• Journal of Gastric Cancer
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• v.23 no.3
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• pp.462-475
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• 2023

Purpose: This study aimed to analyze the incidence and risk factors of complications following gastric cancer surgery in Korea and to compare the correlation between hospital complications based on the annual number of gastrectomies performed. Materials and Methods: A retrospective analysis was conducted using data from 12,244 patients from 64 Korean institutions. Complications were classified using the Clavien-Dindo classification (CDC). Univariate and multivariate analyses were performed to identify the risk factors for severe complications. Results: Postoperative complications occurred in 14% of the patients, severe complications (CDC IIIa or higher) in 4.9%, and postoperative death in 0.2%. The study found that age, stage, American Society of Anesthesiologists (ASA) score, Eastern Cooperative Oncology Group (ECOG) score, hospital stay, approach methods, and extent of gastric resection showed statistically significant differences depending on hospital volumes (P<0.05). In the univariate analysis, patient age, comorbidity, ASA score, ECOG score, approach methods, extent of gastric resection, tumor-node-metastasis (TNM) stage, and hospital volume were significant risk factors for severe complications. However, only age, sex, ASA score, ECOG score, extent of gastric resection, and TNM stage were statistically significant in the multivariate analysis (P<0.05). Hospital volume was not a significant risk factor in the multivariate analysis (P=0.152). Conclusions: Hospital volume was not a significant risk factor for complications after gastric cancer surgery. The differences in the frequencies of complications based on hospital volumes may be attributed to larger hospitals treating patients with younger age, lower ASA scores, better general conditions, and earlier TNM stages.

• Journal of Gastric Cancer
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• v.1 no.4
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• pp.197-201
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• 2001

Purpose: There are variants of gastric cancer assoclated with predominantly peritoneal spread of with haematogenous metastases. Perioperative intraperitoneal chemotherapy as an adjuvant to surgery is considered as a rational therapeutic modality to prevent peritoneal spread. We evaluated the influence of early postoperative intraperitoneal chemotherapy on the prognosis of resectable advanced gastric cancer. Materials and Methods: From 1990 to 1995, 246 patients with biopsy proven advanced gastric cancer were enrolled in the study. Among them 123 patients received early postoperative intraperitoneal mitomycin C and 5-fluorouracil. The survival rate was calculated using by the Kaplan-Meier method and was compared using the log-rank test according to 13 clinico-pathologic factors. Multivariate analysis was performed with the Coxproportional hazards model. Results: Gastric resection plusearly postoperative intraperitoneal chemotherapy showed an improved survival rate as compared to surgery alone ($54.1\%\;versus\;40.3\%;$ P=0.0325). Depth of tumor invasion, degree of regional lymph vode metastasis, distant metastasis, tumor size, tumor location, extent of gastric resection, and curability of surgery significantly influenced survival. When a multivariate analysis was performed, depth of tumor invasion, lymph node metastasis, early postoperative intraperitoneal chemotherapy, curability of surgery, and extent of gastric resection emerged as the statistically significant and independent prognostic factors. Conlusion: Early postoperative intraperitoneal chemotherapy is one of the independent prognostic indicators of resectable advanced gastric cancer.

• Archives of Craniofacial Surgery
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• v.21 no.1
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• pp.22-26
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• 2020

Background: This study investigated the outcomes of pharyngeal flap surgery in Asian patients with velopharyngeal dysfunction (VPD), with a focus on postoperative improvements in speech articulation and complications. Additionally, this study explored whether the cause of VPD and the timing of surgery affected outcomes in terms of speech improvement. Methods: A retrospective review was conducted of the medical records of 72 Asian VPD patients who underwent pharyngeal flap surgery performed by a single surgeon from 1996 to 2014. Operative complications were analyzed for all 72 patients, and preoperative and postoperative speech articulation tests were compared for the subset of 43 patients in whom such testing was possible. The relationships of age at surgery and the cause of VPD with the extent of improvement in speech articulation were also investigated. Results: Nine of the 72 patients (13%) experienced wound-related complications. Furthermore, 34 patients (47%) reported persistent snoring lasting for over 3 months, and 16 (22%) reported snoring for over 1 year. Three patients (4%) underwent reoperation. Speech articulation scores significantly improved postoperatively across all groups. Younger age at surgery was associated with greater improvements in speech outcomes, but no significant relationship was found between the cause of VPD and the extent of the postoperative improvement in speech outcomes. Conclusion: Speech outcomes improved after pharyngeal surgery in Asian patients with VPD. Early surgery was associated with favorable speech outcomes, but no association was found between the cause of VPD and postoperative speech outcomes.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.41
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• pp.21.1-21.3
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• 2019

Background: Treatment planning the correction of a transverse maxillary occlusal plane cant often involves a degree of qualitative "eyeballing", with the attendant possibility of error in the estimated judgement. A simple chair side technique permits quantification of the extent of asymmetry and thereby quantitative measurements for the correction of the occlusal plane cant. Methods: A measuring instrument may be constructed by soldering the edge of a stainless steel dental ruler at 90° to the flat surface of a similar ruler. With the patient either standing in natural head position, or alternatively seated upright in the dental chair, and a dental photographic retractor in situ, the flat under-surface of the horizontal part of this measuring instrument is placed on a unilateral segment of a bilateral structure, e.g. the higher maxillary canine orthodontic bracket hook. The vertical ruler is held next to the contralateral canine tooth, and the vertical distance measured directly from the canine bracket to the flat under-surface of the horizontal part of the measuring instrument. Results: This vertical distance quantifies the overall extent of movement required to level the maxillary occlusal plane. Conclusions: This measuring instrument and simple chair side technique helps to quantify the overall extent of surgical levelling required and may be a useful additional technique in our clinical diagnostic armamentarium.

• Journal of Chest Surgery
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• v.23 no.3
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• pp.577-583
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• 1990

Subglottic stenosis is a disorder characterized by narrowing of the airway below the glottis. In children, the stenosis is usually due to scar formation secondary to prolonged airway intubation, rather than to external trauma. The location and extent of the stenosis are highly variable, consequently, corrective measures need to be selected to suit the individual problem. Conservative treatment is adequate for lesser degrees of stenosis but those with more severe scarring require external laryngeal surgery. We managed 2 children with subglottic stenosis due to prolonged intubation after open heart surgery who needed a resectional surgery of the stenotic upper airway. The preoperative evaluation and surgical technique for subglottic stenosis were reviewed.

• Journal of Chest Surgery
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• v.26 no.11
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• pp.871-873
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• 1993

Bronchiectasis is an irreversible dilatation that may require surgery for successful treatment. We compared High Resolutional Computed Tomography[HRCT]with Bronchography to access the utility of HRCT in diagnosis and determining the extent of Bronchiectasis. We performed a comparative study of HRCT and Bronchography in 10 consecutive patients who were clinically suspected Bronchiectasis were investigated prospectively during last year.A segment-by-segment analysis of the presence, extent, type of bronchiectasis by Amashita classification was done. In 26 segments, Results of HRCT and Bronchogram were both positve, and 119 segments were both negative.But 15 segments were discorded, in 11 segments in positive bronchogram were negative in HRCT and 4 segments in positive HRCT were negative in bronchogram. The diagnostic concordance rate between 2 modalities was 90.6%[145/160]. So, we will be tried to elevate of concordance rate between 2 modalties and applied HRCT in diagnotic tool for bronchiectasis.

• Journal of Korean Neurosurgical Society
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• v.29 no.11
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• pp.1445-1450
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• 2000

Objectives : The Objective of this study was to analyze the prognostic factors affecting survival in the patients with glioblastomas. Methods : We retrospectively studied 55 consecutive patients with glioblastomas who were admitted to neurosurgery department from January 1988 to March 1998. Fifteen pateients were excluded from the analysis because of follow-up loss and surgical motality. There were 24 male and 16 female patients, with a mean age of 51 years. Surgery consisted of biopsy in 4(10.0%) patients, subtotal resection in 9(22.5%) patients and gross total resection in 27(67.5%) patients. Nine(22.5%) patients received second operation. Twenty-eight(70%) received postoperative radiation therapy. Various levels of radiation dose were used, 6,000 rad over 7 weeks in most cases. The variable factors were examined for their relationship with survival ; age at the time of diagnosis, gender, duration of neurological symptoms, preoperative neurological state(Karnofsky performance score), extent of surgical resection, location of tumor, reoperation, and postoperative radiotherapy and chemotherapy. Result : The mean survival time was 55 weeks, three(7.5%) of the 40 patients survived more than two years. Survival time with biopsy only cases was 24 weeks, for those with subtotal resection 43 weeks, and for those with gross total resection 67 weeks. A mean survival time from the time of reoperation was 42 weeks. Statistically significant survival factors in glioblastoma were extent of surgical resection, postoperative radiotherapy and reoperation. Summary : Results of our series support the views that the extent of surgery, reoperation and postoperative radiation are important prognostic factors. We also recommend radical tumor removal, postoperative radiotherapy and reoperation, if possible.

• Journal of Korean Neurosurgical Society
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• v.42 no.4
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• pp.300-304
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• 2007

Objective : We report experiences and clinical outcomes of 61 cases with spinal canal meningiomas from January 1970 through January 2005. Methods : Thirty-eight patients were enrolled with follow-up duration of more than one year after surgery. There were 7 male and 31 female patients. The mean age was 52 years (range, 19 to 80 years). All patients underwent microsurgical resection using a posterior approach. Results : Twenty-nine (79.4%) cases experienced clinical improvement after surgery. The extent of tumor resection at the first operation was Simpson Grade I in 10 patients, Grade II in 17, Grade III in 4, Grade IV in 6, and unknown in one. We did not experience recurrent cases with Simpson grade I, II, or III resection. There were 6 recurrent cases, consisting of 5 cases with an extent of Simpson grade IV and one with an unknown extent. The mean duration of recurrence was 100 months after surgery. Radiation therapy was administered as a surgical adjunct in four patients (10.5%). Two cases were recurrent lesions that could not be completely resected. The other two cases were malignant meningiomas. No immediate postoperative death occurred in the patient group. Conclusion : We experienced no recurrent cases of intraspinal meningiomas once gross total resection has been achieved, regardless of the control of the dural origin. Surgeons do not have to take the risk of causing complication to the control dural origin after achieving gross total resectioning of spinal canal meningioma.

• Korean Journal of Head & Neck Oncology
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• v.12 no.2
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• pp.193-200
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• 1996

We performed a retrospective study to evaluate the effect of posterior approach to facial nerve in parotid surgery, being the standard procedure in our hospital, on postoperative facial palsy and to access the safety of this procedure in preserving the function of facial nerve. A series of 176 parotid surgeries from 172 patients from January 1989 to December 1994 was analyzed, of which, 2 Schwannomas, 4 Kimura's diseases, 6 preoperative facial palsies, and 4 intentional nerve resections for malignancy were excluded. Factors such as pathology of tumor, extent of surgery, location of tumor, size of tumor, frequency of surgery were reviewed to determine if any factor contributed to the developement of facial palsy postoperatively. Of 160 parotidectomies, postoperative facial palsy was found in 58(36.3%), being temporary in 35(35. 6%), recovered within 12 months after surgery and permanent in 1(0.6%). Facial palsy occured in 47(35.7%) of 128 benign tumors, 42(89.5%) recovered completely within 6 months and in 11(34.4%) of 32 malignant tumors, 6(54.5%) within 6 months. Among the factors analyzed, postoperative facial palsy was found to be common in the tumors of deep lobe(p<0.02) and in total or neartotal parotidectomies(p<0.08). In our study, the factors of the location of tumor and extent of surgery would be contributable to developement of postoperative facial palsy and the surgical technique using posterior approach to the facial nerve may be a simple and safe surgical procedure for identification and preservation of facial nerve in parotid surgery.

• Journal of Korean Neurosurgical Society
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• v.50 no.3
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• pp.216-223
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• 2011

Objective : The purposes of this study are to estimate postoperative survival and ambulatory outcome and to identify prognostic factors thereafter of metastatic spinal tumors in a single institute. Methods : We reviewed the medical records of 182 patients who underwent surgery for a metastatic spinal tumor from January 1987 to January 2009 retrospectively. Twelve potential prognostic factors (age, gender, primary tumor, extent and location of spinal metastases, interval between primary tumor diagnosis and metastatic spinal cord compression, preoperative treatment, surgical approach and extent, preoperative Eastern Cooperative Oncology Group (ECOG) performance status, Nurick score, Tokuhashi and Tomita score) were investigated. Results : The median survival of the entire patients was 8 months. Of the 182 patients, 80 (44%) died within 6 months after surgery, 113 (62%) died within 1 year after surgery, 138 (76%) died within 2 years after surgery. Postoperatively 47 (26%) patients had improvement in ambulatory function, 126 (69%) had no change, and 9 (5%) had deterioration. On multivariate analysis, better ambulatory outcome was associated with being ambulatory before surgery (p=0.026) and lower preoperative ECOG score (p=0.016). Survival rate was affected by preoperative ECOG performance status (p<0.001) and Tomita score (p<0.001). Conclusion : Survival after metastatic spinal tumor surgery was dependent on preoperative ECOG performance status and Tomita score. The ambulatory functional outcomes after surgery were dependent on preoperative ambulatory status and preoperative ECOG performance status. Thus, prompt decompressive surgery may be warranted to improve patient's survival and gait, before general condition and ambulatory function of patient become worse.