• 대한한방내과학회지
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• 제34권4호
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• pp.466-477
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• 2013

Objectives : To report and demonstrate the effect of decreasing ascites volume by SB intraperitoneal injection to a refractory ascites patient with synchronous colorectal liver metastasis and metachronous peritoneal carcinomatosis. Methods : Two cycles of intraperitoneal and intravenous SB injection were conducted. Each injection cycle was made up of 4 days. Nine vials of SB were injected to the patient every day. To compare the volume of ascites between pret- and post-treatment, follow-up computed tomography was done on June 3, 2013. To observe other therapeutic effects of SB injection, laboratory tests were conducted periodically. Results : On the follow-up computed tomography images, the amount of ascites and pleural effusion had decreased compared to the April 30, 2013 computed tomography images. The levels of aspartate transaminase, alanine aminotransferase and lactate dehydrogenase decreased significantly from May 9, to May 30, 2013. The amount of oral intake increased constantly during hospitalization. The patient's symptoms such as abdominal distension, abdominal pain and dyspnea were improving until discharge. Conclusions : Even if thiese results cannot be applied to every synchronous colorectal cancer liver metastasis patient, we demonstrated that SB intraperitoneal injection has ascites-decreasing effect to refractory ascites patients with synchronous colorectal liver metastasis and metachronous peritoneal carcinomatosis.

• Asian Pacific Journal of Cancer Prevention
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• 제16권4호
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• pp.1665-1669
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• 2015

Background: The optimal surgical strategy for the treatment of synchronous resectable gastric cancer liver metastases remains controversial. The aims of this study were to analyze the outcome and overall survival of patients presenting with gastric cancer and liver metastases treated by simultaneous resection. Materials and Methods: Between January 1990 and June 2009, 35 patients diagnosed with synchronous hepatic metastases from gastric carcinoma received simultaneous resection of both primary gastric cancer and synchronous hepatic metastases. The clinicopathologic features and the surgical results of the 35 patients were retrospectively analyzed. Results: The 5-year overall survival rate after surgery was 14.3%. Five patients survived for more than 5 years after surgery. No mortality has occurred within 30 days after resection, although two patients (5.7%) developed complications during the peri-operative course. Univariate analysis revealed that patients with the presence of lymphovascular invasion of the primary tumor, bilateral liver metastasis and multiple liver metastases suffered poor survival. Lymphovascular invasion by the primary lesion and multiple liver metastases were significant prognostic factors that influenced survival in the multivariate analysis (p=0.02, p=0.001, respectively). Conclusions: The presence of lymphovascular invasion of the primary tumor and multiple liver metastases are significant prognostic determinants of survival. Gastric cancer patients without lymphovascular invasion and with a solitary synchronous liver metastasis may be good candidates for hepatic resection. Simultaneous resection of both primary gastric cancer and synchronous hepatic metastases may effectively prolong survival in strictly selected patients.

• Journal of Gastric Cancer
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• 제4권4호
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• pp.277-281
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• 2004

조기위암은 림프절 전이에 상관없이 위점막이나 점막하층까지 암이 국한된 것으로 정의된다. 진행성 위암에 동반된 간전이율은 $5\~12\%$이나 조기위암에 동반된 간전이는 드물다. 64세 여자 환자나 상복부 통증을 주소로 성빈센트 병원에 내원하여 시행한 위내시경 검사에서 위전정부에 폴립형 종괴가 있었으나 간전이 소견은 없었다. 수술 시 간에 단일 전이가 발견되었으며, 2군 림프절을 포함하여 원위부 아전절제술과 전이된 간이 절제술을 시행하였다. 조직검사에서 위전정부의 종괴는 선종의 일부에 선암성 변화가 있었고 이는 위점막에 국한되어 있었으며, 절제된 간은 선암의 소견을 보였다. 저자들은 조기위암에 동반된 간전이 1예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.

• Journal of Gastric Cancer
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• 제13권1호
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• pp.58-64
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• 2013

Alpha-fetoprotein-producing gastric cancer is associated with poor prognosis because of frequent liver and lymph node metastasis. We present a case with synchronous liver metastasis who survived for 5 years. A 69-year-old man with upper abdominal pain was referred to our hospital. Gastrointestinal endoscopy revealed a Borrmann II-like tumor in the lower part of the stomach. Computed tomography revealed a tumor in the left lobe of the liver. Serum alpha-fetoprotein levels were markedly increased. We performed distal gastrectomy after administering oral tegafur/gimeracil/oteracil potassium and administered hepatic intra-arterial cisplatin injection. Liver metastasis showed partial response on computed tomography. Despite left hepatic lobectomy, further metastases to the liver and mediastinal lymph nodes became difficult to control. After sorafenib tosylate administration, stabilization of the disease was observed for 4 months. We conclude that hepatic intra-arterial chemotherapy and oral administration of sorafenib tosylate may potentially improve the prognosis in such cases.

• Journal of Gastric Cancer
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• 제9권3호
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• pp.128-135
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• 2009

목적: 동시성 및 이시성 간전이 위암환자들을 대상으로 임상병리학적 특성 및 예후의 차이에 대하여 알아보고 치료 방법에 따른 예후에 대하여 알아보고자 하였다. 대상 및 방법: 1992년 6월부터 2006년 12월까지 한양대학교병원 외과예서 치료받은 위암 환자 중 간전이가 발견된 67명의 환자를 대상으로 임상병리학적 특징 및 치료 방법에 대하여 후향적 분석을 시행하였다. 결과: 두 군의 임상병리학적 특성에 대한 비교에서 림프관 침윤 여부(P=0.041)와 혈관 침윤 여부(P=0.036)가 동시성군에서 유의하게 많았다. 전체 간전이 위암환자의 1년 생존율과 중앙생존기간은 38.9%, 9.2개월이며 동시성 간전이군에서는 30.9%. 9.2개월이었고 이시성 간전이군에서는 44.5%, 9.7개월로 두 군 사이에 통계학적으로 유의한 차이는 없었다(P=0.436). 치료 방법을 수술 혹은 영상의학적 중재술 등의 국소적 치료와 전신적 항암화학치료를 병행한 경우, 전신적 항암화학치료만 받은 경우, 치료 받지 않은 경우 등 세 가지로 나누었을 때 동시성 간전이군과 이시성 간전이군 사이에 치료 방법의 차이는 없었으며 두 군 모두에서 국소적 치료를 전신적 치료와 병행하였을 경우 생존율이 높았다(P<0.001). 결론: 간전이 위암에 있어서 간전이 병소의 발생 시점에 따른 예후의 차이는 없을 것으로 생각한다. 또한 간전이 발견 시점과 관계 없이 적응 예가 되는 경우 수술적 치료나 영상의학적 중재술 등의 적극적인 치료가 환자의 예후 향상에 기여할 수 있겠다.

• Journal of Gastric Cancer
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• 제9권1호
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• pp.14-17
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• 2009

대장암이나 타 장기 암의 간전이 경우 간 절제는 비교적 좋은 결과를 가지는 치료 방법으로 보고되고 있으나, 위암의 간전이에 대한 치료로 절제 수술의 역할과 생존율에 대한 효과는 연구가 많지 않은 실정이다. 위암의 수술 전 진단 때나 수술 후 추적 검사 중 진단된 간전이의 경우 많은 예에서 다발성 전이, 좌, 우엽에 전이, 간외 전이, 복막 파종이나 다발성 림프절 전이 양상으로 절제 수술의 적응이 되지 못하는 악성 경로를 가지는 경우가 많다. 그러나 몇몇 보고에서는 수술 적응 대상 환자가 적으나 간절제 치료로 좋은 결과를 보고하는 경우도 있어 제한된 간전이 환자에 대한 맞춤 치료의 영역은 있다고 하였다. 위암의 간전이 절제 예에 대한 보고를 종합하여 보면 간전이 병소가 진단되는 시기가 예후에 중요하여 동시성으로 전이가 진단된 경우가 나쁘며, 절제연이 10 mm 이상 유지 될 때 좋은 결과를 보고하였다. 반면 전이 병소의 개수는 생존율 검사에서 통계학적 의미는 없는 것으로 보고 되었다. 또한 충분한 절제연을 확보하면서 해부학적 구역 절제 이상의 수술이 시행된 경우와 이시성 간전이가 좋은 생존율을 보이는 것으로 보고되었다. 또한 간 절제 수술 후 가장 많은 재발 병소는 역시 간으로, 재발 시 대부분 2년 내 사망을 초래하여 절제 후 보조항암화학요법 치료도 중요하다.

• Radiation Oncology Journal
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• 제11권1호
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• pp.103-108
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• 1993

Among the patients with rectal cancer who entered Yonsei University Hospital for management from Jan. 1980 to Dec. 1990, we selected 23 subjects who were received surgical resection of tumor in rectum, and who proved to have liver metastasis during the diagnostic work-up, at the time of the operation, or within 3 months after starting definitive treatment. With those subjects, we investigated the role of radiation therapy by comparison of the treatment results of the patients without radiation therapy (S group) with those of the patients with radiation therapy to the primary site (S+R group). The local control rates of S group and S+R group were $64{\%}$ and $89{\%}$, and 2-year survival rates were $50{\%}$ and $78{\%}$, respectively. Although there was not statistically meaningful difference, local control rate and 2-year survival rate were higher in the group with radiation therapy to primary site than that without radiation therapy. The 2-year survival rates of the case with resection of the liver and the case without it were $63.6{\%}$ and $58.3{\%}$ respectively, which was not statistically significant. Also, the 2-year survival rate of the case with sustained local control was higher than that of the case with local failure, which was statistically significant ($76.5{\%}$ and $16.7{\%}$, p<0.005). From the above results, it is thought that radiation therapy to the primary site might improve the local control rate even in the patients with liver metastasis, which seems to be correlated to the higher survival rate.

• Journal of Korean Medical Science
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• 제33권45호
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• pp.283.1-283.10
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• 2018

Background: The role of sorafenib in patients with hepatocellular carcinoma (HCC) recurrence after liver transplantation (LT) has been rarely studied. The aim of this study was to evaluate the efficacy of sorafenib in post-LT era. Methods: Consecutive patients with post-transplant HCC recurrence not eligible to resection or locoregional therapy were included. Patients receiving best supportive care (BSC) until 2007 were compared with those treated by sorafenib thereafter. Results: Of a total of 65 patients, 20 patients received BSC and 45 received sorafenib. Clinical characteristics were similar between two groups except that sorafenib group received tacrolimus and mammalian target-of-rapamycin inhibitors more frequently than BSC group. Treatment with sorafenib conferred a survival advantage as compared with BSC for survival after recurrence (median, 14.2 vs. 6.8 months; P = 0.01). In multivariate analyses, high serum ${\alpha}$-fetoprotein level, synchronous intrahepatic recurrence and distant metastasis at the time of recurrence, and BSC were independently associated with poorer survival after recurrence. Sorafenib treatment was associated with better survival after recurrence as compared with BSC (hazard ratio, 0.25; 95% confidence interval, 0.10-0.62; P = 0.002). In addition, sorafenib group showed tolerable toxicity in the post-transplant setting. Conclusion: Sorafenib may be beneficial in patients with post-transplant HCC recurrence.

• Journal of Yeungnam Medical Science
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• 제37권3호
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• pp.246-249
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• 2020

Synchronous gastric cancer and adenomatous colorectal polyp in patients with Klebsiella pneumoniae-induced pyogenic liver abscess (KP-PLA) and bacteremia is a rare presentation. A 58-year-old man with a 6-month history of diabetes mellitus (DM) presented with febrile sensation and dull abdominal pain in the right upper quadrant of the abdomen. Subsequent to laboratory test results and abdominal computed tomography findings, KP-PLA with bacteremia was diagnosed. After intravenous antibiotic administration, his symptoms improved, and upper endoscopy and colonoscopy were performed to evaluate the cause of KP-PLA. Biopsy specimens of the prepyloric anterior wall revealed a moderately differentiated adenocarcinoma. Endoscopic mucosal resection of the colon revealed high-grade dysplasia. Early gastric cancer (EGC) and adenomatous colorectal polyps with high-grade dysplasia concomitant with KP-PLA and bacteremia were diagnosed in our patient who had DM. Intravenous antibiotic treatment for KP-PLA, subtotal gastrectomy for EGC, and colonoscopic mucosal resection for the colon polyp were performed. After 25 days of hospitalization, subtotal gastrectomy with adjacent lymph node dissection was performed. Follow-up ultrasound imaging showed resolution of the abscess 5 weeks post-antibiotic treatment, as well as no tumor metastasis. Upper gastrointestinal endoscopy and colonoscopy should be performed to evaluate gastric cancer in patients with PLA or bacteremia, accompanied with DM or an immunocompromised condition.

• 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.