• Journal of Gastric Cancer
• /
• v.8 no.2
• /
• pp.79-84
• /
• 2008

Purpose: With advancements in laparoscopic surgery, there have been efforts to expand the indication for laparoscopic surgery up to advanced gastric cancer. However, scant data are available regarding the feasibility and advantages of laparoscopy-assisted distal gastrectomy (LADG) with standard radical D2 lymph node dissection. Materials and Methods: Twenty-two patients who were preoperatively diagnosed with cT1N0M0 gastric cancer underwent LADG with standard D2 lymphadenectomy between February and August 2007. They were compared with patients who underwent conventional open D2 lymphadenectomy with respect to clinicopathologic features, surgical outcomes, and postoperative course. Results: The mean operative time was significantly longer in the LADG group than in the open group ($160{\pm}25min$ vs. $135{\pm}21min$, P<0.001). However, surgical outcomes, such as surgical margin and number of retrieved lymph nodes ($25.7{\pm}11.1$ vs. $26.9{\pm}9.2$, P=ns) were comparable between the groups. The LADG group exhibited quicker postoperative recovery, and both groups exhibited similar postoperative morbidity and mortality. Conclusion: LADG with D2 lymphadenectomy is feasible and safe, with short-term surgical outcomes comparable to those seen in open D2 lymphadenectomy. Further prospective clinical investigation will be needed to better evaluate the advantages of LADG with D2 lymphadenectomy.

• Journal of Gastric Cancer
• /
• v.5 no.2
• /
• pp.79-88
• /
• 2005

Quality assurance may be defined as the complete set of systemic actions that is required to achieve a better treatment result by standardizing treatment and by using various audit programs. In general, application of a quality assurance program in surgery is considered to be more difficult than it is in chemotherapy or radiotherapy. However, recently, the importance of quality assurance in the surgical field has been emphasized in clinical trials comparing different surgical procedures and evaluating the role of postoperative adjuvant therapy. In the case of gastric cancer surgery, excellent quality assurance programs have rarely been applied in most large prospective clinical trials. Although the quality assurance in Dutch trial was conducted very systemically and strictly, the situation is quite different from ours. On the other hand, several quality assurance programs in Japanese trials comparing D2 and D2 plus para-arotic lymph node dissection seem to be applicable to Korean clinical trials. Several factors, including selection of appropriate surgeons based on personal experience and annual number of operations, standardization of surgical procedures by education and consensus, development of a unified database program, application of standardized perioperative management, and standardization of pathologic examination, are required to guarantee a successful multi-institutional prospective clinical trial. In contrast, one needs to realize that protocols that are too strict and sophisticated can make the enrollment of patients and surgeons more difficult and can promote protocol violation during the clinical trials. (J Korean Gastric Cancer Assoc 2005;5:79-88)

• Journal of Gastric Cancer
• /
• v.4 no.1
• /
• pp.32-35
• /
• 2004

Purpose: The most important prognostic factors in gastric cancer is the depth of invasion of the primary tumor and lymph node metastasis. The nodal staging of the 5th edition of the Union Internationale Contrala Cancrums (UICC) TNM classification in 1997 was changed based on the number of metastatic lymph node. We attempted to evaluate the prognostic significance of N2 group metastasis in pT3pN1 gastric cancer patients by comparing two different nodal staging systems. Materials and Methods: A retrospective analysis was made for 352 gastric cancer patients who underwent curative resection, including D2 dissection, from 1991 to 1997 at Asan Medical Center. A clinicopathologic comparison between two groups by using a nodal staging systems was summarized into a table. Cumulative survival rates were calculated by using the Kaplan-Meier method. The difference between the two groups was evaluated by using the log rank test with SPSS 11.5 for Windows Results: There were no statistical differences in clinicopathologic factors. However, there was a significant difference in survival rate between the two groups (P=0.0009). This suggests that N2 group metastasis in pT3pN1 gastric cancer patients has a clinical significance for predicting prognosis. Conclusion: Our results suggest a possibility of prognostic significance of N2 group metastasis. Therefore, anatomical location of the lymph node should be described.

• Journal of Chest Surgery
• /
• v.53 no.3
• /
• pp.104-113
• /
• 2020

Background: Accurate intraoperative assessment of mediastinal lymph nodes is a critical aspect of lung cancer surgery. The efficacy and potential for upstaging implicit in these dissections must therefore be revisited in the current era of uniportal video-assisted thoracoscopic surgery (VATS). Methods: A retrospective study was conducted in which 544 patients with stage I (T1abc-T2a, N0, M0) primary lung cancer were analyzed. To assess risk factors for nodal upstaging and to limit any imbalance imposed by surgical choices, we constructed an inverse probability of treatment-weighted (IPTW) logistic regression model (in addition to non-weighted logistic models). We also evaluated risk factors for early locoregional recurrence using IPTW logistic regression analysis. Results: In the comparison of uniportal and multiportal VATS, the resected lymph node count (14.03±8.02 vs. 14.41±7.41, respectively; p=0.48) and rate of nodal upstaging (6.5% vs. 8.7%, respectively; p=0.51) appeared similar. Predictors of nodal upstaging included tumor size (odds ratio [OR], 1.74; 95% confidence interval [CI], 1.12-2.70), carcinoembryonic antigen level (OR, 1.11; 95% CI, 1.04-1.18), and histologically confirmed pleural invasion (OR, 3.97; 95% CI, 1.89-8.34). The risk factors for locoregional recurrence within 1 year were found to be number of resected N2 nodes, age, and nodal upstaging. Conclusion: Uniportal and multiportal VATS appear similar with regard to accuracy and thoroughness, showing no significant difference in the extent of nodal dissection.

• Asian Pacific Journal of Cancer Prevention
• /
• v.14 no.9
• /
• pp.5219-5223
• /
• 2013

The number of axillary lymph nodes involved and retrieved are important prognostic factors in breast cancer. The purpose of our study was to investigate whether the lymph node ratio (LNR) is a better prognostic factor in predicting disease-free survival (DFS) for breast cancer patients as compared with pN staging. The analysis was based on 804 breast cancer patients who had underwent axillary lymph node dissection between 1999 and 2008 in Sun Yat-Sen University Cancer Center. Optimal cutoff points of LNR were calculated using X-tile software and validated by bootstrapping. Patients were then divided into three groups (low-, intermediate-, and high-risk) according to the cutoff points. Predicting risk factors for relapse were performed according to Cox proportional hazards analysis. DFS was estimated using the Kaplan-Meier method and compared by the log-rank test. The 5-year DFS rate decreased significantly with increasing LNRs and pN. Univariate analysis found that the pT, pN, LNR, molecule type, HER2, pTNM stage and radiotherapy well classified patients with significantly different prognosis. By multivariate analysis, only LNR classification was retained as an independent prognostic factor. Furthermore, there was a significant prognostic difference among different LNR categories for pN2 category, but no apparent prognostic difference was seen between different pN categories in any LNR category. Therefore, LNR rather than pN staging is preferable in predicting DFS in node positive breast cancer patients, and routine clinical decision-making should take the LNR into consideration.

• Journal of Chest Surgery
• /
• v.36 no.8
• /
• pp.630-632
• /
• 2003

In off-pump coronary artery bypass grafting (CABG), multiple proximal anastomosis may increase the risk of cerebral embolism (air, debris) and aortic injury (dissection, pseudoaneurysm). Radial artery (RA) has no intraluminal valve such as saphenous vein. We applied Cabrol technique using aortic root replacement for proximal anastomosis in off-pump CABG. Cabrol technique using RA graft can reduce numbers of proximal anastomosis and reduce number of aortic manipulation in off-pump CABG. We report a Cabrol technique for proximal anastomosis in off-pump CABG with RA graft.

• Journal of Life Science
• /
• v.19 no.6
• /
• pp.720-727
• /
• 2009

Lyophilized powder (BP2FS) of soybeans fermented with Bacillus polyfermenticus KJS-2 (B. polyfermenticus KJS-2) exhibited in vitro antibacterial activities against eight pathogenic bacteria. BP2FS was used as a fodder additive for Oplegnathus fasciatus (0. fasciatus) culture. One group (UFD) of O. fasciatus was fed a commercial fodder, while another group (FD) was fed the same fodder, but including BP2FS ($6{\times}10^{4}$ cfu $g^{-1}$ fodder), two times daily for 120 days. The mean body weight of the FD group (67.29${\pm}$12.62 g) was higher than that of the UFD group (56.56${\pm}$8.21 g) after 120 days. The survival rate of FD was 80% compared to 40% for the UFD group. Cumulative mortalities in the FD and UFD groups were 18.95% and 60.98% respectively. B. polyfermenticus KJS-2 was isolated from the intestines of the FD group and the number of viable colonies was estimated to be $1.04{\times}10^{4}$ cfu $g^{-1}$. Iridovirus and Vibrio vulnificus was detected in the organs of the UFD group but not in the FD group. All of the infected fish showed typical clinical symptoms of hemorrhage in their tail fins. Dissection of the infected internal organs revealed liver congestion and spleen enlargement - typical symptoms caused by iridovirus infection. These results clearly show that BP2FS is highly beneficial in preventing O. fasciatus from iridovirus infection.

• Journal of Gastric Cancer
• /
• v.19 no.4
• /
• pp.427-437
• /
• 2019

Purpose: We aimed to evaluate the clinical characteristics of microsatellite instability in early gastric cancer. Materials and Methods: The microsatellite instability status of resected early gastric tumors was evaluated using two mononucleotide repeat markers (BAT25 and BAT26) and three dinucleotide repeat markers (D5S346, D2S123, and D17S250). Tumors with instability in two or more markers were defined as microsatellite instability-high (MSI-H) and others were classified as microsatellite stable (MSS). Results: Overall, 1,156 tumors were included in the analysis, with 85 (7.4%) classified as MSI-H compared with MSS tumors. For MSI-H tumors, there was a significant correlation with the female sex, older age, tumor location in the lower gastric body, intestinal histology, lymphovascular invasion (LVI), and submucosal invasion (P<0.05). There was also a trend toward an association with lymph node (LN) metastasis (P=0.056). In mucosal gastric cancer, there was no significant difference in MSI status in tumors with LN metastasis or tumors with LVI. In submucosal gastric cancer, LVI was more frequently observed in MSI-H than in MSS tumors (38.9% vs. 25.0%, P=0.027), but there was no difference in the presence of LN metastases. The prognosis of MSI-H tumors was similar to that of MSS tumors (log-rank test, P=0.797, the hazard ratio for MSI-H was adjusted by age, sex, pT stage, and the number of metastatic LNs, 0.932; 95% confidence interval, 0.423-2.054; P=0.861). Conclusions: MSI status was not useful in predicting prognosis in early gastric cancer. However, the frequent presence of LVI in early MSI-H gastric cancer may help guide the appropriate treatment for patients, such as endoscopic treatment or limited LN surgical dissection.

• Journal of the Korean Orthopaedic Association
• /
• v.54 no.6
• /
• pp.574-578
• /
• 2019

For the treatment of a bony Bankart lesion accompanied by an acute traumatic shoulder dislocation, anatomical reduction and stable fixation of the bone fragment and glenohumeral ligament are essential to avoid chronic instability or degenerative changes. If the Bankart lesion has large bony pieces or comminuted fragments, it can be difficult to perform precise and secure fixation of the big intraarticular fragment to the fracture site because of the limited visualization of the arthroscopic procedure. In addition, in the case of the open procedure, it requires an extensive surgical dissection to access the fractured fragment, which may cause surgical approach-related morbidity, such as neurovascular complications, delayed subscapularis healing, and increased risk of stiffness. This paper describes an alternative open suture anchor technique for a large bony Bankart lesion, which was secured anatomically with squared knots after a shuttle relay through bony tunnels and adjacent soft tissue and labrum. This technique can achieve anatomical and firm fixation under direct vision, and reduce the number of surgery related morbidities.

• Journal of Korean Neurosurgical Society
• /
• v.67 no.4
• /
• pp.411-417
• /
• 2024

Objective : To confirm the usefulness of the extradural anterior clinoidectomy during the clipping of a low riding posterior communicating artery (PCoA) aneurysm through cadaver dissection. Methods : Anatomic measurements of 12 adult cadaveric heads (24 sides total) were performed to compare the microsurgical exposure of the PCoA and internal carotid artery (ICA) before and after clinoidectomy. A standard pterional craniotomy and transsylvian approach were performed in all cadavers. The distance from the ICA bifurcation to the origin of PCoA (D1), pre-anterior clinoidectomy distance from the ICA bifurcation to tentorium (D2), post-anterior clinoidectomy distance from the ICA bifurcation to tentorium (D3), pre-anterior clinoidectomy distance from the tentorium to the origin of PCoA (D4) and post-anterior clinoidectomy distance from the tentorium to the origin of PCoA (D5) and the distance of the ICA obtained after anterior clinoidectomy (D6) were measured. We measured the precise thickness of the blade for the Yasargil clip with a digital precision ruler to confirm the usefulness of the extradural anterior clinoidectomy. Results : Twenty-four sites were dissected from 12 cadavers. The age of the cadavers was 79.83±6.25 years. The number of males was the same as the females. The space from the proximal origin of the PCoA to the preclinoid-tentorium (D4) was 1.45±1.08 mm (max, 4.01; min, 0.56). After the clinoidectomy, the space from the proximal origin of the PCoA to the postclinoid-tentorium (D5) was 3.612±1.15 mm (max, 6.14; min, 1.83). The length (D6) of the exposed proximal ICA after the extradural clinoididectomy was 2.17±1.04 mm on the lateral side and 2.16±0.89 mm on the medial side. The thickness of the Yasargil clip blade used during the clipping surgery was 1.35 mm measured with a digital precision ruler. Conclusion : The proximal length obtained by performing an external anterior clinoidectomy is about 2 mm, sufficient for proximal control during PCoA aneurysm surgery, considering the thickness of the aneurysm clips. In a subarachnoid hemorrhage, performing an extradural anterior clinoidectomy could prevent a devastating situation during PCoA aneurysm clipping.