• Clinical Endoscopy
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• 제55권1호
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• pp.58-66
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• 2022

Background/Aims: Anastomotic leakage after esophageal surgery remains a feared complication. During the last decade, management of this complication changed from surgical revision to a more conservative and endoscopic approach. However, the treatment remains controversial as the indications for conservative, endoscopic, and surgical approaches remain non-standardized. Methods: Between 2010 and 2020, all patients who underwent Ivor Lewis esophagectomy for underlying malignancy were included in this study. The data of 28 patients diagnosed with anastomotic leak were further analyzed. Results: Among 141 patients who underwent resection, 28 (19.9%) developed an anastomotic leak, eight (28.6%) of whom died. Thirteen patients were treated with endoluminal vacuum therapy (EVT), seven patients with self-expanding metal stents (SEMS) four patients with primary surgery, one patient with a hemoclip, and three patients were treated conservatively. EVT achieved closure in 92.3% of the patients with a large defect and no EVT-related complications. SEMS therapy was successful in clinically stable patients with small defect sizes. Conclusions: EVT can be successfully applied in the treatment of anastomotic leakage in critically ill patients, while SEMS should be limited to clinically stable patients with a small defect size. Surgery is only warranted in patients with sepsis with graft necrosis.

• Asian Pacific Journal of Cancer Prevention
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• 제16권1호
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• pp.367-372
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• 2015

Background: Human adiponectin (ApN), a 30 kDa glycoprotein of 244-amino acids which is predominantly produced by adipocytes, exerts its effects via two receptors, namely adiponectin receptor-1 (adipo-R1) and adiponectin receptor-2 (adipo-R2) with differential binding affinity to globular adiponectin. Adiponectin receptor expression has been studied in several cancer tissues. However, there are no studies of colorectal adenomas which are considered to be precursors for colorectal carcinoma (CRC). Objectives: In the present study, the expression of adipo-R1 and adipo-R2 was investigated immunohistochemically in colorectal adenomas and colorectal carcinoma tissues in an attempt to determine associations with these tumors. Materials and Methods: The study enrolled 50 CRC patients with tumor resection and 82 patients who were diagnosed with adenomatous polyps, classified as negative for neoplasia, low-grade dysplasia (L-GD) or high- grade dysplasia (H-GD). Results: Expression of both adipo-R1 and adipo-R2 was found to be significantly lower in the CRCs than in colorectal adenomas (tubular and tubulovillous, p=0.009 and p<0.001, respectively). Adipo-R1 and adipo-R2 expression was also significantly lower in the CRC group when compared with the groups of patients with low grade dysplasia, high-grade dysplasia or no neoplasia (p=0.012 and p<0.001, respectively). In addition, it was observed that adipo-R2 expression was generally positive in the non-neoplastic group irrespective of the adipo-R2 expression. In the L-GD, H-GD and CRC groups, the adipo-R2 result was positive whenever adipo-R1 result was positive but some patients with negative adipo-R1 had positive adipo-R2 (p<0.001, p=0.004, p<0.001, respectively). Conclusions: This study indicated that ApN may play a role in the progression of colorectal adenomatous polyps to carcinoma through actions on adipo-R1 and adipo-R2 receptors.

• Journal of Chest Surgery
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• 제25권4호
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• pp.391-397
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• 1992

Postoperative hypoxemia in the absence of hypoventilation occurs more often after thoracic or upper abdominal surgery than lower abdominal operations or surgery on extremities. Although the factors which produce postoperative alveolar collapse have not been fully evaluated, the dominant factor of postoperative hypoxia is shunt of blood passing collapsed alveoli and the postoperative pain is associated with restriction of depth of breathing, sighing and movement. In 1979, the first successful clinical usage of epidurally administered morphine was done by Behar and associates for control of postoperative pain. This study was carried out for twenty patients who received posterolateral thoracostomy with Bled resection between May 1990 and May 1991 and who were primary spontaneous recurrent pneumothoraxes. We selected ten of twenty patients, one after the other and treated with epidural analgesia as study group and the remainder ten were grouped as control. Epidural catheters were inserted for study group before operation through T12-L1, 2 interspinous process at the pain clinic or operation room by anesthesiogist and then the drugs[0.25% Bupivacaine 15ml mixing with morphine 3mg] were instillated through the catheter before extubarion and once a day until 4th day, and the patients of control group were treated intermittently by Demerol 50mg intramuscularly for postoperative pain control. The epidural catheters were removed at postoperative 4th day. Observations were done about vital aigns, a-BGA, tidal volume, FVC and occurence of adverse effects during postoperative 2hr, 8hr, 1st day, 2nd day, 7th day in both groups. The results were as follows; [1] Tidal volume[85.1$\pm$29.8%R VS 60.8$\pm$20.5%R, p<0.05] and FVC[53.7$\pm$14.2%R, VS 35.5$\pm$9.l%R, p<0.01] were significantly improved in study group compared with control group during the first day of operation. [2] But the improvement of FVC was delayed after stopping of epidural analgesia[postoperative 7th day, 97.5$\pm$12.3%R VS 83.9$\pm$15.6%R, P <0.05]. [3] Others were statistically not significant. [4] The side effects of epidural analgesia were identified such as urinary retention[2 cases], itching sensation[1 case] and headache[1 case], but there was no need for active treatments.

• Radiation Oncology Journal
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• 제34권4호
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• pp.297-304
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• 2016

Purpose: To investigate the outcomes of postoperative radiotherapy (RT), in patients with extrahepatic bile duct (EHBD) cancer by comparing the survival rate between patients undergoing surgery alone or surgery plus postoperative RT, and to identify the prognostic factors affecting survival. Materials and Methods: Between 2000 and 2013, 52 patients with EHBD cancer underwent surgical resection. Of these, 33 patients did not receive postoperative RT (group I), and 19 patients did (group II). R1 resection was significantly more frequent in group II. The median radiation dose was 5,040 cGy. Results: The 3-year overall survival (OS) rate for group I and group II was 38% and 56%, respectively (p = 0.274). The 3-year disease free survival (DFS) rate for group I and group II was 20% and 31%, respectively (p = 0.049), and the 3-year loco-regional recurrence free survival (LRFS) rates were 19% and 58%, respectively (p = 0.002). Multivariate analyses showed that postoperative RT and lymphovascular invasion were independent prognostic factors for DFS and LRFS. Overall, 42 patients (80%) experienced treatment failure. Distant metastasis was the predominant pattern of failure in group II. Conclusion: Postoperative RT after surgical resection appeared to improve the loco-regional control and DFS rate. More effort is needed to reduce distant metastasis, the major pattern of failure, in patients who receive postoperative RT.

• Asian Pacific Journal of Cancer Prevention
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• 제15권13호
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• pp.5195-5200
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• 2014

Background: The purpose of this study was to analyze our series of liver resections for metastatic colorectal carcinoma (mCRC) to determine prognostic factors affecting survival and to evaluate the potential roles of neoadjuvant or adjuvant chemotherapy. Materials and Methods: Ninety-nine patients who underwent metastasectomy for liver metastases due to colorectal cancer at the Department of Medical Oncology, 9 Eylul University Hospital between 1996 and 2010 were evaluated in this study. The patients were followed through July 2013. Demographic, perioperative, laboratory, radiological and chemotherapy as well as survival data were obtained by retrospective chart review. Results: In 47 (47.5%) patients, liver metastases were unresectable at initial evaluation; the remaining 52 (52.5%) patients exhibited resectable liver metastases. Simultaneous hepatic resection was applied to 52 (35.4%) patients with synchronous metastasis, whereas 5 (64.5%) patients underwent hepatic resection after neoadjuvant chemotherapy. Forty-two patients with metachronous metastasis underwent hepatic resection following neoadjuvant chemotherapy. R0 resection was obtained in 79 (79.8%) patients. A second hepatectomy was performed in 22 (23.2%) patients. Adjuvant chemotherapy was given to 85 (85.9%) patients after metastasectomy. The median disease-free and overall survivals after initial metastasectomy were 12 and 37 months, respectively, the 1-year, 3-year and 5-year disease-free survival (DFS) and overall survival (OS) rates being 46.5%, 24.3% and 17.9%and 92.3%, 59.0% and 39.0%, respectively. On multivariate analysis, the primary tumor site, tumor differentiation, resection margin and DFS were independent factors predicting better overall survival. Conclusions: In selected cases, hepatic metastasectomy for mCRC to the liver can result in long-term survival. Neoadjuvant chemotherapy did not exert a positive effect on DFS or OS. Adjuvant chemotherapy also did not appear to impact DFS and OS.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제37권1호
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• pp.9-14
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• 2011

Recently, the population of patients who refuse transfusion has increased for both religious and non-religious reasons, even in life threatening emergency situations. Their refusal has highlighted the need to develop nonblood transfusion surgery techniques to decrease the risk from blood transfusions. A 57-year woman with an ulcerative lesion on the gingiva of the right upper molar area visited the department of oral and maxillofacial surgery in Dankook University Dental Hospital. After a preliminary evaluation, the patient was diagnosed with squamous cell carcinoma. As she refused blood transfusion during surgery for religious reasons, surgery was planned using recombinant human erythropoietin (rHuEPO) without a blood transfusion. The patient underwent a partial maxillectomy, supraomohyoid neck dissection, free radial forearm flap and split thickness skin graft under general anesthesia. rHuEPO and iron were used before and after surgery. The hemoglobin/hematocrit (Hb/Hct) level, iron (Fe) and total iron-binding capacity (TIBC) were assessed. The patient recovered completely without any blood transfusions. rHuEPO is a viable alternative for patients with religious objections to receiving blood transfusions.

• Journal of Gastric Cancer
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• 제17권4호
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• pp.319-330
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• 2017

Introduction: The extent of lymphadenectomy in the surgical treatment of gastric cancer is a topic of controversy among surgeons. This study was conducted to analyze the American National Cancer Database (NCDB) and conclude the optimal extent of lymphadenectomy for gastric adenocarcinoma. Methods: The NCDB for gastric cancer was utilized. Patients who received at least a partial gastrectomy were included. Patients with metastatic disease, unknown TNM stages, R1/R2 resection, or treated with a palliative intent were excluded. Joinpoint regression was used to identify the extent of lymphadenectomy that reflects the optimal survival. Cox regression analysis and Bayesian information criterion were used to identify significant survival predictors. Kaplan-Meier was applied to study overall survival and stage migration. Results: 40,281 patients of 168,377 met the inclusion criteria. Joinpoint analysis showed that dissection of 29 nodes provides the optimal median survival for the overall population. Regression analysis reported the cutoff ${\geq}29$ to have a better fit in the prognostic model than that of ${\geq}15$. Dissection of ${\geq}29$ nodes in the higher stages provides a comparable overall survival to the immediately lower stage. Nonetheless, the retrieval of ${\geq}15$ nodes proved to be adequate for staging without a significant stage migration compared to ${\geq}29$ nodes. Conclusion: The extent of lymphadenectomy in gastric adenocarcinoma is a marker of improved resection which reflects in a longer overall survival. Our analysis concludes that the dissection of ${\geq}15$ nodes is adequate for staging. However, the dissection of 29 nodes might be needed to provide a significantly improved survival.

• Journal of Korean Neurosurgical Society
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• 제60권5호
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• pp.550-559
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• 2017

Objective : Subsidence is a frequent complication of anterior cervical discectomy and fusion. Postoperative segmental micromotion, thought to be a causative factor of subsidence, has been speculated to increase with uncinate process resection area (UPR). To evaluate the effect of UPR on micro-motion, we designed a method to measure UPR area based on pre- and postoperative computed tomography images and analyzed the relationship between UPR and subsidence as a proxy of micro-motion. Methods : We retrospectively collected clinical and radiological data from January 2011 to June 2016. A total of 38 patients (53 segments) were included. All procedures included bilateral UPR and anterior plate fixation. UPR area was evaluated with reformatted coronal computer tomography images. To reduce level-related bias, we converted UPR area to the proportion of UPR to the pre-operative UP area (pUPR). Results : Subsidence occurred in 18 segments (34%) and positively correlated with right-side pUPR, left-side pUPR, and the sum of bilateral pUPR (sum pUPR) (R=0.310, 301, 364; p=0.024, 0.029, 0.007, respectively). Multiple linear regression analysis revealed that subsidence could be estimated with the following formula : $subsidence=1.522+2.7{\times}sum\;pUPR$($R^2=0.133$, p=0.007). Receiver-operating characteristic analysis determined that sum $pUPR{\geq}0.38$ could serve as a threshold for significantly increased risk of subsidence (p=0.005, area under curve=0.737, sensitivity=94%, specificity=51%). This threshold was confirmed by logistic regression analysis for subsidence (p=0.009, odds ratio=8.471). Conclusion : The UPR measurement method confirmed that UPR was correlated with subsidence. Particularly when the sum of pUPR is ${\geq}38%$, the possibility of subsidence increased.

• Asian Pacific Journal of Cancer Prevention
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• 제13권12호
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• pp.6139-6144
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• 2012

Aims: Mammalian target of rapamycin (mTOR) is master regulator of the PI3K/Akt/mTOR pathway and plays an important role in NSCLCs. Here we characterized mRNA and protein expression levels of mTOR and its functional associated molecules including PTEN, IGF-1R and 4EBP1 in surgically resected NSCLCs. Methods: Fifty-four patients with NSCLCs who underwent pulmonary resection were included in current study. mRNA levels of mTOR, PTEN, IGF-1R, and 4EBP1 were evaluated by RT-PCR and protein expression of mTOR, PTEN, and IGF-1R by immunohistochemistry (IHC). Association of expression of the relevant molecules with clinical characteristics, as well as correlations between mTOR and PTEN, 4EBP1 and IGF-1R were also assessed. Results: The results of RT-PCR showed that in NSCLCs, the expression level of mTOR increased, while PTEN, 4EBP1 and IGF-1R decreased. Statistical analysis indicated high IGF-1R expression was correlated with advanced clinical stage (stage III) and PTEN expression was reversely associated with tumor size (P=0.16). The results of IHC showed mTOR positive staining in 51.8% of cases, while IGF-1R positive staining was found in 83.3% and loss of PTEN in 46.3%. Protein expression of mTOR was correlated with its regulators, PTEN and IGF-1R, to some extent. Conclusions: Abnormal activation of mTOR signaling, high expression of IGF-1R, and loss of PTEN were observed in resected NSCLC specimens. The poor expression agreement of mTOR with its regulators, PTEN, and IGF-1R, implied that combination strategy of mTOR inhibitors with other targets hold significant potential for NSCLC treatment.

• 대한골관절종양학회지
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• 제14권2호
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• pp.95-105
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• 2008

목적: 악성 근골격계 종양의 치료로 재활용 자가골 이식술을 이용하는 사지구제술에서 종양의 절제 및 재건 방법과 자가골의 재활용 처치 방법에 따라 그 유용성과 임상적 적용에 대하여 후향적 조사를 통하여 알아보고자 한다. 대상 및 방법: 본원에서는 1995년 12월에서 2006년 2월까지 재활용 자가골 이식술을 시행한 58례의 악성 근골격계 종양 환자들을 대상으로 하였다. 나이는 평균 36.5세(5~74세)였고, 성별은 남자가 34례, 여자가 24례였다. 58례 중 47례는 체외 방사선 조사(extracorporeal irradiation)를 시행하였고 11례는 저온 열처리(pasteurization)를 하였다. 재활용 자가골의 절제 및 재건 방법은 조각삽입(fragmentary) 3례, 분절삽입(intercalary) 8례, 골연골 삽입(osteoarticular) 18례, 자가골-종양대치물 복합체(recycling-autograft-prosthesis composite) 23례, 전 관절(total joint) 5례, 아킬레스건(achilles tendon) 1례였다. 결과는 절제 및 재건 방법과 자가골의 재활용 처치 방법에 따라 방사선학적 유합과 기능적인 평가(Musculoskeletal Tumor Society)에 따른 결과를 분석하였고 각각의 합병증에 대하여 조사하였다. 결과: 접합부의 유합은 체외 방사선 조사에서 15.0개월, 저온 열처리에서 12.6개월로 관찰되었다. 절제 방법에 따라 분절삽입 12.8개월, 조각삽입 6.0개월, 자가골-종양대치물 복합체 10.0개월, 골연골 삽입 23.3개월, 전 관절 15.6개월로 관찰되었다. 기능적 결과 점수는 체외 방사선 조사에서 59.6%, 저온 열처리에서 63.5%였고 절제 방법에 따라 분절삽입 60.8%, 조각삽입 65.5%, 자가골-종양대치물 복합체(골반제외) 62.8%, 골연골 삽입 66.0%, 전 관절 이식 66.6%였다. 저온 열처리에서 합병증은 2례(18.1%)로 감염 1례, 비구 돌출 1례가 관찰되었고 체외 방사선 조사에서 22례(46.8%)의 합병증(심부 감염 3례, 불유합 8례, 골절 2례, 성장판 문제 2례, 관절 불안정성 5례, 국소 재발 2례)이 발생하였다. 절제 및 재건 방법에 따라 분절삽입에서 불유합 3례(37.5%), 자가골-종양대치물에서 합병증 9례(50.0%, 불유합 4례, 심부감염 1례, 종양대치물 주위 골절 1례, 성장판 문제 1례, 국소재발 1례, 비구 돌출 1례), 골연골 삽입에서 합병증 6례(33.3%, 심부감염 2례, 불유합 2례, 성장판 문제 1례, 병적 골절 1례), 전 관절 이식에서 합병증 5례(100%, 관절 불안정성 5례), 아킬레스건에서 국소재발 1례(100%)가 발생하였다. 결론: 재활용 자가골 이식술의 유용성은 절제 및 재건 방법에 따라서 조각 및 분절 재건술이 사지의 기능이 우수하고 접합부의 빠른 유합을 보여 가장 좋은 적응증으로 사료되며, 자가골-종양 대치물 복합체의 재건술에서는 절제 후 남은 골이 부족할 때 종양 대치물의 안정성을 위해 고려해 볼 만하다. 자가골의 재활용 처치 방법에서는 저온 열처리법이 체외 방사선 조사법보다 더 우수한 것으로 사료된다.