopic cooperative surgery (LECS) refers to the endoscopic dissection of the mucosal or submucosal layers with laparoscopic seromuscular resection. We recommend a treatment algorithm for the LECS procedure for gastric benign tumors according to the protruding type. In the exophytic type, endoscopic-assisted wedge resection can be performed. In the endophytic type, endoscopic-assisted wedge resection of the anterior wall is relatively easy to perform, and endoscopic-assisted transgastric resection, laparoscopic-assisted intragastric surgery, or single-incision intragastric resection in the posterior wall and esophagogastric junction (EG Jx) can be attempted. We propose an algorithm for the LECS procedure for early gastric cancer according to the tumor location. The endoscopic submucosal dissection (ESD) procedure can be adapted for all areas of the stomach, and single-incision ESD can be performed in the mid to high body and the EG Jx. In full-thickness gastric resection, laparoscopy-assisted endoscopic full-thickness resection can be adapted for the entire area of the stomach, but it cannot be applied to the pyloric and EG Jx. In conclusion, surgeons need to select the LECS procedure according to tumor type, tumor location, the surgeon's individual experience, and the situation of the institution while also considering the advantages and disadvantages of each procedure.

• 대한한방내과학회지
• /
• 제33권1호
• /
• pp.26-38
• /
• 2012

Objectives : The aim of this study was to investigate the effect of partial pyloric obstruction on body weight, gastric juice, gastric surface area and gastric edema in normal intact and/or vagotomized rats. Methods : Partial pyloric obstruction was performed by wrapping a non-absorbable rubber ring (D:6 mm, W:4 mm, T:1 mm) around the 1st portion of the duodenum. Vagotomy was performed by resecting the branches around the esophagogastric junction. Pre-post body weight differential, fasting gastric juice volume, gastric surface area and gastric edema were measured at 8 weeks and 20 weeks. For the effect of pyloric reperfusion the rubber ring was removed after 8 weeks and then an additional 12 weeks of observation was performed to the end of the 20-week experimental period. Results : In the initial 8 weeks observation, the effect of pylorus obstruction and/or vagotomy was significantly remarkable in the pylorus obstructed and vagotomized group; slowdown of weight gain, increase of fasting gastric juice volume, dilatation of gastric surface area and severe gastric edema were shown. In the remaining 12 weeks observation, the effect of reperfusion was significantly remarkable in the ring-removed antral dilated group; recovery of weight gain, decrease of gastric surface area and decrease of gastric edema were shown. However, gastric juice volume was not significantly different from the other group. Conclusions : Partial pyloric obstruction plays a aggravating role and the vagus nerve plays a protective role in body weight, gastric juice, gastric surface area, and gastric edema. Furthermore, pyloric valve dysfunction as an aggravating factor strengthened in defect of the vagus nerve. These results suggest that patients with both functional pyloric outlet obstruction and hypofunction of vagus nerve need to be diagnosed in good time and treated properly.

• Asian Pacific Journal of Cancer Prevention
• /
• 제15권21호
• /
• pp.9529-9534
• /
• 2014

Background: Cancer staging enables planning for the best treatments, evaluation of prognosis, and predictions for survival. The Collaborative Stage (CS) system makes it possible to significantly reduce the proportion of patients labeled at an "unknown" stage as well as discrepancies among different staging systems. This study aims to analyze the factors that influence the accuracy and validity of CS data. Materials and Methods: Data were randomly selected (233 cases) from stomach cancer cases enrolled for CS survey at the Korea Central Cancer Registry. Two questionnaires were used to assess CS values for each case and to review the cancer registration environment for each hospital. Data were analyzed in terms of the relationships between the time spent for acquisition and registration of CS information, environments relating to cancer registration in the hospitals, and document sources of CS information for each item. Results: The time for extracting and registering data was found to be shorter when the hospitals had prior experience gained from participating in a CS pilot study and when they were equipped with full-time cancer registrars. Evaluation of the CS information according to medical record sources found that the percentage of items missing for Site Specific Factor (SSF) was 30% higher than for other CS variables. Errors in CS coding were found in variables such as "CS Extension," "CS Lymph Nodes," "CS Metastasis at Diagnosis," and "SSF25 Involvement of Cardia and Distance from Esophagogastric Junction (EGJ)." Conclusions: To build CS system data that are reliable for cancer registration and clinical research, the following components are required: 1) training programs for medical records administrators; 2) supporting materials to promote active participation; and 3) format development to improve registration validity.

• Journal of Gastric Cancer
• /
• 제14권1호
• /
• pp.39-46
• /
• 2014

Purpose: According to current guidelines, perioperative chemotherapy is an integral part of the treatment strategy for advanced gastric cancer. Randomized controlled studies have been conducted in order to determine whether perioperative chemotherapy leads to improved R0 resection rates, fewer recurrences, and prolonged survival. The aim of our project was to critically appraise three major studies to establish whether perioperative chemotherapy for advanced, potentially resectable gastric cancer can be recommended on the basis of their findings. Materials and Methods: We analyzed the validity of the three most important studies (MAGIC, ACCORD, and EORTC) using a standardized questionnaire. Each study was evaluated for the study design, patient selection, randomization, changes in protocol, participating clinics, preoperative staging, chemotherapy, homogeneity of subjects, surgical quality, analysis of the results, and recruitment period. Results: All three studies had serious shortcomings with respect to patient selection, homogeneity of subjects, changes in protocol, surgical quality, and analysis of the results. The protocols of the MAGIC and ACCORD-studies were changed during the study period because of insufficient recruitment, such that carcinomas of the lower esophagus and the stomach were examined collectively. In neither the MAGIC study nor the ACCORD study did patients undergo adequate lymphadenectomy, and only about half of the patients in the chemotherapy group could undergo the treatment specified in the protocol. The EORTC study had insufficient statistical power. Conclusions: We concluded that none of the three studies was sufficiently robust to justify an unrestrained recommendation for perioperative chemotherapy in cases of advanced gastric cancer.