• Journal of Gastric Cancer
• /
• v.1 no.1
• /
• pp.24-31
• /
• 2001

Purpose: Despite knowledge of the adverse effects of resection-line disease, surgeons continue to perform inadequate resections. This demonstrates the need for a more aggressive approach to assessment of resection margins at operation. Materials and Methods: Seven hundred fifteen gastric cancer patients who were operated on at our hospital from 1992 to 1998 were included in this analysis. Various clinicopathological factors, including resection-line involvement, were ascertained from the surgical and histopathological records. Results: Of the 715 evaluable patients, 27 patients ($3.8\%$) had involvement of one or both resection lines; in 10 patients the proximal resection line only, in 16 the distal resection line only, and 1 both resection lines were involved. Presence of resection-line involvement was significantly associated with T3 and T4 stage, N (+) stage, M (+) stage, type of operation (total gastrectomy), tumor location (entire stomach), size$\geq$11 cm), and gross type of tumor (Borrmann 4 type). When performing a distal subtotal gastrectomy, no involvement was found when the cranial and caudal distances between the lesion and the line of transection was equal to or greater than 2 cm and 3 cm, respectively, for early cancer and 7 cm and 3 cm, respectively, for advanced cancer. When performing a total gastrectomy for upper 1/3 or middle 1/3 gastric cancer, no involvement was found when the cranial distances between the lesion and the line of transection were equal to or greater than 3 cm and 4 cm, respectively, without distinction of the presence of serosal invasion. Conclusions: The difference in survival between positive and negative margin patients is limited to the group of patients with curative surgery. An important principle of treatment is that the entire tumor must be removed with a 3 cm distal margin and a 2- to 7 cm margin depending on the location and the depth of wall invasion of the tumor, to provide histologically negative margins.

• Asian Pacific Journal of Cancer Prevention
• /
• v.17 no.7
• /
• pp.3317-3320
• /
• 2016

Purpose: To assess the success rates of two step loop electrosurgical excision procedure (LEEP) compared with conventional cold conization procedures for decreasing positive surgical margins. Materials and Methods: This study was conducted on 70 patients who underwent colposcopic evaluation in Zeynep Kamil Women and Children's Health Training and Research Hospital between 2013-2015 with indications of CIN 2/3 or persistent CIN 1 for more than 2 years. The study included age matched groups of patients with similar histopathololical lesions who underwent cold conization (n=40) or LEEP (N=30). Results: Comparison of tissue characteristics between the two groups revealed significantly higher deepest depth and lower volume of tissue removed by the two step LEEP. Ectocervical positivity rate was similar between groups (1/39 versus 0/29, P>0.05), while endocervical surgical margin positivity rate was significantly higher in the cold conization group (9/39 versus 0/29, P<0.05). Surgical margin positive cases were significantly older than the cases with negative margins (P<0.05). Conclusions: Two step LEEP made it easier to reach the squamocolumnar junction in the endocervical region with lower blood loss and applicability in office settings. Our study suggests to use two step approach in cases with high grade and glandular CIN.

• Asian Pacific Journal of Cancer Prevention
• /
• v.14 no.4
• /
• pp.2529-2532
• /
• 2013

Background: Pelvic exenteration is a procedure which includes enbloc resection of pelvic organs followed by surgical reconstruction. Aims include both cure and palliation but data for pelvic exenteration in Thailand are very limited. Objective: This study was conducted to evaluate characteristics of patients, operative procedure outcomes and complications. Materials and Methods: This retrospective review covered all of the charts of exenteration patients during January 2002 to December 2011. Baseline characteristic of the patients were collected as well as details of clinical results. Results: A total of 13 cases of pelvic exenteration were included. Most underwent total pelvic exenteration (9 cases) and the remainder posterior and anterior exenteration. Their primary cancers were ovarian, cervical and vulva. Mean operative time was 532 minutes (SD 160.2, range 270-750) and estimated blood loss was 2830 ml (1850, 1000-8000). Mean tumor size was 7.33 cm (3.75, 4-15). Mean hospital stay was 35.2 days (29.8, 13-109). The most common post operative complication was urinary tract infection. Overall disease free survival with a negative surgical margin was significantly better than in positive surgical margin patients (p=0.014). Conclusions: Surgical margin was the most significant prognostic factor for disease free survival, in line with earlier studies.

• Asian Pacific Journal of Cancer Prevention
• /
• v.14 no.1
• /
• pp.321-324
• /
• 2013

Background: Intra- and extrahepatic cholangiocarcinoma (CCA) is the most common cancer in Thailand, especially in the northeast region. Most extrahepatic CCA patients consult a doctor at a late stage. Surgery is still the best treatment. Objectives: The aim of this study was to evaluate survival rates and factors affecting survival in extrahepatic CCA patients following surgery at Srinagarind Hospital, Khon Kaen University, Thailand. Materials and Methods: A retrospective cohort study was conducted with 58 patients who were diagnosed and treated by surgical resection by the same surgeon at Srinagarind Hospital between 2005 and 2009. The patients were followed up until death or the end of the study (31 December, 2011). Survival rates were calculated by the Kaplan-Meier method, and the Cox proportional hazard model was used to identify independent prognostic factors. Results: The total follow-up time was 1,215 person-months, and the mortality rate was 50 per 100 person-years. The cumulative 1-, 3-, and 5-year survival rates were 62.1%, 21.7% and 10.8%, respectively. The median survival time after resection was 15 months. After adjusting for age, gender, lymph node metastasis and histological type, resection margin remained as a statistically significant prognostic factor for survival following surgery. A positive resection margin was associated with a 2.3-fold higher mortality rate than a negative margin. Conclusions: Resection margins are important prognostic factors affecting survival of extrahepatic CCA patients after surgery. A negative resection margin can reduce the mortality rate by 56%.

• Korea Journal of Hospital Management
• /
• v.9 no.1
• /
• pp.22-45
• /
• 2004

This study was performed to identify factors affecting the profitability of private hospitals in Korea different and to make informations that could be very helpful to hospitals in improving profitability. Data used in this study were collected from 112 hospitals with complete general data of present conditions as well as financial statements(balance sheets, income statements). They were chosen from hospitals that passed the standardization audit undertaken by the Korean Hospital Association from 1998 to 2001 for the purpose of accrediting training hospitals. The dependent variables were used operating margin to total assets and operating margin to gross revenues as proxy indicators for profitability. The independent variables were ownership type, location, bed size, period of establishment, debt to total assets, current ratio, fixed ratio, total asset turnover, average length of stay, bed occupancy rate, admission ratio of outpatients, personnel costs per adjusted inpatient, and fiscal years. The factors had significantly positive effect on operating margin to total assets and operating margin to gross revenues were bed size, total asset turnover. And the factors had significantly negative effect on operating margin to total assets and operating margin to gross revenues were period of establishment, debt to total assets, average length of stay, personnel costs per adjusted inpatient. The adjusted $R^2$ of multiple regression equation was 25.2%, 21.4% respectively. It is very important for private hospitals to improve profitability by raising total asset turnover, and reducing debt to total assets, average length of stay, and personnel costs per adjusted inpatient using the rational and efficient business strategy.

• The Journal of the Korea Contents Association
• /
• v.14 no.1
• /
• pp.318-325
• /
• 2014

The aim is to analyze a performance evaluation of local governmental public hospitals. Data were collected from public disclosure system DB of National Tax Service on 15 July 2013. Twenty-two income statements of local governmental public hospitals were analyzed using descriptive statistic analysis. The analyzing factors were medical operating profit, contribution margin, and trend of operating profit. The important result was that the medical operating profit was negative, average medical operating profit was -4,678.9 million won. However, the contribution margin was positive in all local governmental public hospitals, and average contribution margin was 12,572.5 million won. The trend of operating profit was positive in 15 local governmental public hospitals between 2011 and 2012. The average increased operating profit was 1,299.1 million won. Through this result, we suggest that not only individual public health hospital perspective, but also the enterprise wide perspective like nation was significantly considered to make decision of closure or maintain of local governmental public hospitals.

• Korean Journal of Head & Neck Oncology
• /
• v.6 no.2
• /
• pp.114-118
• /
• 1990

A clinical study of 37 cases with thyroid nodules, which were treated by surgical excision and confirmed pathologically at the Department of Surgery, Chonnam National University Medical School, from Dec. 1988 to Feb. 1990, was conducted and following results were obtained in ultrasonographic evaluation of thyroid nodules. 1) The thyroid adenoma were showed well-defined margin, homogenous internal echo and surrounding Halo, but thyroid cancer were showed ill-defined margin, inhomogenous internal echo and no surrounding Halo. 2) The sensitivity of high resoution ultrasonography compared with pathologic diagnosis to thyroid cancer was 87.5%, specificity 94.1%, accuracy 88%, false positive 5.88%, and negative 12.5%.

• KSII Transactions on Internet and Information Systems (TIIS)
• /
• v.9 no.2
• /
• pp.742-762
• /
• 2015

In this study, we propose a distance metric learning approach called discriminant metric learning (DML) for face verification, which addresses a binary-class problem for classifying whether or not two input images are of the same subject. The critical issue for solving this problem is determining the method to be used for measuring the distance between two images. Among various methods, the large margin nearest neighbor (LMNN) method is a state-of-the-art algorithm. However, to compensate the LMNN's entangled data distribution due to high levels of appearance variations in unconstrained environments, DML's goal is to penalize violations of the negative pair distance relationship, i.e., the images with different labels, while being integrated with LMNN to model the distance relation between positive pairs, i.e., the images with the same label. The likelihoods of the input images, estimated using DML and LMNN metrics, are then weighted and combined for further analysis. Additionally, rather than using the k-nearest neighbor (k-NN) classification mechanism, we propose a verification mechanism that measures the correlation of the class label distribution of neighbors to reduce the false negative rate of positive pairs. From the experimental results, we see that DML can modify the relation of negative pairs in the original LMNN space and compensate for LMNN's performance on faces with large variances, such as pose and expression.

• Journal of the Korean Data and Information Science Society
• /
• v.27 no.4
• /
• pp.855-863
• /
• 2016

In this study, a simple diagnostic statistic for determining the size of random forest is proposed. This method is based on MV (margin of victory), a scaled difference in the votes at the infinite forest between the first and second most popular categories of the current random forest. We can note that if MV is negative then there is discrepancy between the current and infinite forests. More precisely, our method is based on the proportion of cases that -MV is greater than a fixed small positive number (say, 0.03). We derive an appropriate diagnostic statistic for our method and then calculate the distribution of the statistic. A simulation study is performed to compare our method with a recently proposed diagnostic statistic.

• Journal of Gastric Cancer
• /
• v.12 no.2
• /
• pp.113-119
• /
• 2012

Purpose: The aim of this study is to compare the characteristics of tumor and prognosis, depending on the status of resection margin involvement, on the frozen section diagnosis in gastric cancer. Materials and Methods: This study was conducted retrospectively, in 83 margin-positive patients on the frozen section diagnosis, who underwent gastrectomy from July 1995 to September 2006. The control group was selected by matching the age, gender, TNM stage and status of adjuvant chemoradiotherapy, among those who had shown clear resection margins. The characteristics of tumor and patient survival are investigated, and they were analyzed between the two groups. Results: The tumor size was significantly larger in the study group than that of the control group (P=0.037). There was significant difference between the two groups in location of the tumors (P=0.003). Multivariate analysis indicated that only the location and Lauren's classification are independent factors, which affected the resection margin involvement. Median survival was $41.0{\pm}11.5$ months in the study group and $93.0{\pm}30.3$ months in the control group (P=0.049). In the survival analysis, it was investigated that TNM stage and the resection margin involvement of the frozen section diagnosis were the critical variables. Conclusions: When the tumor is located at the middle or the upper third, or the Lauren's indeterminate type, they are highly likely to show the resection margin involvement on the frozen section diagnosis, and it can, therefore, have negative effects on the prognosis. It is considered as good to perform more extensive resection as possible, during the initial resection.