• Title/Summary/Keyword: Expanded indication

Search Result 26, Processing Time 0.022 seconds

Discrepancy between Clinical and Final Pathological Evaluation Findings in Early Gastric Cancer Patients Treated with Endoscopic Submucosal Dissection

  • Kim, Young-Il;Kim, Hyoung Sang;Kook, Myeong-Cherl;Cho, Soo-Jeong;Lee, Jong Yeul;Kim, Chan Gyoo;Ryu, Keun Won;Kim, Young-Woo;Choi, Il Ju
    • Journal of Gastric Cancer
    • /
    • v.16 no.1
    • /
    • pp.34-42
    • /
    • 2016
  • Purpose: Early gastric cancer cases that are estimated to meet indications for treatment before endoscopic submucosal resection are often revealed to be out-of-indication after the treatment. We investigated the short-term treatment outcomes in patients with early gastric cancer according to the pretreatment clinical endoscopic submucosal resection indications. Materials and Methods: We retrospectively reviewed the medical records of patients with early gastric cancer that met the pretreatment endoscopic submucosal resection indications, from 2004 to 2011. Curative resection rate and proportion of out-of-indication cases were compared according to the pre-endoscopic submucosal resection indications. Pre-endoscopic submucosal resection factors associated with out-of-indication in the final pathological examination were analyzed. Results: Of 756 cases, 660 had absolute and 96 had expanded pre-endoscopic submucosal resection indications. The curative resection rate was significantly lower in the patients with expanded indications (64.6%) than in those with absolute indications (81.7%; P<0.001). The cases with expanded indications (30.2%) were revealed to be out-of-indication more frequently than the cases with absolute indications (13.8%; P<0.001). Age of >65 years, tumor size of >2 cm, tumor location in the upper-third segment of the stomach, and undifferentiated histological type in pre-endoscopic submucosal resection evaluations were significant risk factors for out-of-indication after endoscopic submucosal resection. Conclusions: Non-curative resection due to out-of-indication occurred in approximately one-third of the early gastric cancer cases that clinically met the expanded indications before endoscopic submucosal resection. The possibility of additional surgery should be empha-sized for patients with early gastric cancers that clinically meet the expanded indications.

Expansion of Indication for Endoscopic SD in Early Gastric Cancer

  • Kim, Do-Hoon;Jung, Hwoon-Yong
    • Journal of Gastric Cancer
    • /
    • v.10 no.2
    • /
    • pp.49-54
    • /
    • 2010
  • Endoscopic resection is now accepted as curative treatment modalities for early gastric cancer without lymph node metastasis. However, based on large-scaled data about the risk of lymph node metastasis in early gastric cancer and as a result of the technical development of endoscopic devices, it was suggested that the criteria for endoscopic resection should be extended. According to the treatment guidelines for gastric cancer in Japan, the extended indications include the following: differentiated-type mucosal cancer without ulceration and greater than 2 cm in diameter, differentiated-type mucosal cancer with ulceration and up to 3 cm in diameter, undifferentiated-type mucosal cancer without ulceration and up to 2 cm in diameter, and, in the absence of lymphovascular invasion, a tumor not deeper than submucosal level 1 (less than $500\;{\mu}m$). In this review, we discuss the evidence of the application of expanded endoscopic indication based on analysis of biologic behavior and data of endoscopic resection.

Endoscopic Resection for Early Gastric Cancer beyond Absolute Indication with Emphasis on Controversial Issues

  • Min, Yang Won;Lee, Jun Haeng
    • Journal of Gastric Cancer
    • /
    • v.14 no.1
    • /
    • pp.7-14
    • /
    • 2014
  • Endoscopic resection is the established treatment for early gastric cancer in selected patients with negligible risk of lymph node metastasis ('absolute indication'). Based on clinical observations and large pathological databases, expanding indications for endoscopic resection beyond absolute indication has been tried in Japan and Korea. However, controversies exist regarding the safety of treating early gastric cancer beyond absolute indication in terms of pathological evaluation of the resected specimen, definition of expanded indication, discrepancy between pre-endoscopic resection and post-endoscopic resection diagnoses of gastric neoplasm, and the best strategy for cases with non-curative resection. In this brief review, current evidence and clinical experience regarding issues of endoscopic resection beyond absolute indication will be summarized.

Extragastric Metastasis of Early Gastric Cancer After Endoscopic Submucosal Dissection With Lymphovascular Invasion and Negative Resected Margins

  • Lee, Han Myung;Kwak, Yoonjin;Chung, Hyunsoo;Kim, Sang Gyun;Cho, Soo-Jeong
    • Journal of Gastric Cancer
    • /
    • v.22 no.4
    • /
    • pp.339-347
    • /
    • 2022
  • Purpose: Lymphovascular invasion is a criterion for non-curative resection in patients who have undergone endoscopic submucosal dissection (ESD) for early gastric cancer (EGC). We aimed to determine the rate of extragastric metastasis (EGM) and identify the predictors of EGM in patients with negative resection margins (R0 resection) and lymphovascular invasion in post-ESD pathology. Materials and Methods: A total of 2,983 patients underwent ESD for EGC. Among them, 110 had a pathology of R0 resection and positive lymphovascular invasion. Patients underwent additional gastrectomy (n=63) or further follow-up without gastrectomy (n=47). Results: The 110 patients were assigned to one of the 3 groups according to ESD indications based on post-ESD pathology. The first group satisfied the absolute indication for ESD (n=18), the second group satisfied the expanded indications for ESD (n=34), and the last group satisfied the beyond indication (n=58). The number of occurrences of EGM in each group was 1 (5.6%), 3 (8.8%), and 3 (5.2%), respectively. The logistic regression analysis adjusted for age, sex, tumor size, and indication for ESD, showed that larger tumor size was associated with EGM (odds ratio, 1.76; 95% confidence interval, 1.00-3.10; P=0.048). In contrast, ESD indication criteria did not affect EGM (P=0.349). Conclusions: Tumor size was the only predictive indicator for EGM in patients who underwent R0 resection and lymphovascular invasion on post-ESD pathology. Even patients with pathology corresponding to the absolute indication criteria of ESD had lymphovascular invasion, which means that they require additional gastrectomy due to the risk of EGM.

Transthoracic Needle Biopsy of Thoracic Lesions (흉부 병터에 대한 경흉부 바늘생검)

  • Song, Jae-Woo
    • Tuberculosis and Respiratory Diseases
    • /
    • v.56 no.3
    • /
    • pp.241-247
    • /
    • 2004
  • In the diagnostic evaluation of thoracic lesions, the image-guided transthoracic needle biopsy was developed, and its role was expanded with the development of cross-sectional detection and characterization of thoracic lesions and advances in biopsy needle design and techniques. Particularly for diagnostic evaluation of solitary pulmonary nodules, transthoracic needle biopsy has emerged as the invasive procedure of choice. This article covers the indication, the pre-procedure preparation, various guidance-modalities and techniques, and complications.

Updated Surgical Techniques and Expanded Indications of Free Vascularized Fibular Graft

  • Park, Jong Woong
    • Archives of Reconstructive Microsurgery
    • /
    • v.24 no.2
    • /
    • pp.41-49
    • /
    • 2015
  • Free or pedicled vascularized fibular grafts (VFG) are useful for the reconstruction of large skeletal defects, particularly in cases of scarred or avascular beds, or in patients with combined bone and soft tissue defects. Compared to non-VFG, VEG, which contains living osteocytes and osteoblasts, maintains its own viability and serves as good osteoconductive and osteoinductive graft. Due to its many structural and biological advantages, the free fibular osteo- or osteocutaneous graft is considered the most suitable autograft for the reconstruction of long bone defects in the injured extremity. The traditional indication of VFG is the long bone and soft tissue defect, which cannot be reconstructed using a conventional operative method. Recently, the indications have been widely expanded not only for defects of midtibia, humerus, forearm, distal femur, and proximal tibia, but also for the arthrodesis of shoulder and knee joints. Because of its potential to allow further bone growth, free fibular epiphyseal transfer can be used for the hip or for distal radius defects caused by the radical resection of a tumor. The basic anatomy and surgical techniques for harvesting the VFG are well known; however, the condition of the recipient site is different in each case. Therefore, careful preoperative surgical planning should be customized in every patient. In this review, recently expanded surgical indications of VFG and surgical tips based on the author's experiences in the issues of fixation method, one or two staged reconstruction, size mismatching, overcoming the stress fracture, and arthrodesis of shoulder and knee joint using VFG are discussed with the review of literature.

Wolsong 3&4 Steam Generator Tube Inspection (월성 3,4호기 증기발생기 전열관 검사)

  • Jang, Kyoung-Sik;Kwon, Dong-Ki;Choi, Jin-Hyuk;Son, Tai-Bong
    • Proceedings of the KSME Conference
    • /
    • 2001.11b
    • /
    • pp.859-866
    • /
    • 2001
  • During the Pre-service Inspection for Wolsong Unit 3&4 in 1997/1998 respectively, 17 Distorted Roll Transition indications(over expanded beyond tubesheet secondary face) were identified at the Unit 4 (S/G B, D). Six(6) tubes out of these tubes were plugged in 1998. However the first Periodic Inspection identified additional 110 indications in 1999 and 2000. The additionally identified 110 indication call, not reported at the Pre-service Inspection, are; 2 Not-Finally-Expanded-Tubes and 108 Distorted Roll Transition tubes. Design limit of each Steam Generator tube Plugging is 6.4%. Plugging was performed by the Steam Generator manufacturer under the warranty. When Distorted Roll Transition indications were first identified on the Unit 4 in 1998 the degree of Over-expansion was measured using an inner dial-gage to make the disposition of Nonconformance report. 2 Not-Finally-Expanded-Tubes were plugged and 10 tubes out of 108 Distorted Roll Transition Tubes were also plugged as a preventive measure.

  • PDF

Evolving Indication of Meniscal Allograft Transplantation (진화하고 있는 동종 반월연골판 이식술의 적응증)

  • Lee, Bum-Sik;Bin, Seong-Il;Kim, Taehyung
    • Journal of the Korean Orthopaedic Association
    • /
    • v.55 no.3
    • /
    • pp.200-209
    • /
    • 2020
  • The first human meniscal allograft transplantations (MATs) were performed 30 years ago. In the early era, candidates were limited to patients who have favorable joint conditions. MAT is currently indicated for patients with post-meniscectomy symptoms, such as compartmental pain or effusion after a subtotal or total meniscectomy. The current indication for MAT is being expanded to other patients who were not indicated previously. The present article reviews how the indications of MAT have changed over the years.

Regional Lymph Node Dissection as an Additional Treatment Option to Endoscopic Resection for Expanded Indications in Gastric Cancer: a Prospective Cohort Study

  • Seo, Ho Seok;Yoo, Han Mo;Jung, Yoon Ju;Lee, Sung Hak;Park, Jae Myung;Song, Kyo Young;Jung, Eun Sun;Choi, Myung-Gyu;Park, Cho Hyun
    • Journal of Gastric Cancer
    • /
    • v.20 no.4
    • /
    • pp.442-453
    • /
    • 2020
  • Purpose: Expanded indications for endoscopic submucosal dissection (ESD) in early gastric cancer (EGC) remain controversial due to the potential risk of undertreatment after adequate lymph node dissection (LND). Regional LND (RLND) is a novel technique used for limited lymphadenectomy to avoid gastrectomy. This study established the safety and effectiveness of RNLD as an additional treatment option after ESD for expanded indications. Materials and Methods: A total of 69 patients who met the expanded indications for ESD were prospectively enrolled from 2014 to 2017. The tumors were localized using intraoperative esophagogastroduodenoscopy (EGD) before RLND. All patients underwent RLND first, followed by conventional radical gastrectomy with LND. The locations of the preoperative and intraoperative EGD were compared. Pathologic findings of the primary lesion and the RLND status were analyzed. Results: The concordance rates of tumor location between the preoperative and intraoperative EGD were 79.7%, 76.8%, and 63.8% according to the longitudinal, circumferential, and regional locations, respectively. Of the 4 patients (5.7%) with metastatic LNs, 3 were pathologically classified as beyond the expanded indication for ESD and 1 had a single LN metastasis in the regional lymph node. Conclusions: RLND is a safe additional option for the treatment of EGC in patients meeting expanded indications after ESD.

Permanent Surgical Treatment for Posthemorrhagic Hydrocephalus in Preterm Infants

  • Atsuko Harada
    • Journal of Korean Neurosurgical Society
    • /
    • v.66 no.3
    • /
    • pp.281-288
    • /
    • 2023
  • While the standard management for posthemorrhagic hydrocephalus (PHH) has not been determined, many patients initially receive temporary treatment such as a ventricular drainage, a ventricular reservoir, or a ventriculosubgaleal shunt. Subsequently, approximately 15% of patients with PHH will require permanent cerebrospinal fluid diversion. Shunt placement is most commonly performed for PHH as permanent treatment. However, shunting still has high complication rates. Since the development of the neuroendoscopic technique has progressed, and indication has been expanded, endoscopic third ventriculostomy with or without choroid plexus cauterization has performed more frequently in recent years in patients with PHH. In this paper, the permanent treatment for PHH will be reviewed based on the latest evidence.