• Journal of Gastric Cancer
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• v.20 no.4
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• pp.421-430
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• 2020

Purpose: Currently, there is no clear evidence to support any specific treatment as a principal therapy for stage IV gastric cancer outlet obstruction (GCOO) patients. This study evaluated the outcomes of palliative gastrectomies and survival prognostic factors in patients with stage IV resectable GCOO. Materials and Methods: We retrospectively reviewed the medical records of 48 stage IV GCOO patients who underwent palliative gastrectomies between June 2010 and December 2019. Palliative gastrectomies were performed only in patients with resectable disease. Early surgical outcomes and prognostic factors were analyzed using univariate and multivariate analyses. Results: There were no specific risk factors for postoperative complications, except for being underweight. Severe postoperative complications developed in five patients, and most of the patients underwent interventional procedures and received broad-spectrum antibiotics for intra-abdominal abscesses. The multivariate survival analysis showed that palliative chemotherapy is a positive prognostic factor, while the specific type of hematogenous and lymphatic metastasis is a negative prognostic factor. Conclusions: We recommend that the treatment method for stage IV GCOO should be selected according to each patient's physical condition and tumor characteristics. In addition, we suggest that palliative gastrectomies can be performed in stage IV resectable GCOO patients without unfavorable prognostic factors (types of hematogenous and lymphatic metastases).

• Radiation Oncology Journal
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• v.11 no.1
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• pp.133-141
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• 1993

From Jan.1982 to Dec.1990, 77 patients with rectal cancer were treated with curative surgical resection followed by postoperative adjuvant irradiation alone or combined with chemotherapy at the Department of Radiation Oncology, Korea University Hospital (KUH). Fifty-four (54/77, $70.1{\%}$) patients underwent abdominoperineal resection , 20 (20/77, $26{\%}$) patients underwent low anterior resection, and 3 (3/77, $3.9{\%}$,) patients had wide excision only. Thirty-nine (39/77, $50.5{\%}$) received sequential chemotherapy (2 cycles to 12 cycles). The 5-year survival rate for the entire group was $43{\%}:\;78.2{\%}$ in B2+B3, $39.4{\%}$ in stage C1+C2+C3. Survival rates decreased with increasing penetration of the bowel wall by tumor and the presence of regional lymph node metastasis. Those patients survival who underwent an abdominoperineal resection also experienced a significant decrease in compared to low anterior resection ($23.1{\%}$ vs. $63.8{\%}$ in 5-year survival, p <0.05). Local failure occurred in 15 ($19.5{\%}$) out of the 77 patients overall, 1($5.3{\%}$) of 19 in stage B2+B3, and 14 ($24.1{\%}$,) of 58 in stage C1+C2+C3. Presacral area was most common site of local failufre (8/17, $47.1{\%}$). Distant failure occurred in 13 ($16.9{\%}$) of 77 patients. The most frequent site of distant failure was the lung followed by the liver, the bone, and the brain. Combined locoregional and distant failure occurred in 2 ($2.6{\%}$) of 77 patients. Pathological confirmation of perirectal fat and/or regional lymph node involvement resulted in a singificant decrease in survival and local control.

• Journal of Gastric Cancer
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• v.23 no.3
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• pp.462-475
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• 2023

Purpose: This study aimed to analyze the incidence and risk factors of complications following gastric cancer surgery in Korea and to compare the correlation between hospital complications based on the annual number of gastrectomies performed. Materials and Methods: A retrospective analysis was conducted using data from 12,244 patients from 64 Korean institutions. Complications were classified using the Clavien-Dindo classification (CDC). Univariate and multivariate analyses were performed to identify the risk factors for severe complications. Results: Postoperative complications occurred in 14% of the patients, severe complications (CDC IIIa or higher) in 4.9%, and postoperative death in 0.2%. The study found that age, stage, American Society of Anesthesiologists (ASA) score, Eastern Cooperative Oncology Group (ECOG) score, hospital stay, approach methods, and extent of gastric resection showed statistically significant differences depending on hospital volumes (P<0.05). In the univariate analysis, patient age, comorbidity, ASA score, ECOG score, approach methods, extent of gastric resection, tumor-node-metastasis (TNM) stage, and hospital volume were significant risk factors for severe complications. However, only age, sex, ASA score, ECOG score, extent of gastric resection, and TNM stage were statistically significant in the multivariate analysis (P<0.05). Hospital volume was not a significant risk factor in the multivariate analysis (P=0.152). Conclusions: Hospital volume was not a significant risk factor for complications after gastric cancer surgery. The differences in the frequencies of complications based on hospital volumes may be attributed to larger hospitals treating patients with younger age, lower ASA scores, better general conditions, and earlier TNM stages.

• Journal of Chest Surgery
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• v.26 no.1
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• pp.47-53
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• 1993

The high relapse rate after curative surgery of lung cancer suggests that tumor cells are remained at the site of resection and in the distant organs. Postoperative radiochemoimmunotherapy including protein-bound polysaccharide PS-K[Copolang] and/or chemotherapy to improve the prognosis in lung cancer has been adopted. The patients with lung cancer who were treated with a combined modality therapy after surgery were reviewed to determine the effects of adjuvant immunotherapy[PS-K] and the relationship between midterm survival and clinicopathologic variables. During the past 5 years, 95 patients with lung cancer underwent resective operation. Of them, 30 cases were curative surgery, 29 were relative curative surgery, and the remainders were non-curative surgery. Postoperative combination therapies consisted of three types of therapies: postoperative BRM[biological response modifiers] with PS-K [Copolang] 50 mg/kg for 24 weeks[Group 1], chemoimmunotherapy with chemotherapy[a combination of cisplatin, etoposide, vindesine] and PS-K [Group 2], radioimmunotherapy with postoperative prophylactic irradiation to the mediastinum at total dose of 54 Gy-60 Gy and PS-K [Group 3] and surgery without adjuvant therapy[Group 4]. Twenty months survival rates of localized disease [Stages I and II] treated with PS-K, with radioimmunotherapy and no therapy were 73 %, 60 %, and 50 %, respectively [p [0.05]. Three-year survival rates of regionally advanced cases [stage Ilia and IIIb] were 23 % in Group 1.57 % in Group 2.20 % in Group 3, and 0 % in Group 4, respectively.According to above results, we suggest that postoperative combination therapy including PS-K might improve the prognosis of lung cancer. The similar survival pattern of patients with squamous cell carcinoma and adenocarcinoma treated with BRM, chemoimmunotherapy or radioimmunotherapy need to evaluate the role of postoperative immunotherapy[PS-K] in randomized studies.

• Journal of Gastric Cancer
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• v.5 no.4 s.20
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• pp.281-287
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• 2005

Purpose: This study was conducted to evaluate the effectiveness and the role of post-operative adjuvant chemoradiation therapy in a stage-II (UICC, 1997) primary gastric cancer. Materials and Methods: From September 1994 to December 2004, 954 stage-II gastric-cancer patients were seen, and all of them underwent a curative resection with extensive (D2) lymph-node dissection. The chemotherapy consisted of fluorouracil $(400mg/m^2)$ plus leucovorin $(20mg/m^2)$ for 5 days, followed by 4,500 cGy of radiotherapy for 5 weeks with fluorourcil and leucovorin on the first 4 days and the last 3 days of radiotherapy. Two five-day cycles of chemotherapy were given four weeks after the completion of radiotherapy. The Kaplan-Meier method was used to estimate the survival rates. To assess the importance of potential prognostic factors, we performed univariate and multivariate analyses using a log-rank test and Cox's proportional hazards regression model. A P value <0.05 was considered significant. Results: Univariate analysis revealed that age, tumor size, gross type, surgical method, and postoperative adjuvant therapy had statistical significance. Among these factors, age, surgical method, tumor size, surgical method, and postoperative adjuvant therapy were found to be independent prognostic factors by using a multivariate analysis. The postoperative adjuvant chemotherapy group and the chemoradiation therapy group had survival benefit compared to the surgery-only group. However the chemoradiation therapy group had no significant survival benefit compared to the chemotherapy group. Conclusion: The postoperative adjuvant therapy in stage-II gastric-cancer patients had significant benefit. Therefore, postoperative adjuvant chemoradiation therapy has an acceptable effect. A large-scale, randomized study is needed to evaluate the effectiveness and the role of postoperative radiation therapy.

• Archives of Reconstructive Microsurgery
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• v.21 no.2
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• pp.118-130
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• 2012

Background: Women receiving mastectomy usually prefer a single-stage surgical procedure without the need for additional surgery. Hence, nipple sparing mastectomy was introduced, and the follow-up data on the aesthetic outcome and recurrence of breast cancer were investigated in this study. Materials and Methods: The study subjects comprised 22 patients who received nipple-sparing mastectomy and immediate breast reconstruction using the free transverse abdominal rectus abdominis myocutaneous flap between June of 2007 and June of 2012. The patients' aesthetic outcomes were measured with 2 methods for the objective result: Breast size measurements and breast volume calculation both at preoperative phase and postoperative 1 years phase. Also, the patients' satisfaction was evaluated at postoperative 1 year with the self-assessment questionnaire. Follow up check for assessing cancer recurrence was performed for an average period of postoperative 1063 days. Results: First, in objective aesthetic outcome, there were no significant differences between the preoperative and postoperative results on both the breast size and the volume. Second, the patient satisfaction analysis scores were graded as very good in 15 patients (68.2%), and as good in 6 patient (27.3%). Most of the patients were very satisfied with our surgery method. Last, there was no local or distant recurrence in these 22 patients during the follow-up period. Conclusion: In this study, the nipple-sparing mastectomy achieved satisfactory results for the breast scar and shape with a single-stage surgical procedure, and the cancer recurrence rate was not significantly different from that of the conventional mastectomy. Besides, the nipple-sparing mastectomy is more cost-effective than the conventional mastectomy since it reduces the need for additional procedures. However, we think that it is necessary to determine the long-term outcomes about the recurrence rate.

• Korean Journal of Head & Neck Oncology
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• v.3 no.1
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• pp.25-35
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• 1987

Irradiated 88 patients of Maxillary Sinus Carcinoma at Yonsei Cancer Center for 10years between 1971 and 1980 were retrospectively analysed. The majority of patients had very advanced disease(87.5% of $T_3\;and\;T_4$) and 17% of cervical lymph node involvement. 80.6% of all patients were epidermoid type. In 44 cases(50%), irradiation alone was performed. 28 cases(32%) of postoperative radiation after incomplete surgery and the remaining 16 cases(18%) of postoperative radiation after radical surgery were done. The majority of patients except 6 cases had irradiation a dose between 60Gy and 80Gy in 30-40 fractions over 6-8 weeks. The actuarial overall 3 and 5 year survival rate were 362% and 26%, respectively. The actuarial 5 year survival rate for 44 cases of radiation alone group was 14.1%, The actuarial 5 year survival rate for 28 cases of incomplete surgery and postoperative radiation group and 16 cases of radical surgery and postoperative radiation group were 312% and 67.4% respectively. In the actuarial 5 year survival rate according to the stage, stage II, III and IV were 79.5%, 20.9% and 0%. In recent, for the improvement of survival rate of advanced Maxillary Sinus Carcinoma at Yonsei Cancer Center, combined multidisplinary or trimodal treatment modality have been applied and in near time the more excellent results expect to be analyse.

• Archives of Craniofacial Surgery
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• v.25 no.2
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• pp.71-76
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• 2024

Background: The rising incidence of dialysis-dependent end-stage renal disease (ESRD) has underscored the need for collaboration between plastic surgeons and nephrologists, particularly concerning preoperative and postoperative management for facial reconstruction. This collaboration is essential due to a scarcity of comprehensive information in this domain. Methods: A study initiated in January 2015 involved 10 ESRD cases on dialysis undergoing Mohs micrographic surgery for facial skin cancer, followed by reconstructive surgery under general anesthesia. To ensure surgical safety, rigorous measures were enacted, encompassing laboratory testing, nephrology consultations, and preoperative dialysis admission. Throughout surgery, meticulous control was exercised over vital signs, electrolytes, bleeding risk, and pain management (excluding nonsteroidal anti-inflammatory drugs). Postoperative assessments included monitoring flap integrity, hematoma formation, infection, and cardiovascular risk through plasma creatinine levels. Results: Adherence to the proposed guidelines yielded a notable absence of postoperative wound complications. Postoperative plasma creatinine levels exhibited an average decrease of 1.10 mg/dL compared to preoperative levels, indicating improved renal function. Importantly, no cardiopulmonary complications or 30-day mortality were observed. In ESRD patients, creatinine levels decreased significantly postoperatively compared to the preoperative levels (p< 0.05), indicating favorable outcomes. Conclusion: The consistent application of guidelines for admission, anesthesia, and surgery yielded robust and stable outcomes across all patients. In particular, the findings support the importance of adjusting dialysis schedules. Despite the limited sample size in this study, these findings underscore the effectiveness of a collaborative and meticulous approach for plastic surgeons performing surgery on dialysis-dependent patients, ensuring successful outcomes.

• Radiation Oncology Journal
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• v.19 no.2
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• pp.113-117
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• 2001

Purpose : To evaluate effect of postoperative radiotherapy on survival and local control for patients with non-small cell lung cancer (NSCLC). Materials and Methods : Ninety two NSCLC patients with N1or N2 involvement who were treated with postoperative radiotherapy following surgery with curative intent from May 1987 to October 1999 were retrospectively analyzed. Age of the patients was ranged from 32 to 78 years. According to TNM Stage, 35 patients had Stage II and 57 had Stage III disease. There were 49 patients with N1 involvement and 43 patients with N2 involvement. Fifty six patients were noted to have $T1\~2$ tumors and 36 patients to have $T3\~4$ tumors. Delivered total dose was ranged from 40 to 60 Gy. Majority of patients received 50 Gy or 50.4 Gy. Follow-up period was ranged from 9 month to 7 years with median follow-up of 26 months. Results : Overall survival rates at 3 and 5 years for entire group of patients were $46\%\;and\;38\%$, respectively. Corresponding disease free survival rates were $44\%\;and\;36\%$. There was significant difference in survival between patients with Stage II and Stage III disease ($50\%\;vs\;28\%$ at 5-year). Five year survival rates for N1 and N2 patients were $52\%\;and\;20\%$, respectively (p<0.05). These were $40\%\;and\;34\%$ for patients with $T1\~2$ tumors and $T3\~4$ tumors. There were documented local relapses in $13\%$ of the patients. For patients with N1 and N2 Stage, local relapse rates were $8\%\;and\;18\%$, respectively. Conclusion : Our study confirms that postoperative radiotherapy for patients with non-small cell lung cancer improves local control. However, influence of postoperative radiotherapy on long-term survival is less clear. More effective systemic treatment to prevent distant metastasis should be investigated in future study to improve long-term survival.

• Radiation Oncology Journal
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• v.19 no.4
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• pp.312-318
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• 2001

Purpose : To assess the locoregional recurrence rate, survival rate and prognostic factors after modified radical mastectomy and postoperative adjuvant radiation therapy with or with chemotherapy in high-risk breast cancer patients. Methods : Between $1984\~1995$, 48 patients underwent postoperative irradiation to the regional lymphatics and chest wall due to large tumor size $(\geq5\;cm)$ or small tumor size (<5 cm) with axillary lymph node involvement after modified radical mastectomy. The median age of the patients was 47 years (range, $31\~79\;years$). The clinical tumor size was <2 cm in 1 patient, $2\~5\;cm$ in 15 patients, and >5 cm in 32 patients. Thirty two patients had positive axillary lymph nodes. Forty two patients were irradiated to the chest wall and regional lymph node and 6 patients were irradiated in the chest wall only. Radiation dose to the chest wall and regional lymph node was 5040 cGy/28 fraction. The median follow-up time was 61 months. Results : Locoregional recurrence rate was $8\%$ and distant metastatic rate was $14\%$. The actuarial overall survival rate and disease-free survival rate was $53\%\;and\;62\%$ at 5 years, respectively. The median survival time was 57 months. Five-year overall survival rate by the stage is $70\%$ in IIB and $58\%$ in IIA. The significant prognostic factor for survival on multivariate analysis was the stage. Conclusion : Postoperative adjuvant radiation therapy in high-risk breast cancer can reduce the locoregional recurrence rate and increase the survival time by combined chemotherapy. The significant prognostic factor for survival rate was the stage.