• Journal of Chest Surgery
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• 제29권11호
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• pp.1248-1256
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• 1996

원자력병원에서는 1987년 6월부터 1994년 12월까지 식도암으로 수술받은 372명중 병리학적으로 원격 복부 림파절의 전이가 확인된 병기 IV(M1LYN) 48명(12.9%)의 기록을 분석하였다. 원발 종양의 위치는 주로 하흉부 식도이었고, 전이된 림프절의 위치는 복강 동맥(n=45),총간 동맥(n=4), 대동맥 주위(n=1), 췌장하(n=1) 이었다. 대부분의 종양은 T3, T4(n=43)이고 국소 림프절 전이 (n=41)가 있었으나, T1, T2 종양(n=5)와 국소 림프절 전이없이 원격 림프절에 전이한 경우(n=7)도 일부있었다. 절제률과 완전 절제률은 각각 87.5%, 64.6%이었다. 절제 불가능과 불완전 절제의 원인의 대부분은 절제 불가능한 T4 병소(n=8), 림프절 막외 침습(n=7)이었으며, 전체 수술 사망률과 유병률은 각각 4.2%, 22.9%이었고, 절제 사망률은 4.8%이었다. 27명에서 수술후 보조 치료를 병행하였으며, 수술후 모든 생존 환자에서 추적이 가능하였다(추적 중앙값, 32개월). 수술 사망을 포함하여 식도암의 절제를 받은 환자(n=42)의 I년, 3년 생존률은 각각 54.0%, 18.1%(중앙값, 386일)이었다. 이상의 결과로, 원격 복부 림프절의 전이를 동반한 식도암은 수술의 사망률과 유병률이 높지 않으며, 수술을 받지 않은 환자의 예후가 극히 나쁘므로 잘 선택된 환자에서는 원격장기로 전이된 환자에 비하여 절제술의 역할이 인정된다. 그러나 수술만으로는 장기 성적이 좋지 않으므로 항암제 치료나 방사선 치료 등의 복합 치료에 대한 연구가 필요하다고 생각한다.

• Radiation Oncology Journal
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• 제4권2호
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• pp.129-133
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• 1986

한 환자에서 두개 이상의 중복암이 발생하는 경우는 매우 드물게 알려져 왔으나 근래에 들어와 치료법의 발달로 환자의 수명이 연장되고 진단법이 발달되면서 그 보고가 증가되고 또한 관심도 높아지고 있는 상태이다. 따라서 이런 중복암을 가진 환자의 특성을 분석함으로써 발생할 수 있는 2차 3차 암의 조기 발견 및 나아가서는 발암 물질과 유전적 요인 등을 찾아 암의 치료 및 예방에 이응 할 수 있겠다. 이에 $1978.7\~1986.8$까지 8년간 서울 대학교 병원에서 중복암으로 진단되어 치료받은 121예를 대상으로 하여 다음과 같은 결과를 얻었다. 전체 발생율은$0.7\%$이 있으며 이중 2중복암이 119례, 3중복암이 2례 있었다. 동시성은 (6개월 이내) 51례, 속발성은 (6개월 이상) 70례이었으며 속발성의 경우 $70\%$이상에서 3년내에 2차 암이 발생했다. Moertel분류에 의한 mvlticentriz은 $11.6\%$로 다소 낮은 빈도를 보였으며 다른 장기에 발생한 중복암 중에서는 위암과 간암, 위암과 직장암의 빈도가 가장 높았다.

• 대한기관식도과학회지
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• 제2권1호
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• pp.57-62
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• 1996

Tracheal stenosis can be classified into intrinsic stenosis secondary to tracheal inflammatory lesion or mass effect and extrinsic stenosis secondary tumors of thyroid, esophagus and mediastinum. Extrinsic stenosis which is frequently encountered in clinical setting could be often overlooked due to mild symptom. Recently, even with the increasing interest in extrinsic tracheal stenosis there are limitation in it's diagnosis and treatment. The purpose of this study is to provide guidance in the diagnosis and treaonent of extrinsic tracheal stenosis. Here, we report the etiology, symptoms, radiologic findings, pulmonary fuction finding, treatment and its results in 26 cases of extrinsic tracheal stenosis. Causes of extrinsic tracheal stenosis included compression of aiway by thyroid benign tumor in 13 cases to be the most common, next by thyroid malignancy in 9 cases, metastatic mediastinal turner in 2 cases, 1 case each for esophageal cancer and parathyroid cancer. In 3 cases simple tracheal resection and end to end anastomosis were done, 1 cases underwent total laryngectomy, and 8 cases were treated by conservative management, where all cases failed in treatment. The remaining 14 cases were successfully treated by removing the causes and maintaining tracheal tube insertion for amount of time. Extrinsic tracheal stenosis due to benign conditions were treated satisfactorily by removing mass, however with the malignant causes there was considerable amount of difficulty in treatment.

• 대한두경부종양학회지
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• 제16권1호
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• pp.26-32
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• 2000

Background and Objectives: Various flaps are using for reconstruction of hypopharyngeal and esophageal defect. However, complication and indication of each flap are not fully analyzed. Patient and Methods: Records of 52 hypopharyngeal cancer patients who had surgical treatment and 13 other head and neck cancer patients who underwent hypopharyngeal and/or esophageal reconstruction with flap were retrospectively analyzed. Eighty three percent(54 cases) of patients needed reconstruction other than primary pharyngeal closure. Five split thickness skin graft, 1 pectoralis major myocutaneous flap, 20 forearm free flap, 13 jejunal free flap, 15 gastric pull up were used. Result: Flap failure was noted in 2 cases who had subsequent gastric transposition. Wound dehiscence and fistula were most common problem of forearm free flap. Most fistulas were developed in patients with conduit type reconstruction of forearm flap while there wasn't any fistula in patient with patch type reconstruction. Stenosis of lower anastomosis was the frequent problem of jejunal transfer. Gastric pull-up has frequent com-plication of stomal stenosis. All but three patients had reached oral feeding postoperatively. Conclusion: Based on this study, forearm flap is effective in partial hypopharyngeal defect while jejunum is the choice for circumferential defect. Gastric pull-up is for combined esophageal defect.

• Asian Pacific Journal of Cancer Prevention
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• 제16권7호
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• pp.2999-3001
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• 2015

Background: This study aimed to evaluate upper gastrointestinal polyps detected during esophago-gastroduodenoscopy tests. Materials and Methods: We conducted a retrospective analysis on data regarding 55,987 upper gastrointestinal endoscopy tests performed at the endoscopy unit of Istanbul Education and Research Hospital between January 2006 and June 2012. Results: A total of 66 upper gastrointestinal polyps from 59 patients were analyzed. The most common clinical symptom was dyspepsia, observed in 41 cases (69.5%). The localizations of the polyps were as follows: 29 in the antrum (43.9%), 15 in the corpus (22.7%), 11 in the cardia (16.7%), 3 in the fundus (4.54%), 3 in the second portion of the duodenum (4.54%), 2 in the bulbus (3.03%) and 3 in the lower end of the esophagus (4.54%). Histopathological types of polyps included hyperplastic polyps (44) (66.7%), faveolar hyperplasia (8) (12.1%), fundic gland polyps (4) (6.06%), squamous cell polyps (4) (6.06%), hamartomatous polyps (3) (4.54%), and pyloric gland adenoma (3) (4.54%). Histopathological analysis of the gastric mucosa showed chronic atrophic gastritis in 30 cases (50.84%), HP infection in 33 cases (55.9%) and intestinal metaplasia in 19 cases (32.20%). In 3 cases with multiple polyps, adenocarcinoma was detected in hyperplastic polyps. Conclusions: Among polypoid lesions of the upper gastrointestinal tract, the most common histological type is hyperplastic polyps. Generally, HP infection is associated with chronic atrophic gastritis and intestinal metaplasia. The incidence of adenocarcinoma tends to be higher in patients with multiple hyperplastic polyps.

• Journal of Chest Surgery
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• 제51권3호
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• pp.187-194
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• 2018

Background: Death domain-associated protein (DAXX), originally identified as a pro-apoptotic protein, is now understood to be either a pro-apoptotic or an anti-apoptotic factor with a chromatin remodeler, depending on the cell type and context. This study evaluated DAXX expression and its clinical implications in squamous cell carcinoma of the esophagus. Methods: Paraffin-embedded tissues from 60 cases of esophageal squamous carcinoma were analyzed immunohistochemically. An immune reaction with more than 10% of tumor cells was interpreted as positive. Positive reactions were sorted into 2 groups: reactions in 11%-50% of tumor cells and reactions in more than 51% of tumor cells, and the correlations between expression and survival and clinical prognosticators were analyzed. Results: Forty-three of the 60 cases (71.7%) showed strong nuclear DAXX expression, among which 19 cases showed a positive reaction (31.7%) in 11%-50% of tumor cells, and 24 cases (40.0%) showed a positive reaction in more than 51% of tumor cells. A negative reaction was found in 17 cases (28.3%). These patterns of immunostaining were significantly associated with the N stage (p=0.005) and American Joint Committee on Cancer stage (p=0.001), but overall survival showed no significant difference. There were no correlations of DAXX expression with age, gender, or T stage. However, in stage IIB (p=0.046) and stage IV (p=0.014) disease, DAXX expression was significantly correlated with survival. Conclusion: This investigation found upregulation of DAXX in esophageal cancer, with a 71.7% expression rate. DAXX immunostaining could be used in clinical practice to predict aggressive tumors with lymph node metastasis in advanced-stage disease, especially in stages IIB and IV.

• Journal of Chest Surgery
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• 제25권5호
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• pp.504-510
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• 1992

Overall 25,095 cases of general thoracic surgery were analysed, which were performed by 48 institutes in Korea during recent 6 years[242 hospital-years]. The proportions of tumorous disease and infectious disease to be operated were 6,864 cases[27.4%] and 6,775 cases [27.0%], The most common organ involved for operation was lung-bronchus 16,542 cases [69.5%], and remainders were pleura 2,500 [10.0%], esophagus 2,433[9.7%], mediastinum 1,902[7.6%], chest wall 1,297 [5.2%], and diaphragm 421 [1.7%] in order. Among 6,864 cases of tumorous diseases, the most common causes for operation were lung-bronchus tumor 3132 cases [45.6%] and most of them were lung cancer 2,731 cases [88.7%]. In the 2,019 cases of primary lung cancer with known cell type, squamous cell carcinoma 1,296 cases [64.2%] and adenocarcinoma 460 cases [22.8%] were the most. The common types in the 1,207 cases of mediastinal tumor with known cell type were neurogenic tumor 348 cases [28.8%], thymoma 311 [25.8%], and teratoma 252[20.9%]. The annual cases of operation for tumorous disease including malignant tumor were increased steadily. Operation for infectious lung diseases [including bronchiectasis and tuberculosis] were about twice common than infectious pleural disease [i.e. empyema], and operations for tuberculous disease occupied about half cases of infectious lung disease. In 11,456 cases of other disease entities, excluding tumorous and infectious disease, there were bullous lung disease 9,074 cases[79.2%], benign esophageal disease 484[4.2%], myasthenia gravis 356[3.1%], chest wall deformity 483[4.2%], and diaphragmatic lesion 421[3. 7%] in order. We propose that above results for inquiry can be used as the basic data of general thoracic surgery in Korea.

• 임상이비인후과
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• 제29권2호
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• pp.316-320
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• 2018

Esophageal diverticulum is very rare disease. Since it usually has no symptoms, it is hard to find and diagnose. Moreover, if the diverticulum is located nearly to thyroid gland, surgeons sometimes misdiagnose as a thyroid nodule. Here, we represent our case which has papillary thyroid cancer and esophageal diverticulum together. In this case, we experienced the surgical procedure and postoperative complications of the esophageal diverticulum. Even though esophageal diverticulum was in preoperative computed tomography and ultrasound, it was neglected before the surgery so that found during the operation. The purpose of this study was to know the preoperative radiological findings of the esophageal diverticulum and to find out what to be aware of during surgery and how to manage the complications after surgery.

• Archives of Plastic Surgery
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• 제48권1호
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• pp.49-54
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• 2021

Background Reconstruction after removal of a malignant tumor in the head and neck region is crucial for restoring tissue integrity, function, and aesthetics. We retrospectively analyzed patients who underwent intraoral reconstruction surgery using radial forearm free flaps (RFFF) and anterolateral thigh free flaps (ALT) at a single institution to provide more information supporting the choice of a reconstruction method after removal of head and neck cancer. Methods The charts of 708 patients who underwent head and neck reconstruction between 1998 and 2018 at the Department of Plastic and Reconstructive Surgery at our institution were retrospectively reviewed. Patients' age, sex, and history of radiation therapy, diabetes mellitus, and smoking were retrieved. The primary cancer site, types of defects, and complications were investigated. Results Overall, 473 and 95 patients underwent reconstruction surgery with RFFF and ALT, respectively. RFFF was more often used in patients with cancers of the pharynx, larynx, esophagus, or tonsil, while ALT was more frequently used in patients with cancers of the mouth floor with tonsil or tongue involvement. The proportion of patients undergoing ALT increased gradually. Flap failure and donor site morbidities did not show significant differences between the two groups. Conclusions RFFF and ALT flaps resulted in similar outcomes in terms of flap survival and donor site morbidity. ALT can be an option for head and neck reconstruction surgery in patients with large and complex defects or for young patients who want to hide their donor site scars.

• 한국의학물리학회지:의학물리
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• 제34권1호
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• pp.10-13
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• 2023

Patients with breast cancer can be positioned with their head turned to the contra lateral side or with their head straight during the radiation therapy treatment set-up. In our hospital, patients with locally advanced breast cancer who were receiving radiation therapy have experienced swallowing difficulty after 2 weeks of irradiation. In this pilot study, the impact of head position on reducing dysphagia occurrence was dosimetrically evaluated. Patients were divided into two groups viz., HT (head turned to the contra lateral side of the breast) and HS (head straight) with 10 members in each. Treatment planning was performed, and the dosimetric parameters such as Dmin, Dmax, Dmean, V₅, V₁₀, V₂₀, V₃₀, V₄₀, and V₅₀ of both groups were extracted from the dose volume histogram (DVH) of esophagus. The target coverage in the supraclavicular fossa (SCF) region was analyzed using D₉₅ and D₉₈; moreover, the dose heterogeneity was assessed with D₂ from the DVHs. The average values of the dose volume parameters were 27.6%, 58.6%, 35.4%, 19%, 13.8%, 14.1%, 11.8%, 8.4%, and 8.1% higher in the HT group compared with those in the HS group. Furthermore, for the SCF, the mean values of D₉₈, D₉₅, and D₂ were 42.4, 47.5, and 54 Gy, respectively, in the HS group and 38.9, 45.35, and 55.5 Gy, respectively, in the HT group. This pilot study attempts to give a solution for the poor quality of life of patients after breast radiotherapy due to dysphagia. The findings confirm that the head position could play a significant role in alleviating esophageal toxicity without compromising tumor control.