• Journal of Chest Surgery
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• 제15권2호
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• pp.148-154
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• 1982

The experience with operative treatment for peripheral situated solitary circumscribed lesions of the lung at the Department of Thorac. & Cardiovasc. Surg., Korea University Hospital during 8 years from March 1974, through April, 1982 was reviewed. Our criteria for Solitary pulmonary nodule were 1. Round or Ovoid shape 2. Surrounded by normal lung Parenchyme 3. Well circumscribed peripheral location 4. No other visible pulmonary diseases on chest X-ray except minimal atelectasis or pneumonitis 5. Largest diameter less than 8 cm Of the 55 patients reviewed, there were 69% of malignancy and 31% of benign pulmonary diseases. In malignancy 38 patients, there were 18 patients with squamous cell carcinoma, 8 patients with undifferentiated large cell carcinoma, 2 patients with undifferentiated small cell carcinoma, 10 patients with adenocarcinoma and patient with metastatic carcinoma. In benign pulmonary nodule 17 patients, here were 5 patients with tuberculoma, 5 patients with aspergilloma, 2 patients with A-V fistula, 1 patient with pulmonary blastoma, 1 patient with paragonimiasis, and 1 patient with lung abscess. Overall male to female occurrence ratio was 39:16, and most prevalent age incidence was 7th decades. Most frequent size distribution was 4-6 cm in diameter. All of benign diseases were cured by resection and 66% of malignancy performed operation and has 75% resectability.

• Journal of Chest Surgery
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• 제11권1호
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• pp.26-34
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• 1978

We observed 82 cases of primary lung cancer clinically and statistically, which had been experienced at the dept. of thoracic surgery, Chonnam University Hospital, during the period of 13 years from 1964 to 1967. The results obtained were as follows: Peak incidence of age was from 5th decade to 6th decade, and the ratio of male to female was 3: 1. The frequency of lung cancer was higher in the heavy smoker than in the lighter smoker, and undifferentiated carcinoma showed low resectability in spite of the shorter clinical duration. Major symptoms were coughing and chest tightness & pain, especially coughing was initial symptom in the majority of patients. Of the 82 cases, operation was performed in the 32 cases [39%], but resection was possible in the 22 cases [27%]. The delaying factors led patients to an inoperable stage were physician’s misdiagnosis of bronchogenic carcinoma due to non-specific symptoms and signs of the patients, old age patients were dependence on herb medicine, and poor economical condition of the patients in our region especially. Basic conditions of treatment in lung cancer were early detection & early surgery, so, chest P-A would be checked per 3 to 6 months interval associated with sputum cytology in the smoker over 45 age routinely.

• Journal of Chest Surgery
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• 제26권6호
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• pp.463-469
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• 1993

From May 1986 to May 1992, 72 patients were diagnosed and operated for primary lung cancer, among them 65 patients were clinically evaluated at the department of Thoracic & Cardiovascular Surgery, Masan Koryo General Hospital. 1. There were 52 males 13 females[M:F=4:1], and 5th, 6th decade of life[72%] was peak incidence. 2. The preoperative diagnosis and its positive rate were sputum cytology 35%, bronchoscopy 47%, pleural effusion cytology 80%, and pleural biopsy 50%. 3. The classification histologic types were squamous cell cancer 71%, adenocarcinoma 17%, undifferentiated cell carcinoma 4.6%, and staging classification were Stage I 31%, Stage II 22%, Stage IIIa 26%, and Stage IIIb 20%. 4. The operative methods were lobectomy 52%, pneumonectomy 36%, and open biopsy 12%, and operability was 89%, resectability was 88%. 5. The postoperative complications developed 13 patients[22%], and operative mortality was 5%. 6. The overall actuarial survival rate was 1year 70%, 2year 42%, 3year 32%, 4year 26%, and 5year 22%, according to Stage 5year survival rate was Stage I 37%, Stage II 22%, Stage IIIa 3year 12%, Stage IIIb 2year 23%. And according to operative method lobectomy 23%, pneumonectomy 19%.

• Journal of Chest Surgery
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• 제27권3호
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• pp.209-214
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• 1994

Lung cancer is one of the most disastrous of all the current cancers in Korea. In 1990 it was projected that there would be 5, 500 new lung cancer patients in Korea and that 5, 000 would die of their disease. This is a mortality rate of 91 percent. We reviewed the surgically treated 153 bronchogenic cancer patients from January 1987 to December 1991 in St. Mary`s Hospital of Catholic University Medical College. There were 121 men and 32 women ranging in age from 18 to 83 years, with a mean of 56 years. Of the 153 patients, resection was possible in 138 patients and the resectability was 90.1 percent. Squamous cell carcinoma was present in 48 percent of patients, adenocarcinoma in 29 percent, adenosquamous carcinoma in 7 percent, large cell carcinoma in 6 percent, salivary gland tumor in 5 percent, and small cell carcinoma and carcinoid in 3 percent respectively. Postoperative cancer staging was grouped stage I 33 percent, stage II 21 percent, stage IIIa 35 percent, and stage IIIb 10 percent. Lobectomy was performed in 70 percent, pneumonectomy in 17 percent, and segmentectomy in 14 percent. Three and 5-year postoperative survival in resectable 138 patients were 47 and 29 percent respectively.

• Journal of Digestive Cancer Reports
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• 제8권1호
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• pp.51-55
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• 2020

Prognosis of patients with pancreatic cancer is poor due to difficulty in early diagnosis and low resectability rate at the time of diagnosis. Apart from the progression of cancer, venous thromboembolism - a complication that can increase patient mortality - is known to occur frequently in pancreatic cancer. This review was aimed at identifying whether venous thromboembolism is more common in pancreatic cancer than in other cancer types. In addition, we reviewed several studies to determine whether thromboprophylaxis increases the survival rates of patients with pancreatic cancer.

• Journal of Digestive Cancer Research
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• 제4권2호
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• pp.77-82
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• 2016

The 26^th World Congress of the International Association of Surgeons, Gastroenterologists and Oncologists (IASGO) was held in Seoul, Korea from September 8 to 10, 2016. In this congress, I gave a State-of-the-Art Lecture II entitled "Mesenteric Approach in Pancreatoduodenectomy." The ideal surgery for pancreatic head cancer is isolated pancreatoduodenectomy, which involves en bloc resection using a non-touch isolation technique. My team has been developing isolated pancreatoduodenectomy for pancreatic cancer since 1981, when we developed an antithrombogenic bypass catheter for the portal vein. In this operation, the first and most important step is the use of a mesenteric approach instead of Kocher's maneuver. The mesenteric approach allows dissection from the non-cancer infiltrating side and determination of cancer-free margins and resectability, followed by systematic lymphadenectomy around the superior mesenteric artery. This approach enables early ligation of the inferior pancreatoduodenal artery and total mesopancreas excision. It is the ideal surgery for pancreatic head cancer from both oncological and surgical viewpoints. The precise surgical techniques of the mesenteric approach are herein described.

• Journal of Chest Surgery
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• 제9권1호
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• pp.27-37
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• 1976

In the presence of clinical evidence and chest roentgenogram suggestive of bronchogenic carcinoma, reliance is almost wholly placed on Papanicolaou staining of the sputum, bronchoscopy, and biopsy of peripheral lesion, together referred to as the "diagnostic triad". However, bronchography remains relatively non-utilized. Our experience with 56 bronchograms in which the modality of bronchial obstruction, distance to obstruction and reduction rate of caliber in leading bronchus were used in an attempt to explain underlying chest pathology and operability of bronchogenic carcinoma, indicated as follows: 1. The bronchographic findings in bronchogenic cancer consist of malignant bronchial obstruction in which the modality of obstruction is classified as abrupt type, conical type and compressed type in incidence of 50.0%, 23.2% and 26.8%, respectively. 2. Abrupt type of bronchial obstruction is more common in hilar type and particularly in squamous cell and undifferentiated cell type of bronchogenic cancer. In this type of obstruction the inoperability revealed in 57.8% and resectability in 17.8%. 3. Conical type of obstruction was a sign of most malignancy, in which 61.5% was undifferentiated cell type and 38.4% was squamous cell type. All this type of obstruction was inoperable even feasibility was presumed in simple roentgenograms. 4. Compressed type of obstruction was more common in peripheral type of bronchogenic cancer and showed 50.0% of resectability. 5. The distance from carina to bronchial obstuction revealed average 3.8cm in undifferentiated type, 5.76cm in squamous cell type and 7.60am in adeno cell type of carcinoma. 6. The reduction rate of caliber in leading bronchus to obstruction (mm per unit cm lenghth of leading bronchus) revealed average 2.15mm/cm in undifferentiated type 1.90mm/cm in squamous cell type and 1.13mm/cm in adeno cell type of carcnoma. 7. The reduction rate of caliber in leading bronchus showed 2.14mm/cm in inoperable cases and 1.42mm/cm in resectable cases. 8. The modality of bronchial obstruction and estimation of the reduction rate of caliber seemed to be a most reliable key-point to decide feasibility of resection.

• Journal of Gastric Cancer
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• 제1권3호
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• pp.174-179
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• 2001

Purpose: For curative resection of recurrent gastric cancer, it is imperative that there be no unrecognized foci of tumoral disease outside the operation field. PET (positron emission tomography) with FDG (18 fluoro-2 deoxy-D-glucose) is a whole-body imaging technique that exploits the increased rate of glycolysis in tumor cells to detect disease. The authors evaluated the usefulness of FDG-PET in assessing resectability of recurrent gastric cancer. Materials and Methods: Seven patients with recurrent gastric cancer were studied with FDG-PET from December 1998 to October 2000. All FDG-PET images were interpreted in conjunction with conventional diagnostic methods. All imaging results were correlated with the pathological diagnosis and clinical outcome. Results: A final diagnosis of recurrence was obtained at 14 sites in all 7 patients by histology or clinical follow up. Locoregional recurrence, including distant metastasis, developed in 6 of 7 patients and distant recurrence in only one. FDG-PET detected all recurrent sites (5 locoregional and 5 distant) in 5 patients without peritoneal recurrence, but did not detect peritoneal seeding in 2 patients with peritoneal recurrence. The accuracy of FDG-PET in estimating resectability was $71.4\%$ (5/7), and that of CT and PET together was $85.7\%$ (6/7). A curative resection could be performed in three of the recurrent patients (2 locoregional and 1 distant recurrence). Conclusion: Our results suggest that FDG-PET may be useful for detecting locoregional and distant recurrence of gastric cancer and for selecting appropriate treatment. However, considering that FDG-PET was limited in detecting peritoneal seeding and determining the exact anatomical extension of tumor, it should be used in conjunction with other anatomical images.

• Asian Pacific Journal of Cancer Prevention
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• 제17권4호
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• pp.2137-2140
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• 2016

Background: Gall bladder cancer (GBC) usually presents as unresectable or metastatic disease. We conducted a feasibility study to evaluate the effect of neoadjuvant therapy (NAT) on radiologic downstaging and resectability in unresectable GBC cases. Materials and Methods: Patients with locally advanced disease were treated with chemoradiotherapy [CTRT] ( external radiotherapy (45Gy) along with weekly concurrent cisplatin $35mg/m^2$ and 5-FU 500 mg) and those with positive paraaortic nodes were treated with neoadjuvant chemotherapy [NACT (cisplatin $25mg/m^2$ and gemcitabine $1gm/m^2$ day 1 and 8, 3 weekly for 3 cycles). Radiological assessment was according to RECIST criteria by evaluating downstaging of liver involvement and lymphadenopathy into complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD). Results: A total of 40 patients were evaluated from January 2012 to December 2014 (CTRT=25, NACT=15). Pretreatment CT scans revealed involvement of hilum (19), liver infiltration (38), duodenum involvement (n=22), colon involvement (n=11), N1 involvement (n=11), N2 disease (n=8), paraaortic LN (n=15), and no lymphadenopathy (n=6). After neoadjuvant therapy, liver involvement showed CR in 11(30%), PR in 4 (10.5%), SD in 15 (39.4%) and lymph node involvement showed CR in 17 (50%), PR in 6 (17.6%), SD in 4 (11.7 %). Six patients (CTRT=2, NACT=4) with 66.6 % and 83% downstaging of liver and lymphnodes respectively underwent extended cholecystectomy. There was 16.6 % and 83.3% rates of histopathological CR of liver and lymph nodes. All resections were R0. Conclusions: Neoadjuvant therapy in unresectable gall bladder cancer results in a 15% resectability rate. This approach has a strong potential in achieving R0 and node negative disease. Radiologic downstaging (CR+PR) of liver involvement is 40.5% and lymphadenopathy is 67.5%. Nodal regression could serve as a predictor of response to neoadjuvant therapy.

• Journal of Chest Surgery
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• 제21권5호
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• pp.856-862
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• 1988

The survival rate after resectional operation for carcinoma of the esophagus is still very low and many factors contribute to these poor results. We analyze the clinical results of 56 operated patients among 62 esophageal cancer patients between March, 1974 and July, 1988. Among the 62 patients, 52 patients were squamous cell carcinoma and 8 were adenocarcinoma, one was leiomyosarcoma and one was adenosquamous cell carcinoma. The classification of esophageal cancer was based on TNM classification of American Joint Committee on cancer". Among the operated patients, stage I was 5[9.6%], stage II was 13[25%], stage III was 26[50%], stage IV was 8[15.4%]. And its one year survival rate was 80%, 69%, 11.5%, 0% for each stages. The rate of resectability was 30.3% and resection of esophagus with esophagogastrostomy and extended lymph node dissection was performed on 17 patients without distant metastasis or adjacent organ invasion. Substernal esophago-colono-gastrostomy, Celestine tube insertion and feeding gastrostomy was performed on remained 39 patients. The analysis of postoperative survival duration revealed the superiority of esophagectomy with extended lymph node dissection over other palliative operation. [1 year survival rate: 79% versus 21%] We concluded that the survival rate of esophageal resection with lymph node dissection group was superior to nonresective palliative operation group. And transthoracic approach was superior to extrathoracic approach in involved lymph node dissection and esophageal resection in locally invaded cases.ases.