• Journal of Gastric Cancer
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• v.1 no.3
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• pp.168-173
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• 2001

Purpose: A positive esophageal margin is encountered in a total gastrectomy not infrequently. The aim of this retrospective review was to evaluate whether a positive esophageal margin predisposes a patient to loco-regional recurrence and whether it has an independent impact on long-term survival. Materials and Methods: A retrospective review of 224 total gastrectomies for adenocarcinomas was undertaken. The Chisquare test was used to determine the statistical significance of differences, and the Kaplan-Meier method was used to calculate survival rates. Significant differences in the survival rates were assessed using the log-rank test, and independent prognostic significance was evaluated using the Cox regression method. Results: The prevalence of esophageal margin involvement was $3.6\%$ (8/224). Univariate analysis showed that advanced stage (stage III/IV), tumor size ($\geq$5 cm), tumor site (whole or upper one-third of the stomach), macroscopic type (Borrmann type 4), esophageal invasion, esophageal margin involvement, lymphatic invasion, and venous invasion affected survival. Multivariate analysis demonstrated that TNM stage, venous invasion, and esophageal margin involvement were the only significant factors influencing the prognosis. All patients with a positive esophageal margin died with metastasis before local recurrence became a problem. A macroscopic proximal distance of more than 6 cm of esophagus was needed to be free of tumors, excluding one exceptional case which involved 15 cm of esophagus. Conclusion: All of the patients with a positive proximal resection margin after a total gastrectomy had advanced disease with a poor prognosis, but they were not predisposed to anastomotic recurrence. Early detection and extended, but reasonable, surgical resection of curable lesions are mandatory to improve the prognosis.

• Journal of Chest Surgery
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• v.5 no.2
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• pp.107-112
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• 1972

Recently we experienced a case of the portal hypertension, extrahepatlc origin in the National Medical Center, Seoul. The case was a male aged 19 who was undergone the elective splenorenal shunt with splenectomy 9 years ago and emergency ligation of the coronary vein because of recurred variceal rupture 6 years later and had recurring esophageal varices with bleeding this time.At the age of 10 he had been occasionally suffering from nasal bleeding and visited to our Pediatric department, when there was encountered for the first time the splenomegaly, esophageal varices in the lower third esophagus on the esophagogram, and stenosis and kinking of the portal vein with rich collateral circulation on the splenoportography without hepatic functional impairment.The elective splenorenal shunt with splenectomy was undergone under the diagnosis of portal hypertension due to congenital anomaly of the portal vein and postoperatlvely no troubles had been obtained until postoperative 1st attack of massive hematemesis due to esophagenl variceal rupture recurred about 6 years later which was confirmed by control esophagogram and it was resulted by stenosis of previous anastomotic site of the splenorenal shunt.Then emergency ligation of the coronary vein was only made for bleeding control and no episodes of hematemesis had been encountered thereafter until April 1972 about 3 years after the 2nd operation, when hematemesis recurred again. In this time, recurring esophageal varices were noted in the lower third esophagus on the control esophagogram and he was employed side to end mesocaval shunt as the final step of portal decompression,and following results were obtained. 1] No postoperatlve troubles as leg edema or pain: Postoperatively leg elevation and elastic bandage on the both legs were employed until discharge. 2] During operation the portal pressure was 300 mm $H_2O$ and immediately lowered to 170 mm $H_2O$ after shunt.

• Journal of Chest Surgery
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• v.25 no.12
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• pp.1530-1536
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• 1992

From January 1984 to December 1991, One hundred sixty five patients with carcinomoa of the esophagus were treated surgically at the department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital. Among them, hospital records were available in 121 patients and were included in this study. There were 115 men and 6 women, with ages ranging from 40 years to 79 years[mean age of 59.2 years]. The most frequent preoperative symptoms included dysphagia[72.7%], weight loss[60.3%], chest pain or discomfort[14.9%], general malaise[13.2%]. All were treated surgically: 100 patients were managed by curative or palliative resection with reconstruction, and 6 by palliative bypass surgery. In 15 patients, explorative thoracotomy or laparotomy was only done due to unresectability. [operability: 87.6%, resectability: 82.6%] All specimens[those from resectable 100 cases] were sent to pathology, and histopathologic examinations were done; squamous cell carcinomas were found in 95 cases, adenocarcinoma in l. Adenosquamous carcinomas were found in 3, and malignant melanoma in l. Postoperative complications occurred in 34 cases; anastomotic site leakage[10], which was followed by empyema in 9 of them, wound problem[7], hepatic failure[6], pneumonia [3], post-operative bleeding[3], chylothorax[2], post-operative stricture[2], sepsis[1], and tracheobronchial fistula[1]. Hospital deaths were in 6 cases[Hospital mortality: 5.0%]. During the follow up period, 26 patients were proven to be recurrence of cancer locally or distantly. The one, two, and five-year actuarial survival raf.es were 71.3$\pm$4.5%, 57.4$\pm$5.6%, 34.7$\pm$8.9%, respectively. The data from this study suggested that esophagectomy with reconstruction of gastrointestinal tract could be performed with a low operative mortality and a few serious postoperative complications and achieved reasonable long term palliation for carcinoma of the esophagus.

• Journal of Chest Surgery
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• v.30 no.4
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• pp.453-456
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• 1997

Acquired tracheoesophageal fistula is a rare but serious condition which is usually a result of prolonged intubation or tracheostomy statc, and is difficult to treat. A fifty-seven year old woman who was in a state of prolonged intubation and tracheostomy following a traf%c accident, presented with recurrent aspirati n. A tracheoesophageal fistula was demonstrated ) cm above the carina by csophagogram. We confirmed a subglottic web and tracheoesophageal fistula by bronchoscopic examination. Fistulectomy was performed with collor incision and partial sternotomy. The esophagus was repaired by two-layer interrupted suture using 4-0 Vicr)1, and the trachea was repaired by single layer suture using a 4-0 PDS. The sternohyoid muscle was interposed between the trachea and the esophagus. A T-tube was inserted through the previous tracheostomy site for easy tracheal suction and maintenance of the tun:on. The T-tube was removed on the 14th postoperative day, and the patient recovered well without any complications.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1976.06a
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• pp.88.2-89
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• 1976

Clinical observation is made on the total 205 cases of foreign bodies in the air and food passages. The entire foreign body cases that had visited ENT Dept. of Han Gang Sacred Heart Hospital from January, 1972 to March, 1976 are included in this study. The results summarized are as follows: 1) The majority of the cases of foreign bodies are found in the food passage, 200 cases (97.6%) while in the air passage only 5 cases was present. 2) The most common foreign bodies in the esophagus was coin (90%) and in the air passage, the sorts of foreign bodies are bean, peanut, plastic bullet, corn and towel clip. 3) In the locality of foreign bodies, the first narrowing is the most frequent site in the esophagus. 4) The majority of the cases with esophageal foreign body is male (M:F 1.4 : 1), in the air passage (M:F 3:2). 5) The patients with esophageal foreign body visited within 3 days in 87%, and with trachiobronchial foreign body visited within a day in all cases.

• Journal of Chest Surgery
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• v.24 no.12
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• pp.1232-1237
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• 1991

The cervical esophageal stricture has various surgical modalities and difficulties in reconstruction. We had experienced a case of successful reconstruction of the cervical esophageal restenosis using the free jejunal graft, on 30 year old man had had esophageal stricture after ingestion of lye. He had undergone colon interposition[esophagocologastrostomy] with left colon feeding gastrostomy. But restenosis was occurred just above of the cervical esophagocolostomy site several times of balloon dilatation were failed. So, we decided to use of the free jejunal graft. The free jejunal graft was isolated about 15cm length with it`s vascular arcades. The graft was irrigated with the mixed solution as isotonic saline, heparin and papaverine chloride. The artery of graft was anastomosed to the branch of the external carotid artery in end to side with continuous sutures of the 8.0 Prolene. The vein of the graft was anastomosed to the branch of the anterior facial vein in end to end with continuous sutures of the 8.0 prolene. Postoperative course was uneventful and the patient was discharged after removal of the tracheostomy cannula and gastrostomy tube.

• Journal of Chest Surgery
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• v.27 no.1
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• pp.43-47
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• 1994

Prompt recognition and proper treatment of esophageal perforation or rupture may ax~ert death or minimize complications. We have experienced sixteen patients of esophageal perforation at the department of thoracic and cardiovascular surgery, Hallym Medical college during the period fromJan. 1986 to Sep. 1993. The ratio between male and female patient was 13:3 and their age ranged from 23 years to 67 years old. The major cause of esophageal perforations was spontaneous rupture in 7 cases[45%], surgical trauma in 2 cases[12%], instrumental trauma in 2 cases[12%], and others in 5 cases[31%]. The common site of esophageal perforation was in the lower third portion of the esophagus[10 cases, 62%]. The most consistent symptom of esophageal perforation was chest pain in 11 cases, temperature elevation within a few hours was 9 cases.Contrast roentgenographic studies demonstrated the perforation in all but 2 of the 16 patients. The frequent complications of esophageal perforation were empyema in 7 cases[45 %] and mediastinitis in 2 cases[12%]. fourteen patients had suture closure and drainage with 2 deaths, and 2 patient received only drainage procedures. The mortality rate was 12%[2 cases] and cause of death was sepsis and aortic rupture.

• Journal of Chest Surgery
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• v.56 no.5
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• pp.362-366
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• 2023

The stomach has become the most commonly used site for grafts to replace the esophagus in esophageal cancer surgery because of its good blood supply and ability to enable single-reconstruction anastomosis. However, anastomotic failure is a serious complication after esophageal cancer surgery. Unlike anastomotic leakage due to local ischemia, gastric tube necrosis is a life-threatening condition with a high mortality rate. Gastric tube necrosis involves extensive ischemia due to a decreased blood supply, and an urgent operation is mandatory in most cases. Endoscopic vacuum therapy (EVT) has been used for anastomotic leakage after esophageal surgery. In recent years, it has been successfully used for more extensive disease, including large esophageal perforation as an indication for reoperation. Hence, we report a case of extensive gastric tube necrosis treated by EVT after an Ivor Lewis operation.

• Journal of Chest Surgery
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• v.27 no.10
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• pp.888-892
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• 1994

Acquired, traumatic tracheoesophageal fistula [TEF] is rare and difficult problem to manage. This 55 years old man met with a roller accident of a tractor. During accident, he received a penetrating injury on the left upper sternal border. At local clinic, he received closed thoracotomy drainage [CTD]for relief of pneumothorax[left]. Three days after CTD, he complained abdominal pain and hematemesis. The endoscopy revealed large ulcer at the stomach, so he received subtotal gastrectomy. On 10th day post subtotal gastrectomy, he developed aspiration and coughing from a TEF. The esophagogram showed large TEF at the mid-trachea level. So he transfered to our hospital for operation. This patient was operated on for late TEF three weeks after injury. We have used absorble 4-0 Vicryl sutures to repair trachea. We repair all esophageal injuries with two layers of nonabsorbable silk suture. Where suture line on the esophagus, the strap muscle was interposed for reinforcement. And for feeding, the feeding jejunostomy was performed. Postoperatively the osteomyelitis of the manubrium site was developed, so on the 30th postoperative day, an ostectomy of manubrium, both clavicle and fight 1st, 2nd ribs, and the pectoralis major musculo-cutaneous flap coverage were performed.

• Journal of Chest Surgery
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• v.36 no.1
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• pp.51-54
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• 2003

This patient was an 53-year-old man who had undergone Sengstaken-Blackmore tube insertion for esophageal varix bleeding. Two days after Sengstaken-Blackmore tube insertion, he developed severe left hemothorax and was transferred to our hospital. The esophagoscopic findings revealed a large perforation lengthening 8-cm in the intrathoracic esophagus. A left thoracotomy was performed 33 days after the injury due to repeated varix bleedings and poor conditions. An 8-cm longitudinal perforation of the intrathoracic esophagus with gross suppurative empyema was found. Primary repair and esophageal exclusion was performed 2cm proximal and distal to the perforation, using rows of nonabsorbable staplers(TA stapler 60 $\times$ 4.8) and large bore thoracostomy tubes were placed for local drainage. Six days after intrathoracic esophageal exclusion, an esophagogram revealed a leakage at just above the proximal stapling site. A cervical esophageal exclusion was performed using the same method. One hundred thirty seven days after exclusion operation for the intra-thoracic esophageal perforation, the patient was able to eat per orally without any secondary esophageal reconstructive surgery.