• Journal of Chest Surgery
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• 제27권2호
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• pp.140-147
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• 1994

Reconstruction of the pharynx and cervical esophagus presents a tremendous challenges to surgeons. Over the past 2 years[1990, Dec.-1993, Jun], the free jejunal graft has been performed in 17 cases in Korea Cancer Center Hospital.The indications of this procedures were almost malignant neoplasms involving neck and upper aero-digestive tract; Hypopharyngeal cancer[12 cases, including 2 recurrent cases], laryngeal cancer[2 cases], thyroid cancer[2 cases, including 1 recurrent case], cervical esophageal cancer[1 case]. There were fifteen men and two women, and the mean age was 59.6 years. The anastomosis site of jejunal artery were common carotid artery[16 cases] or external carotid artery[1 case] and that of jejunal vein were internal jegular [15 cases] or facial[1 case] and superior thyroid vein[1 case]. The length of jejunal graft was from 9 cm to 17 cm[mean 13 cm] and the mean ischemic time was 68 minutes. There was one hospital mortality which was irrelevant to procedures[variceal bleeding] and one graft failure[1/16]. Other postoperative complications were neck bleeding or hematoma[3 cases], abdominal wound infection or disruption[5 cases], anastomosis site leakage[1 case], pneumonia[2 cases], graft vein thrombosis[1 case], and food aspiration[1 case]. The function of conduit was excellent and ingestion of food was possible in nearly all cases. Postoperative adjuvant radiation therapy was also applicable without problem in 7 cases. During follow-up periods, the anastomosis site stenosis developed in four patients, and the tracheal stoma was narrowed in one case but easily overcome with dilation. In conclusion, we think that the free jejunal graft is one of the excellent reconstruction methods of upper digestive tract, especially after radical resection of malignant neoplasm in neck with a high success rate and low mortality and morbidity rate.

• Journal of Gastric Cancer
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• 제15권2호
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• pp.143-146
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• 2015

Sarcomatoid carcinoma of the small intestine is rare, and only 30 cases have been reported to date. This disease generally exhibits a very poor prognosis. Here we report the case of a 67-year-old man with a sarcomatoid carcinoma in the jejunum, who was hospitalized for diarrhea, fever, nausea, and vomiting. The tumor was located at the jejunum and had a large round shape with geographic necrosis. It involved the entire wall of the small intestine and had directly invaded the neighboring sigmoid colon. Both lobes of the liver had multiple metastases. The patient underwent surgical resection of the jejunum. On immunohistochemical analysis, the tumor was positive for epithelial and mesenchymal markers. The patient died from rapid progression of the liver metastases 6 weeks after the surgery.

• Journal of Chest Surgery
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• 제53권4호
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• pp.211-216
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• 2020

Esophageal fistulas may occur in an advanced stage or as a potentially life-threatening complication of treatment. They can be divided into esophageal-respiratory and esophageal-aorta fistulas. The diagnosis is confirmed with fluoroscopy using dilute barium oral contrast, followed by thin-section computed tomography, which defines the precise location and extent of the fistula. Flexible esophagoscopy and bronchoscopy are required for confirmation and anatomic assessment of the suspected fistula and provide additional information for treatment planning. Contamination is traditionally controlled by surgical exclusion, along with a jejunal feeding tube. Currently, fully covered self-expanding metal stents are the primary treatment option.

• 대한두개안면성형외과학회지
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• 제20권2호
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• pp.134-138
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• 2019

Colon interposition is commonly used for esophageal reconstruction in patients with a previous gastrectomy. However, when colon interposition fails and alternative reconstruction is required, there are few options for reconstructing the long segment from the esophagus to the stomach. Here, we report on cases of esophagogastric reconstruction with limited alternative options after the failure of transverse and left colon interposition. In these cases, reconstruction was performed using two different microvascular methods: double-pedicle jejunal free flap and supercharged ileocolic interposition graft.

• Journal of Chest Surgery
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• 제38권11호
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• pp.791-794
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• 2005

식도절제술 후 재건술에서 위장은 가장 흔한 식도 대체물로 사용된다 그러나, 인두 이상의 위치까지 위장을 끌어 올려 연결하는 경우 위장만으로는 길이가 모자라는 경우가 많이 있다. 후두암과 식도암을 동반한 환자에서 후두전절제술과 식도전절제술을 시행하였고 유리공장이식편을 이용하여 경부에서 인두공장위장문합을 시행하였다. 유리공장을 이용하여 문합에 충분한 길이를 확보함으로써 문합부 긴장을 줄이고, 혈액공급을 확보할 수 있었다.

• Journal of Gastric Cancer
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• 제18권1호
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• pp.37-47
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• 2018

Purpose: The endoscopic management of a fully covered self-expandable metal stent (SEMS) has been suggested for the primary treatment of patients with anastomotic leaks after total gastrectomy. Embedded stents due to tissue ingrowth and migration are the main obstacles in endoscopic stent management. Materials and Methods: The effectiveness and safety of endoscopic management were evaluated for anastomotic leaks when using a benign fully covered SEMS with an anchoring thread and thick silicone covering the membrane to prevent stent embedding and migration. We retrospectively reviewed the data of 14 consecutive patients with gastric cancer and anastomotic leaks after total gastrectomy treated from January 2009 to December 2016. Results: The technical success rate of endoscopic stent replacement was 100%, and the rate of complete leaks closure was 85.7% (n=12). The mean size of leaks was 13.1 mm (range, 3-30 mm). The time interval from operation to stent replacement was 10.7 days (range, 3-35 days) and the interval from stent replacement to extraction was 32.3 days (range, 18-49 days). The complication rate was 14.1%, and included a single jejunal ulcer and delayed stricture at the site of leakage. No embedded stent or migration occurred. Two patients died due to progression of pneumonia and septic shock 2 weeks after stent replacement. Conclusions: A benign fully covered SEMS with an anchoring thread and thick membrane is an effective and safe stent in patients with anastomotic leaks after total gastrectomy. The novelty of this stent is that it provides complete prevention of stent migration and embedding, compared with conventional fully covered SEMS.

• Journal of Chest Surgery
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• 제41권2호
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• pp.253-259
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• 2008

배경: 경부식도암은 흉부식도암에 비해 발생 빈도가 상대적으로 낮고 방사선치료나 항암 약물치료의 역할이 흉부식도암에서보다 상대적으로 높다. 따라서 경부식도암에 대한 수술적 치료의 역할이 흉부식도암에 비해 상대적으로 제한적이다. 저자들은 경부식도암에 대한 수술적 치료의 결과를 알아보기 위해 본 연구를 시행하였다. 대상 및 방법: 1989년 1월부터 2002년 12월까지 경부식도암(경흉부식도 암 포함 )으로 수술을 시행 받은 환자 43명의 결과를 후향적으로 분석하였다. 모든 환자에서 추적이 가능하였으며, 최종 추적일은 2004년 2월 28일이었다. 결과: 대상 환자의 평균 나이는 60세$(43{\sim}77)$였고, 남녀 비는 40:3이었다. 조직학적으로 편평상피세포암이 42명, 악성 흑색종이 1명이었다. 식도 재건 방법은 gastric pull-up 32명, 유리 공장 이식 7명, colon interposition 4명이었다. 전체 43명 중 31명(72%)의 환자에서 합병증이 발생하였고, 수술 사망자는 7명(16%)이었다. 수술 후 최종 병기는 I 3명, IIa 14 명, IIb 1명, III 19명, IVa 6명이었다. 수술 사망자를 제외한 36 명 중 16명(44%)에서 종양이 재발하였고, 수술 후 3년, 5년 생존율은 29.3% 와 20.9%이었다. 결론: 경부식도암에 대한 수술은 수술 사망률, 합병증 발생률, 재발률이 높고, 장기 생존율이 낮지만, 방사선치료나 항암약물치료 만으로는 연하곤란의 완전한 해소 및 종양의 완치가 어려우므로 수술이 포함되는 다방법 병합치료가 필요하다고 생각한다.