• Journal of Chest Surgery
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• v.8 no.2
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• pp.149-152
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• 1975

In spite of great advances in surgical treatment during past several decades, surgery of the trachea failed to develop correspondingly, partly because of relative rarity of the tracheal lesions and partly because of difficulties in surgical technique and anesthesia. Surgical diseases of the trachea are largely obstructions due to neoplasm or cicatrical stenosis and tracheal malacia. The present treatment of respiratory failure, using cuffed endotracheal and tracheostomy tubes, has produced, apparently with increasing frequency, tracheal stenosis, tracheomalized tracheal erosion. Surgery is presently the only reasonable way to treat stenotic lesions of the tracheobronchial tree. In the case of tumors, the current trend has been that of radical excision. Primary end-to--end reconstruction of the trachea has been generally recognized as the ideal method of repair following resection. However, for decades it was believed that a maximum of four tracheal rings only might be excised and primary healing achieved with safety. A great variety of procedures, developed by numerous investigations and directed at tracheal substitution, have almost invariably met with discouraging results. A meticulous study done by Grillo and associates on autopsy specimens has shown that an average 6.4cm of mediastinal trachea can be safely resected by full mobilization of the right lung and transplantation of the left main bronchus into the bronchus intermedius. Recently, we experienced a case of successful resection of a tumor of the tracheal carina and primary tracheo-left main bronchial anastomosis at the Department of Thoracic & Cardiovascular Surgery, the National Medical Center in Seoul. The patient, a 29-year-old man, was admitted to the hospital with complaints of dyspnea and cough. On admission, chest film showed hydropneumothorax on the right. After closed thoracostomy, hydropneumothorax disappeared, but hazy densities, developed in the right middle and lower lung fields, resisted to treatment. Bronchoscopy uncovered irregular tumor covering the carina and the right main bronchus, and biopsy indicated well differentiated squamous Cell carcinoma. Operation was performed on July 2, 1975. A right postero-lateral thoracotomy was used. Excision involved the lower trachea, the carina, the left main bronchus and the right lung. This was followed by direct anastomosis between the trachea and the left main bronchus. Bronchography was done on 17th postoperative day revealed good result of operation without stricture at the site ofanastomosis. About one month after the operation symptoms and signs of bronchial irritation with dyspnea developed, and these responded to respiratory care. On 82nd postoperative day, sudden dyspnea developed at night and the patient expired several hours later. Autopsy was not done and the cause of death was uncertain.

• Journal of Chest Surgery
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• v.43 no.4
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• pp.399-403
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• 2010

Background: Video-Assisted Thoracic Surgery can be performed with the lung collapsed. During the procedure, pleural adhesion may result in lung injury, bleeding, and thoracotomy conversion. Identifying the presence of pleural adhesion before surgery can make it easy to plan trocar introduction and perform the procedure. Material and Method: Between June 2009 and November 2009, we performed ultrasound in 24 patients to detect pleural adhesion before surgery and compared the results with the operative findings. We primarily examined the lateral chest, where the trocar would be inserted, and, occasionally, the anterior or posterior chest. Result: Patient diseases were: 6 hyperhidroses, 8 interstitial lung diseases, 5 lung cancers, 2 mediastinal tumors, 1 peripheral pulmonary embolism, 1 metastatic lung cancer, and 1 sarcoidosis. Of the 22 patients who did not have pleural adhesions on ultrasound, four revealed mild adhesions not related to the trocar insertion sites. However, ultrasound showed pleural adhesions in two patients, consistent with the operative findings. There was no air leak or thoracotomy conversion related with trocar insertion. Conclusion: Ultrasound requires only a few minutes to detect the presence of the pleural adhesion and was very useful in identifying the pleural adhesion before VATS.

• Journal of Chest Surgery
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• v.52 no.4
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• pp.221-226
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• 2019

Background: Accurate mediastinal lymph node staging is vital for the optimal therapy and prognostication of patients with lung cancer. This study aimed to determine the preoperative risk factors for pN2 disease, as well as its incidence and long-term outcomes, in patients with clinical N0-1 non-small cell lung cancer. Methods: We retrospectively analyzed patients who were treated surgically for primary non-small cell lung cancer from November 2005 to December 2014. Patients staged as clinical N0-1 via chest computed tomography (CT) and positron emission tomography (PET)-CT were divided into two groups (pN0-1 and pN2) and compared. Results: In a univariate analysis, the significant preoperative risk factors for pN2 included a large tumor size (p=0.083), high maximum standard uptake value on PET (p<0.001), and central location of the tumor (p<0.001). In a multivariate analysis, central location of the tumor (p<0.001) remained a significant preoperative risk factor for pN2 status. The 5-year overall survival rates were 75% and 22.9% in the pN0-1 and pN2 groups, respectively, and 50% and 78.2% in the patients with centrally located and peripherally located tumors, respectively. In a Cox proportional hazard model, central location of the tumor increased the risk of death by 3.4-fold (p<0.001). Conclusion: More invasive procedures should be considered when preoperative risk factors are identified in order to improve the efficacy of diagnostic and therapeutic plans and, consequently, the patient's prognosis.

• Journal of Chest Surgery
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• v.36 no.11
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• pp.846-851
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• 2003

Background: To clarify the clinical significance of the aortic nodes in resected non-small cell lung cancer of the left upper lobe. Material and Method: One hundred fifty six patients with resected non-small cell lung cancer of the left upper lobe were studied. Patients who received preoperative induction therapy, non-curative operation or defined as operative mortality were excluded from this study. Result: In N2 left upper lobe tumors, aortic nodes comprised 52.7% of the metastatic mediastinal lymph nodes. In single station N2 disease, a frequently metastasized station was aortic node (64.3%). 5-year actuarial survival according to the N status was 65.0% in N0, 30.4% in N1, and 17.9% in N2. There was no statistically significant difference in survival between N1 and N2 diseases (p=0.06). The patients with metastasis to aortic node alone had a comparatively good prognosis (5-year survival: 35.6%) than other N2 diseases (5-year survival: 4.6%) (p=0.01) and had a similar survival outcome as N1 diseases (p=0.97). Considering the aortic node as N1 node, 5-year survival according to the N status was 65.0% in N0, 31.2% in N1, 4.6% in N2 and significant survival difference was observed between N1 and N2 disease (p=0.00). In multivariate analysis, the male sex (hazard ratio 6.892, p=0.011) and the involvement to the aortic node alone (hazards ratio 2.799, p=0.009) were the significant factors affecting postoperative survival. Conclusion: According to the our data, involvement to the aortic node alone in left upper lobe tumors should be grouped with N1 disease because this combined category reflects the surgical outcome more accurately.

• Radiation Oncology Journal
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• v.14 no.3
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• pp.221-228
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• 1996

Purpose : We tried to evaluate the clinical characteristics, the treatment methods, the results of treatments, and the Patterns of failure in ovarian dysgerminoma retrospectively According to the results we would like to suggest the proper management guideline of stage la ovarian dysgerminoma patients who want to maintain fertility. Materials and Methods : Between 1975 and 1990, 34 patients with ovarian dysgerminoma were treated at the Yonsei University Hospital. The case records of these patients have been reviewed for presenting symptoms, treatment methods, local control and survival following treatment. Excluded from analysis were five patients with mixed ovarian germ cell tumors and gonadoblastomas (46,XY) Treatment results of the twenty nine patients were analysed by each treatment modality. Twenty one patients were treated with surgery and postoperative adjuvant radiotherapy (group 2). The other eight patients were treated with operation alone (group 2). The median age of twenty-nine patients was 23 years with a range of 8 to 39 years. Presenting symptoms were abdominal mass (20) pelvic discomfort or pain (5) et al. Radiotherapy was performed by 10MV LINAC or Co-60 teletherapy unit. The total radiation dose of the whole abdomen was 20-25 Gy/3weeks, 1-1.5 Gy/fraction with a boost to the whole pelvis 10-15 Gy/l-2weeks 1.8-2.0 Gy/fraction. Advanced stage disease (stage II or stage III) patients received prophylactic mediastinal and supraclavicular irradiation to a dose of 16-26 Gy. Median duration of follow-up of living patients was 80 months (range 13-201 months). Results : All of the twenty one patients of group 1 were alive without disease ($100\%$). Among the eight patients who were not treated with radiotherapy (group 2), six patients developed local recurrence. Four Patients referred with recurrent disease were treated with salvage radiotherapy. Three of four patients were salvaged and one Patient who had recurrent intra-abdominal disease died of progressed carcinomatosis at 11 months after salvage radiotherapy. The other two patients with recurrence were salvaged with chemotherapy (1 patient) or re-operation (1 Patient). Twenty eight patients remained alive without disease at last follow up, so the 5 year local control rate and 5 year overall survival rate for all groups were $96.6\%$ (28/29), respectively. Among thirteen patients with stage la unilateral tumors seven patients were treated with postoperative radiotherapy and the other six patients were treated with unilateral salpingo-oophorectomy alone. Five patients who did not received radiotherapy developed local failure but all of the recurrent ovarian dysgerminomas were salvaged with radiotherapy, chemotherapy or re-operation. So all the 13 patients with stage la ovarian dysgerminoma were free of disease from 20-201 months (median 80 months). Conclusion : The authors consider external irradiation to be an effective treatment as a complement to surgery in ovarian dysgerminoma. For those patients with disease presenting in stage la tumors who wish to maintain fertility, unilateral salpingo-oophorectomy alone may be curative and spare ovarian function considering excellent salvage rate of recurrent ovarian dysgerminoma in present study.

• Journal of Chest Surgery
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• v.31 no.2
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• pp.134-141
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• 1998

Primary lung cancer has recently increased progressively in its incidence in Korea. It is clearly evident that surgical resection offers the best offortunity for cure of non-small cell carcinoma. This study was designed to analyse the clinical data of 100 primary non-small cell carcinoma patients who underwent lung resection surgery from January 1992 to July 1995 at the department of Thoracic and Cardiovascular Sugery, Kyungpook National University Hospital. There were 86 males and 14 females(6:1). In the age distribution, the peak incidence was recorded in the seventh decade(43%). The methods of tissue diagnosis were bronchoscopic biopsy in 53 patients(50.5%), percutaneous needle aspiration in 17 patients(16.2%), transbronchial lung biopsy in 11 patients(10.5%), mediastinoscopic biopsy in 2 patients (1.9%), sputum cytology in 2 patients(1.9%), and thoracotomy in 20 patients(19.0%). Fifty-five lobectomies, 22 pneumonectomies, 15 bilobectomies, 2 segmentectomies, 4 sleeve lobectomies, a sleeve pneumonectomy, and a wedge pneumonectomy were performed. Operative mortality occured in 4 cases(sepsis in 2 cases, respiratory failure in 1 case, and acute myocardiac infarction in 1 case). The histologic types of tumor were 67 squamous cell carcinomas, 26 adenocarcinomas, 6 large cell carcinomas, and an adenosquamous cell carcinoma. Eighteen patients with N2 mediastinal lymph node metastases had 8 squamous cell carcinomas(11.9%), 9 adenocarcinomas(34.6%), and a large cell carcinoma(16.7%). The primary tumors in these patients were in the right upper lobe in 4 patients, the right middle and lower lobe in 9 patients, the left upper lobe in 3 patients, and the left lower lobe in 2 patients. With regard to pathologic stages, 45 patients had stage I disease; 13 patients, stage II; 36 patients, stage IIIa; 5 patients, stage IIIb; and 1 patient, stage IV. The overall actuarial survival rate was 77.5% at 12 months, 56.1% at 24 months and 43.7% at 43 months. The actuarial survival rates at 43 months were 81.3% in Stage I, 20.8% in Stage II, 27.9% in Stage IIIa, 25.0% in Stage IIIb and 33.3% in Stage IV. These facts suggest that early detection and surgical resection are recommended for favorable postoperative survival in non-small cell lung cancer.

• Journal of the Korean Society of Radiology
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• v.82 no.3
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• pp.562-574
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• 2021

MRI has the advantages of having excellent soft-tissue contrast and providing functional information without any harmful ionizing radiation. Although previous technical limitations restricted the use of chest MRI, recent technological advances and expansion of insurance coverage are increasing the demand for chest MRI. Recognizing the need for guidelines on appropriate use of chest MRI in Korean clinical settings, the Korean Society of Radiology has composed a development committee, working committee, and advisory committee to develop Korean chest MRI justification guidelines. Five key questions were selected and recommendations have been made with the evidence-based clinical imaging guideline adaptation methodology. Recommendations are as follows. Chest MRI can be considered in the following circumstances: for patients with incidentally found anterior mediastinal masses to exclude non-neoplastic conditions, for pneumoconiosis patients with lung masses to differentiate progressive massive fibrosis from lung cancer, and when invasion of the chest wall, vertebrae, diaphragm, or major vessels by malignant pleural mesothelioma or non-small cell lung cancer is suspected. Chest MRI without contrast enhancement or with minimal dose low-risk contrast media can be considered for pregnant women with suspected pulmonary embolism. Lastly, chest MRI is recommended for patients with pancoast tumors planned for radical surgery.

• Journal of Chest Surgery
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• v.38 no.1 s.246
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• pp.44-49
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• 2005

Although thymomas are relatively common mediastinal tumors, to date not only has a universal system of pathologic classification not been established but neither has a clearly defined predictable relationship between treatment and prognosis been made. Recently, a new guideline for classification was reported by WHO, and efforts, based on this work, have been made to better define the relationship between treatment and pro­gnostic outcome. In the present study a comparative analysis between the WHO classification and Masaoka stage system with the clinical disease pattern was conducted. Material and Method: A total of 98 patients undergoing complete resection for mediastinal thymoma between Juanuary 1993 and June 2003 were included in the present study. The male female ratio was 48 : 50 and the mean age at operation was $49.6{\pm}13.9\;years.$ A retrospective analytic comparison studying the relationship between the WHO classification and the Masaoka stage system with the clinical disease pattern of thymoma was conducted. Pathologic slide specimens were carefully examined, details of postoperative treatment were documented, and a relationship with the prognostic outcome and recurrence was studied. Result: There were 7 patients in type A according to the WHO system of classification, 14 in AB, 28 in B 1, 23 in B2, 18 in B3, and 9 in type C. The study of the relationship between the Masaoka stage and WHO classification system showed 4 patients to be in WHO system type A, 7 in type AB, 22 in B 1, 17 in B2, and 3 in type B3 among 53 $(54{\%})$ patients shown to be in Masaoka stage I. Among 28 $(28.5{\%})$ patients in Masaoka stage II system, there were 2 patients in type A, 7 in AB, 4 in B 1, 2 in B2, 8 in B3, and 5 in type C. Among 15 $(15.3{\%})$ in Masaoka stage III, there were 1 patient in type B1, 3 in B2, 7 in B3, and 4 in type C. Finally, among 2 $(2{\%})$ patients found to be in Masaoka stage IV there was 1 patient in type B1, and 1 in type B2. The mean follow up duration was $28{\pm}6.8$ months. There were 3 deaths in the entire series of which 2 were in type B2 (Masaoka stages III and IV), and 1 was in type C (Masaoka stage II). Of the patients that experienced relapse, 6 patients remain alive of which 2 were in type B2 (Masaoka III), 2 in type B3 (Masaoka I and III) and 2 in type C (Masaoka stage II). The 5 year survival rate by the Kaplan-Meier method was $90{\%}$ for those in type B2 WHO classification system, $87.5{\%}$ for type C. The 5 year freedom from recurrence rate was $80.7{\%}$ for those in WHO type B2, $81.6{\%}$ for those in type B3, and $50{\%}$ for those in type C. By the Log-Rank method, a statistically significant correlation between survival and recurrence was found with the WHO system of classification (p<0.05). An analysis of the relationship between the WHO classification and Masaoka stage system using the Spearman correction method, showed a slope=0.401 (p=0.023), showing a close correlation. Conclusion: As type C of the WHO classification system is associated with a high postoperative mortality and recurrence rate, aggressive treatment postoperatively and meticulous follow up are warranted. The WHO classification and Masaoka stage system were found to have a close relationship with each other and either the WHO classification method or the Masaoka stage system may be used as a predict prognostic outcome of Thymoma.

• Radiation Oncology Journal
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• v.15 no.4
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• pp.379-385
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• 1997

Purpose : Ovarian dysgerminoma is a highly radiosensitive malignant tumor occurring in young age group. The conventional treatment was total abdominal hysterectomy and bilateral salpingo-oophorectomy followed by radiotherapy. We retrospectively analyzed the treatment results of Patients who had received radiotherapy in the era before chemotherapy was widely used. Material and Method : Twenty two patients with ovarian dysgerminoma were treated at the Department of Therapeutic Radiology, Seoul National University Hospital between August, 1980 and May, 1991. Four patients were excluded from this study, because three patients received incomplete treatment and one received combined chemotherapy. Sixteen patients received postoperative radiotherapy and two patients had radical radiotherapy as tumor was unresectable. Median follow-up period was 99 months (range, 51-178) Median age was 22 years (range, 11-42). Among the postoperatively treated patients, three Patients were in stage IA, eight in stage IC, two in stage II, and three in stage III. One patient had Turner's syndrome. Radiotherapy was performed with high energy photon (telecobalt unit or linear accelerator, either 6MV or 10MV), The radiation dose to the whole abdomen was 1950-2100cGy (median, 2000) and 1050-2520cGy was added to the whole pelvis, the total dose to the whole pelvis was 3000-4500cGy (median, 3500). Prophylactic Paraaortic area irradiation was done in six Patients (dose range, 900-1500cGy). One patient who had positive Paraaortic node, received radiation dose of 1620cGy, followed by additional 900cGy to the gross mass with shrinking field. Total dose to the paraaortic node was 4470cGy. Six patients, including one who had paraaortic node metastasis, received Prophylactic irradiation to mediastinum and supraclavicular area (2520cGy). Of the two patients with unresectable tumors who received radical radiotherapy, one was in stage III and the other was in stage IV with left supraclavicular lymph node metastasis. The stage III patient received radiation to the whole abdomen (2000cGy), followed by boost to whole pelvis (2070cGy) and paraaortic area (2450cGy). Stage IV patient received radiation to the whole abdomen (2000cGy), followed by radiation to the whole pelvis and paraaortic area (2400cGy), mediastinum (2520cGy) , and left supraclavicular area (3550cGy) .Results : The 5 year local control rate was $100\%$ in patients who received postoperative adiuvant radiotherapy after total abdominal hysterectomy and bilateral salpingo-oophorectomy. Only one patient in stage III who did not receive prophylactic irradiation to mediastinum developed mediastinal metastasis. but was salvaged by chemotherapy. So. the 5 year overall survival rate uras also $100\%$. Two patients who received radiation only, are alive without disease at 112 and 155 months. Conclusion : Postoperntive adjuvant radiotherapy as well as radical radiotherapy in unresectable ovarian dysgerminoma was very effective. aut chemotherapy is also an effective treatment modality We now recomrneifd chemotherapy for Patients who need to save their ovarian functien and reserve radiotherapv fov chemo-resistant tumor or recurrence alter che motherapy.