• Journal of Chest Surgery
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• v.30 no.9
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• pp.908-913
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• 1997

From May 1988 to December 1995, 77 patients underwent surgical re ection for primary non-small cell lung cancer at GNUH, and were evaluated clinically. There were 65 males and 12 females(M:P=5.4:1), and the peak incidence of age was 6th decade of life(44.5%). The major symptoms were cough, hemoptysis and chest pain due to anatomical effects of the mass. Histopathologically, squamous cell carcinoma was 81.8%, adenocarcinoma 14.3%, and adenosquamous carcinoma 3.9% . There was no significant difference in survival among three groups. The pneumonectomy was performed in 26 cases(33.8%), lobectomy 30 cases(38.9%), bilobectomy 9 cases(11.7%), and overall resectability was 84.4%. The postoperative official stagings were as follows ; 26 patients of stage I(34%), 14 patients of stage II(18%), 22 patients of stage IIIa(29%), 14 patients of stage IIIb(18%), and one patients of stage IV(1%). In all cases, 3 year survival rate are showed stage 183%, stage II 26%, stage IIIa 17%, and stage IIIb 0%.

• Journal of Chest Surgery
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• v.20 no.3
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• pp.473-482
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• 1987

The records of 65 patients with a confirmed diagnosis of primary lung cancer who underwent surgical therapy at the Department of Thoracic and Cardiovascular Surgery of the Keimyung University Hospital were analyzed during the period of 8 years and 4 months, from August, 1978 to December, 1986. The peak incidence was observed in the 5th decade of life and the mean age was 52.9 years old. Male versus female ratio was 8.3:1 Cough was the most frequent presenting symptom, 76.9% then chest discomfort, hemoptysis and dyspnea followed in order. 44.6% of the patient had 2 months of prediagnostic symptomatic period, 72.3% had 5 months, and the mean was 5.7 months. As for preoperative diagnosis, 62 of total 65 patients revealed the mass lesion on simple chest x-ray, and 56 of 65 patients on bronchoscopic biopsy, 10 of 37 patients on sputum cytology and 15 of 15 patients on computerized tomography of the chest were positive. Of the 65 patients, 35 [53.9%] had squamous cell carcinoma, 18 [27.7%] adenocarcinoma, 3 [4.6%] large cell carcinoma, and 3 [4.6%] small cell carcinoma all which was oat cell carcinoma. 83.1% of the total patient was resectable, and 34 underwent pneumonectomy and 20 lobectomy. Of these 65 operations, 29 was radical resection, 25 palliative, and 11 exploratory thoracotomy. As for clinical stagings, 23 patients were in Stage, I, another 23 in Stage II and 19 in Stage III, while 16 was in stage, I, 14 in stage ll and 35 in stage III in postoperative staging evaluation. In correlation of postoperative TNM classification and radical resection, those patients who had lung cancer of stage I [14/16] and stage II [9/13] had more radical resection. As postoperative complications, one patient had massive bleeding, two empyema, one empyema with bronchopulmonary fistula, and one cardiac herniation. Operative mortality rate was 1.5% [1 patient]. Mean duration between 1st operation and discovering recurrence in 18 patients was 12.7 months.

• Journal of Chest Surgery
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• v.26 no.5
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• pp.373-379
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• 1993

Primary lung cancer has increased markedly in its incidence and prevalence rate recently in Korea. In frequency, it occupies the second rank cancer preceded by stomach cancer in korean male. From February 1986 to December 1992, we have operated on 55 cases of primary lung cancer in Korea Veterans Hospital and followed them. The results are as follows; 1. The peak incidence of age of primary lung cancer was 6th decade and 5th decade and those were 87.3% of study group, mainly in male. 2. Symptoms were cough [63.6%], dyspnea [41.8%], chest pain and discomfort [38.2%], blood tinged sputum and hemoptysis [21.8%]. Symptoms were frequently encountered before hospitalization and asymptomatic cases were 9.1% of study group. 3. Methods of diagnostic confirmation were bronchoscopic biopsy [52.7%], percutaneous needle aspiration[PCNA][21.8%], sputum cytolgy [12.7%], open biopsy [12.7%]. 4. Histopathologically, squamous cell carcinoma [76.4%] was the most frequent cancer and adenocarcinoma [10.9%], giant cell cancer [7.3%], and the others in order. 5. Methods of operation were pneumonectomy [32.7%], bilobectomy [18.2%], lobectomy [27.3%], lobectomy and segmenectomy [1.8%], exploration [20%], and overall resectability was 80%. 6. Operative mortality was 5.5% [3 cases] and there were 5 cases of complication. 7. Postoperative long-term follow up reveals that the cumulative survival rates in 6 months, 12 months, 26 months, 34 months, 43 months, 64 months were 89.5%, 71.7%, 66.7%, 57.2%, 50.8%, 42.3% respecively.

• Journal of Chest Surgery
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• v.28 no.5
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• pp.499-503
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• 1995

Since the insertion of self expandable metalic stent[SEMS has became popular method for hollow organ stenosis, many attempts for further apply the stent to airway stenosis as an simple procedure has been made, but intrabronchial migration of stent or occurrence of inflammatory granuloma around stent develop occasionally and sometimes it worsen bronchial stenosis further more. This report describes 2 case of surgically treated bronchial restenosis in whom intrabronchial stent were applied for release of bronchial stenosis. Our surgical option was pneumonectomy and bronchoplasty with sleeve right middle and upper lobectomy respectively. During the operation we found the SEMSs were tightly impacted in restenotic bronchial lumen with overgrowth of granulation tissues. The bronchial obstructions occupied more than 90% of lumens in both cases, and needed much complicated procedure to be relieved. Therefore, even though the insertion of SEMS remains as a prcedure determined by the physician`s preference, it has to be considered prudently that the use of SEMS can cause severe restenosis and the surgeon has more difficulties in performing segmental resection of restenotic bronchus in patient with SEMS previously inserted. Throughout these experiences we can conclude that the insertion of SEMS must be performed only in very selected cases of bronchial stenosis.

• Journal of Chest Surgery
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• v.29 no.1
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• pp.107-111
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• 1996

Persistent bronchopleural fistula (BPF) still presents a troublesome therapeutic challenge and demands an aggressive approach when conventional measures fail. A 50-year-old man had a rigtlt pneumonectomy for far-advanced pulmonary tuberculosis with the development of postopneumonectomy empyema and BPF 1 month postoperatively in October 1 81. The condition was managed with BPF closure and the Clagett procedure, which failed with the recurrence of BPF and empyema, followed by a spontaneous open window at about 1 year port:operatively. The BPF, which had been aggravated to a large size, was managed by the closure and obliteration of the empyema cavity using a Pectoralis-skin pedicled flap 13 years postoper atively on Jul, 1994. The BPF was controlled by the procedure, and the patient, with improved respiratory symptom, was discharged 43 days postoperatively. We conclude that the use of myocutaneous flap Is an effective procedure for the closure of a large BPF. The surgical technique of the pedicled flap operation is described and the case is reported.

• Journal of Chest Surgery
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• v.2 no.1
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• pp.3-12
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• 1969

Prior to availability of antibiotics, lung abscess has been recognized as one of the most serious pulmonary disease, and despite of diminished morbidity and mortality rate with the advent of antibiotics and development of better technique in the fields of surgery on pulmonary disease it continues to be a virulent form of pulmonary supuration. It is the purpose of this paper to present a clinical review of 115 lung abscess treated by surgically at "The National Medical Center" during past 9 years. 1. The most common age of occurrence is between the age of 30 and 50, and 105 cases were male and 31 cases occurred in female. 2. Numerous etiological factors may play a role in the formation of a pulmonary abscess; aspiration in 36 patients of which 2 patients had diabetes, 54 patients had preceding URI or pneumonia, and 5 patients followed liver abscess, one of which in hematogenous route. In 20 patients, no predisposing factor could be determined- 3. Clubbing digits were presented in 26 of 1315 patients suggesting chronicity of the disease, and gastric ulcer were combined in 3 of 136 patints. 4. Apparently the onset was insidious, and the progress was masked by indiscriminate administration of antibiotics for URI and TB remedies under impression of pul. tbc. Previous TB treatments were done in 56.%[76 cases] for one week to two years and administration of antibiotics in 51 cases. 5. 89 cases were on tbe right and 2t5 cascs were on the left side. 51 cases of pneumonectomy and 8 of open drainage, of which 4 of Monaldi procedure, were made and operative mortality rate was 5.2%. Numerous complications such as 8 of empyema, 4 of each bleeding and atelectasis, 2 of BPF, 1 of esophageal fistula and one of pneumothorax which were responded well to prolonged treatment with good results, were obtained. 6. The incidence of Klebsiella and Pseudomonas were increased recently. In these results, we submit the surgery should be performed if the conservative therapy had failed. The resection was most favorable operation for pulmonary abscess though drainage procedure may be of value in certain patients with grave systemic menifestations. In chronic long standing abscess, more complications and high mortality rate were assumable although the prognosis has been improved with the advent of antibiotics, the development of improved surgical technique and complete preoperative care.

• Journal of Chest Surgery
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• v.51 no.1
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• pp.35-40
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• 2018

Background: The treatment of malignant pleural mesothelioma (MPM) is challenging, and multimodal treatment including surgery is recommended; however, the role of surgery is debated. The treatment outcomes of MPM in Korea have not been reported. We analyzed the outcomes of MPM in the context of multimodal treatment, including surgery. Methods: The records of 29 patients with pathologically proven MPM from April 1998 to July 2015 were retrospectively reviewed. The treatment outcomes of the surgery and non-surgery groups were compared. Results: The overall median survival time was 10.6 months, and the overall 3-year survival rate was 25%. No postoperative 30-day or in-hospital mortality occurred in the surgery group. Postoperative complications included tachyarrhythmia (n=4), pulmonary thromboembolism (n=1), pneumonia (n=1), chylothorax (n=1), and wound complications (n=3). The treatment outcomes between the surgery and non-surgery groups were not significantly different (3-year survival rate: 31.3% vs. 16.7%, respectively; p=0.47). In a subgroup analysis, there was no significant difference in the treatment outcomes between the extrapleural pneumonectomy group and the non-surgery group (3-year survival rate: 45.5% vs. 16.7%, respectively; p=0.23). Conclusion: Multimodal treatment incorporating surgery did not show better outcomes than non-surgical treatment. A nationwide multicenter data registry and prospective randomized controlled studies are necessary to optimize the treatment of MPM.

• Journal of Chest Surgery
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• v.28 no.6
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• pp.591-595
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• 1995

Recently, primary lung cancer has increased markedly in incidence and prevalence in Korea. From January 1986 to June 1993, 86 patients were operated and evaluated at the Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital. The results are as follows; 1. There were 79 males and 7 females with the peak incidence of 5th and 6th decades of life[75.6% . The age ranged from 13 to 76[mean 56.6$\pm$10.3 years. 2. Symptoms were cough[47.7% , sputum[25.6% , chest pain or dyspnea[18.6% , and hemoptysis or blood tinged sputum[20.9% in order. Symptoms were frequently encountered before hospitalization, but asymtomatic patients were 12.8% in this study. 3. Methods of diagnostic confirmatiom were bronchoscopic biopsy[55.8% , percutaneous needle aspiration[29.1% , suspicious sputum cytology[1.2% , and open biopsy[14.0% . 4. Histopathologically, squamous cell carcinoma[51.2% was the most frequent cell type and adenocarcinoma[26.7% , large cell carcinoma[8.1% , adenosquamous cell carcinoma[3.5% , and the others in order. And TNM stages were Stage I 40.5%, Stage II 15.5%, Stage IIIa 27.4%, and Stage IIIb 3.6%. 5. Methods of operation were pneumonectomy[25.6% , bilobectomy[5.8% , lobectomy[53.4% , segmentectomy[1.2% , and exploration[14.0% . The overall resectability was 86.0% 6. The operative mortality was 2.3% and postoperative complications developed in 7 cases[8.1% . 7. The postoperative follow-up reveals that the overall cumulative survival rates at 1 year, 2 year, 3 year, 4 year, 5 year were 76%, 62%, 43%, 36%, and 27%, respectively.

• Journal of Chest Surgery
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• v.32 no.2
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• pp.158-163
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• 1999

Background: The author studied to define the current indications for surgical management of chest tuberculosis and to analyze the results of the operative procedures. Material and Method: The records of 87 patients among 107 patients operated on between January 1992 and May 1995 were reviewed. These patients were divided into 4 groups. Group I patients (n=45) underwent decortication with or without wedge resection of the lesion. Group II patients(n=23) underwent radical curettages of chest wall involving rib caries with or without thoracotomy. Group III patients(n=12) underwent standard pneumonectomy or pleuropneumonectomy. Group IV patients(n=7) underwent exploratory thoracotomy or wedge resection of tuberculous lung lesion. Result: Statistical analysis revealed an inverse correlation between AIs and intratumoral microvessel densities in squamous cell lung carcinoma(Spearman rank correlation coefficient r=- 0.229, p=0.047). Conclusion: The author concludes that surgery for chest tuberculosis is the definite management for therapeutic indications and surgical radication of tuberculous carriers for management of chest tuberculosis is safe and has satisfactory results.

• Journal of Chest Surgery
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• v.33 no.1
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• pp.68-72
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• 2000

Background: The resection of recurrent non-small cell lung cancer can be performed very rarely. There has been many arguments for longterm result and therapeutic role in surgical management of recurrent non-small cell lung cancer(NSCLC). We analyze our result of surgical re-resection of recurrent NSCLC for 10 years retrospectively. Material and Method: In the period from 1987 to 1997, 702 patients who had been confirmed for NSCLC had undergone complete resection in Seoul National University Hospital. As December 1997, 22 of these patients have been operated on the diagnosis of recurrent lung cancer. In these patients one has revealed for benign nodule at postoperative pathologic pathologic was unresectable. and two had revealed other cell type on postoperative pathologic examination. Analysis about postoperative survival rate and the factors that influence postoperative survival rate - sex, age, pathologic stage, cell type, operation adjuvant therapy after first and second operation location of recurrence disease free survival-was 59.1$\pm$10.9 year. There were 14 men and 3 women. Four patients was received radiation therpy after first opration and two patients was received postoperative chemotherapy. At first operation 2 patients was stage Ia, 8 was stage Ib, 1 was stage IIa 6 was stage IIb. Eleven patients had squamous. cell carcinoma at postoperatrive pathologic examination five had adenocarcinoma and one had bronchioalveolar carcinoma. In second operation 8 patients were received limited resection. 9 were received lobectomy or pneumonectomy. One-year survival rate was 82.4% and five-year survival rate was 58.2% Non-adjuvant therapy group after initial operation was more survived than adjuvant therapy group statistically. Conclusion: operation was more survived than adjuvant therapy group statistically. Conclusion : Operation was feasible treatment modality for re-resectable non-small cell lung cancer. But we cannot rule out possibility of double primary lung cancer for them. Postoperative prognostic factor was adjuvant therapy or nor after first oepration but further study of large scale is needed for stastically more valuable result.