• Journal of Chest Surgery
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• v.29 no.11
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• pp.1241-1247
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• 1996

From January 1989 to March 1996, we have operated on 102 cases of non-small cell lung cancer at the department of Thoracic and Cardiovascular Surgery, Yonsei University Wonju College of Medicine. They were clinically evaluated. The results are as follows; 1. The peak incidence of age of primary lung cancer was 5th decade(34.3%) and 6th decade(38.2%). Male to female ratio was 2.5:1. 2. Most of symptoms were respiratory, which were cough(61.8%), sputum(43.l%), chest discomfort and pain(30.4%), dyspnea(27.5%), and hemoptysis(9.8%). Asymptomatic cases were 1.9% of study group. 3. Methods of diagnostic confirmation were bronchoscopic biopsy(59.8%), sputum cytology(17.6%), percutaneous needle aspiration(11.8%) and open biopsy(10.8%). 4. Histopathologic classifications were squamous cell carcinoma(55.9%), adenocarcinoma(30.5%), adenosquamous cell carcinoma(6.9%), large cell carcinoma(4.9%), bronchioalveolar cell carcinoma(0.9%), and mixed cell carcinoma(0.9%). 5. Methods of operation were pneumonectony(47.1%), lobectomy(38.2%), bilobectomy(5.9%), wedge resection(1.9%), exploration(6.9%), and overall resectability was 93.1%. 6. Postoperative staging classifications were Stage I (13.7%), Stage II(31.4%), Stage IIIa(38.3%), Stage IIIb(14.7%), and Stage IV(1.9%). 7. The postoperative complications developed in 9.8%, and operative mortality was 1.9 %. 8. One year survival rate was 81.7%, 3 year 49.7% and 5 year 21.8%. According to stage, 5 year survival rate was 39% in stage I, 24.3% in stage II, 23.9% in stage IIIa.

• Journal of Chest Surgery
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• v.42 no.4
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• pp.497-501
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• 2009

Background: Prolonged air leakage and pleural fluid drainage from a chest tube may delay removing the chest tube after a patient undergoes video-assisted thoracoscopic wedge resection and the patient is otherwise ready for discharge. We reviewed 37 outpatients patients who were being managed with a postoperative chest tube (a Panda Pneumothorax set with a Heimlich valve). Material and Method: From January 2005 to December 2007, 294 patients underwent video-assisted thoracoscopic wedge resections & pleurodesis. Of them, 37 patients met the criteria for outpatient chest drainage management with using a Panda Pneumothorax set with a Heimlich valve. The patients received written instructions, and they demonstrated competence with using the Panda system. The patients returned for chest tube removal after satisfactory resolution of their air leak and pleural fluid drainage. Result: The patients discharged with a Panda pneumothorax set had a longer duration of hospital stay (mean: 10.3$\pm$1.7 days, range: 11 to 17 days) as compared with the patients without a Panda pneumothorax set (mean: 6.2$\pm$1.5 days, range: 4 to 7 days). The chest tube was removed successfully from the patients with a Panda pneumothorax set at an average of 9.8$\pm$1.6 days (range: 9$\sim$18 days) after discharge. There were no major complications. Four patients experienced minor complications. Thirty six patients (97.3%) experienced uneventful and successful outpatient chest tube management. Conclusion: Successful postoperative outpatient chest tube management with using the Panda set was accomplished in 36 selected patients. This program resulted in a substantially reduced hospital cost and enhanced patient satisfaction by allowing earlier discharge.

• Journal of Chest Surgery
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• v.43 no.4
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• pp.404-408
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• 2010

Background: Pleural symphysis is regarded as an important treatment option in reducing recurrence rates after surgical treatment of spontaneous pneumothorax. However, there is much debate over the best method for achieving pleural symphysis. We retrospectively compared apical pleurectomy (AP) with mechanical pleural abrasion (MPA). Material and Method: Between January 2000 and December 2007, 83 patients underwent video-assisted thoracoscopic surgery (VATS) for spontaneous pneumothorax. In addition to wedge resection of bullae, MPA was performed in 21 patients (group A) and AP in 62 patients (group B). Result: There were no significant differences in age, gender and site of pneumothorax between the two groups. Operative time was $97{\pm}44$ minutes in group A and $77{\pm}18$ minutes in group B (p>0.05). The mean amount of pleural drainage through the chest tube on the first postoperative day was $156{\pm}87 cc$ in group A and $147{\pm}87 cc$ in group B (p>0.05). There was no mortality or significant morbidity in all patients with the exception of reoperation for bleeding in two patients in group B. In the postoperative course, there were no statistical differences between the two groups in the rate of residual air space, air leak and indwelling time of chest tube, and hospital stay. Mean follow up time was $31.7{\pm}25.3$ months, and the recurrence rate of pneumothorax was 9.5% (2/21) in group A and 6.5% (4/62) in group B, without statistical significance. Conclusion: AP was no more advantageous than MPA in terms of operative time, postoperative course and prevention of recurrent pneumothorax. Therefore, complete resection of bullae and existence of residual bullae are more important factors in reducing the incidence of recurrent pneumothorax than pleural symphysis.

• Tuberculosis and Respiratory Diseases
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• v.41 no.1
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• pp.26-35
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• 1994

Background: Bronchioloalveolar cell carcinoma today needs further studies as an early diagnosis will drastically improve the chances of cure. Methods: Twenty-four cases of bronchioloalveolar cell carcinoma for the period of 5 years were studied in terms of incidence, age, sex, underlying diseases, symptoms, radiographic findings, methods of diagnosis, clinical and pathologic staging, methods of treatment, and survival retrospectively. Results: No correlation was found between patients' age, sex and underlying diseases. Most common symptoms were cough(62.5%), chest pain(29.2%), and sputum(29.2%). Of the 24 cases, 13 patients(54.2%) had solitary nodule, 6 patients(25%) had multiple nodules. At the time of diagnosis, 3 patients(12.5%) had the stage I diseases, 3 patients(12.5%) had the stage II diseases, 4 patients(16.7%) had the stage IIIa diseases, 3 patients(12.5%) had the stage IIIb diseases, and 11 patients(45.8%) had the stage IV diseases. 14 cases(58.3%) were found inoperable at the time of admission; they all died within 17 months. In 7 cases with stage I, II, IIIa diseases curative resection were attempted, in 1 case with stage IV disease wedge resection for palliative management was performed, and in 4 cases patients were still alive at the time of conclusion of this study. Conclusion: We conclude that early diagnosis of disease will increase operability and improve chances of survival and that aggressive diagnostic workup for suspicious pulmonary infiltrate is essential as early operation offers the best chances of cure.

• Journal of Chest Surgery
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• v.32 no.3
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• pp.281-286
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• 1999

Background: The purpose of this study is to analyze the types of complications, the incidences of complications, and preoperative and postoperative risk factors affecting the incidence of the complication. Material and Method: Between August 1990 and August 1997 in Asan Medical Center, 42 patients(24 men and 18 women) underwent surgical resection for pulmonary aspergilloma. The mean age was 46.6${\pm}$11.5 years(range 29 to 69 years). Hemoptysis(90%) was the most common presentation. Pulmonary tuberculosis was the most common predisposing cause(81%). The associated diseases were bronchiectasis(n=11), active puolmonary tuberculosis(n=9), diabetes mellitus(n=8), lung carcinoid(n=1), and acute myeloblastic leukemia(n=1). Lobectomy was done in 32 cases(76%), segmentectomy or wedge resection in 4, pneumonectomy in 2, and lobectomy combined with segmentectomy in 4. Result: Operative mortality was 2%. The most common postoperative complication was persistent air leakage(n=6). The variables such as age, sex, pulmonary function test, amount and duration of hemoptysis, associated diseases(diabetes mellitus, active pulmonary tuberculosis), mode of preoperative management(steroid, antifungal agent, bronchial arterial embolization), and modes of operative procedures were statistically insignificant. The radiologic extent of infiltration to normal lung parenchyme was statistically significant(p=0.04). Conclusion: We conclude that the extent of the infiltration to normal lung parenchyme in preoperative radiologic studies should be carefully evaluated to reduce the postoperative complications in surgery for pulmonary aspergilloma.

• Journal of Chest Surgery
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• v.30 no.9
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• pp.899-907
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• 1997

Recently, primary lung cancer has increased markedly in incidence & prevalence in korea. Prom July 1979 to June 1996, 183 patients were diagnosed and operated for primary non-small cell lung cancer, and evaluated clinically. 1. There were 164 males and 19 females(M:P=8.6: 1), and the peak incidence of age was 50th and 60th decade of life(73.7%). 2. Most of symptoms were respiratory, whitch were cough(44.8%), chest pain(30.1%), dyspnea(20.8%), hemoptysis or blood tinged sputum(19.7%), sputum(15.3%), and asymptomatic cases were 12.0%. 3. Histopathologically, sguamous cell carcinoma was 68.9%, adenocarcinoma 19.7%, bronchioloalveol r cell carcinoma 2.2%, adenosguamous cell carcinoma 1.6%, and large cell carcinoma 7.7%. 4. In the operation, pneumonectomy was 41.0%, lobectomy 42.1%, bilobectomy 13.1%, stagmentectomy or wedge resection 1.6%, and explore tharacotomy 2.2%, and the overall resectability was 97.8%. 5. Postoperative complications were developed in 31.9%, and operative mortality was 1.6%. 6. In postoperative stagings, stage I was 38.3%, stage H 14.8%, stage llla 31.1%, and stage IIIb 15.8%. 7. The overall cumulative survival rates were 1 year 77.8%, 3 year 42.7%, and 5 year 39.5%. The 5 year survival rate according to stage were stage 153.0%, stage H 46.5%, stage I[la 28.2%, and stage IIIb 13.8%(p<0.05), according to operation method were lobectomy 45.0%, and pneumonectomy 30.3%(p<0.05), and according to mediastinal involvement were Nl 32.0%, and N2 11.1%(p<0.05). The 5 year survival rate according to histologic type were squamous cell carcinoma 43.1%, adenocarcinoma 23.3%, and large cell carcinoma 30.3 (p>0.05).

• Journal of Chest Surgery
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• v.37 no.10
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• pp.833-838
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• 2004

Background: Despite the excellent early results after the repair of congenital bicuspid aortic valve (BAV) disease, the mid-term durability of the repaired valve has still controversies. Material and Method: To evaluate the mid-term results of BAV repair, retrospective review of medical records and echocardiographic data were done. Between 1994 and 2003, twenty-two patients underwent reparative procedure for either regurgitant or stenotic congenital bicuspid aortic valve (BAV). Result: Mean age was $41\pm14$ years with male predominance (Male=17, Female=5). The pathophysiologies of the BAV were regurgitation-dominant in 20 (91%) and stenosis-dominant in 2 (9%) cases. Various repair techniques were used for raphe, prolapsed leaflet, thickened leaflet, and commissures; 1) release of raphe in 19 (86%), 2) wedge resection and primary repair in 11 (50%), pericardial patch reinforcement after plication of the leaflet in 6 (27%), and plication of the leaflet in 3 (14%), 3) slicing of thickened leaflet was used in 12 (55%) cases, 4) commissuroplasty in 8 (36%), and commissurotomy in 6 (27%) cases. There was no in-hospital mortality. During the mean follow-up of $38\pm17$ months, one patient underwent aortic valve replacement after developing acute severe regurgitation from dehiscence of the suture on postoperative 2 months. New York Heart Association functional class was improved from $1.9\pm0.6$ to $1.2\pm0.5$ (p<0.01). Left ventricular end-systolic and diastolic dimension (LVESD/LVEDD) were also improved from $45\pm9$ and $67\pm10$ to $37\pm10$ and $56\pm10,$ respectively (p<0.01). The grade of aortic regurgitation (AR) was improved from preoperative $(3.1\pm1.2)$ to post-bypass $(0.9\pm0.7).$ However, the grade at last follow-up $(1.7\pm1.1)$ was deteriorated during the follow-up period (p<0.01). Freedom from grade III and more AR at one, three, and four year were 89.7%, 89.7%, and 39.9% respectively. Conclusion: Midterm clinical result of the BAV repair was favorable. But, the durability of the repaired valve was not satisfactory.

• Journal of Chest Surgery
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• v.40 no.5 s.274
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• pp.362-368
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• 2007

Background: Spontaneous pneumothorax patients with blebs or bullae are considered to be good candidates for operation, and various objective diagnostic modalities have been performed for detection of blebs and bullae. This study was performed to compare the efficacy of thoracoscopic examination with using a minimally invasive 2 mm thoracoscope with high-resolution computed tomography (HRCT) for treating primary spontaneous pneumothorax. Material and Method: From June 2001 to March 2002, 34 patients with spontaneous pneumothorax undewent study with 2 mm video-thoracoscopic examination and HRCT. We regarded a blob larger than 5 mm in diameter as significant. Standard thoracoscopic wedge resection was performed in 18 patients with significant blob via a 2 mm video-thoracoscopic examination. 1 patient incurred bleeding, and the remaining 15 patients were treated with pleural drainage. Result: Multiple or single blob lesions were detected by 2 mm video-thoracoscope in 52.9% (18/34) of the patients with primary pneumothorax. For a total of 19 patients who were operated on, the diagnostic accuracy of the 2 mm video-thoracoscopic examination for bullae and blob was 94.7% (18/19), which was superior to that of HRCT (73.7%, 14/19). At a mean follow-up of $30{\pm}3$ months, no recurrence occurred in both the operative group and the non-operative group. Conclusion: 2 mm video-thoracoscopic examination under local anesthesia has higher diagnostic accuracy than HRCT, and it is a useful alternative for determining the operative indications for spontaneous pneumothorax.

• Tuberculosis and Respiratory Diseases
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• v.40 no.4
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• pp.384-389
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• 1993

Background: Pulmonary sclerosing hemangioma is rare, but still the second most common benign lung tumor, occurring most1y in middle-aged women. Methods: From January 1985 through April 1993, we experienced eight cases of solitary pulmonary sclerosing hemangioma. Results: Subjects studied were 7 female and 1 male patients. They ranged from 14 to 63 years of age(mean age, 43.8 years) at the time of operation. The patients were frequently asymptomatic and the tumor was often shown to be a large lobulated mass on radiographic examination. The tumor can usually be diagnosed on operation because of its subtle clinical and radiographic presentation. All eight cases were diagnosed intraoperatively. The mean interval between initial radiographic detection and operation was 7.9 months. Out of 8 cases, preoperative impression of benign tumor was made in 4 cases, whereas malignant tumor was suspected in the remaining 4 cases. Enucleation, wedge resection or lobectomy was performed which appropriate in each patient. Conclusion: Surgical removal of the tumor preserving as much lung parenchyma as possible is indicated for proper diagnosis and treatment of this condition.

• Journal of Chest Surgery
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• v.40 no.6 s.275
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• pp.435-440
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• 2007

Background: Primary malignant lymphoma of the lung is a very rare neoplasm. Although the prognosis of lymphoma is favorable, the clinical features, prognostic factors and management have not been clearly defined. Material and Method: We retrospectively reviewed the records of 8 patients we managed between 1994 and 2000. They all had malignant lymphoma on the pathologic examination of the lung wit no evidence of mediastinal adenopathy and extrathoracic disease, and no past history of lymphoma. Result: The study group consisted of 3 males and 5 female patients with a mean age of 53.9 years. Three patients were asymtomatic and 5 patients were seer with pulmonary or systemic symptoms. The diagnostic methods were 3 CT needle aspiration biopsies, 1 bronchoscopic biopsy and 4 surgical methods (wedge resection, lobectomy). There were 3 patients with MALT lymphoma, two with diffuse large B-cell lymphoma, two with small lymphocytic lymphom, and one with follicular lymphoma. The 8 patients were treated with a variety of modalities, including surgery, chemotherapy, radiotherapy and combination therapy. The 8 patients have survived for a median follow-up of 38 months. Conclusiian: Although this entity of lymphoma appears to have a good prognosis, further clinical experience and long-term follow-up are needed to identify its clinical features, prognostic factors and management.