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Lim, Myong Cheol,Lee, Dong Ock,Kang, Sokbom,Seo, Sang-Soo,Lee, Bo-Yon,Park, Sang-Yoon Parthenon Pub 2009 Gynecological endocrinology Vol.25 No.7
<P>OBJECTIVES: The symptoms associated with ovarian cancer are vague. Endometriosis, which causes dysmenorrhea and dyspareunia, is frequently detected along with ovarian clear cell carcinoma (OCCC). We have therefore evaluated the clinical manifestations of OCCC based on the co-existence of endometriosis. METHODS: A retrospective analysis was conducted on 43 patients who had been treated for OCCC at the National Cancer Center between June 2000 and July 2007. Using medical records and the cancer registry, the clinical features and laboratory findings were analysed. RESULTS: Endometriosis was identified in 16 (37.2%) of the 43 patients with OCCC. The main presenting symptoms included a hard, palpable mass (32.6%), and newly developed or an exacerbation of dysmenorrhea (32.6%) and dyspareunia (25.6%). Gastrointestinal symptoms, pelvic pain, and abdominal distension existed in nine (20.9%), eight (18.6%) and one (2.3%) of the patients, respectively. The symptoms did not differ statistically in patients with or without endometriosis. Thirty-seven percent (11/30) of the patients had a normal CA-125 level (<35 U/ml); 18.8% (3/16) of the patients without endometriosis and 57% (8/14) of the patients with endometriosis had normal levels of CA-125 (<35 U/ml). Nine of 16 (56.3%) patients with early stage OCCC had a normal CA-125 level. CONCLUSIONS: The main presenting symptoms in patients with OCCC include a hard, palpable mass, dysmenorrhea and dyspareunia, irrespective of co-existing endometriosis. A normal CA-125 level has limited value in excluding OCCC, especially in the early stages.</P>
Lim, Myong Cheol,Yoo, Heong Jong,Song, Yong Jung,Seo, Sang-Soo,Kang, Sokbom,Kim, Sun Ho,Yoo, Chong Woo,Park, Sang-Yoon Asian Society of Gynecologic Oncology; Korean Soci 2017 Journal of Gynecologic Oncology Vol.28 No.4
<P><B>Objective</B></P><P>To investigate the survival outcomes in patients with bulky stage IIIC and IV ovarian cancer, treated by primary debulking surgery (PDS) and selective use of neoadjuvant chemotherapy (NAC) according to institutional criteria.</P><P><B>Methods</B></P><P>Medical records for advanced ovarian cancer patients who were treated at National Cancer Center (NCC) between December 2000 and March 2009 were retrospectively reviewed in the comprehensive cancer center. Bulky stage IIIC and IV ovarian cancer cases were included. Current NCC indication for NAC is determined based on patients' performance status and/or computerized tomography (CT) findings indicating difficult cytoreduction. After NAC, all traces of regressed metastatic ovarian cancer, potentially including chemotherapy-resistant cancer cells, were surgically removed.</P><P><B>Results</B></P><P>Of the 279 patients with bulky stage IIIC and IV, 143 (51%) underwent PDS and 136 (49%) received NAC. No gross residual and residual tumor measuring ≤1 cm was achieved in 66% and 96% of the PDS group and 79% and 96% of the NAC group, respectively. The median progression-free survival (PFS) and overall survival (OS) time were 20 months and not reached, but might be estimated more than 70 months in the PDS group and 15 and 70 months in the NAC group, respectively.</P><P><B>Conclusion</B></P><P>Extensive cytoreductive surgery to minimize residual tumor and selective use of NAC based on the institutional criteria could result in improved survival outcomes. Until further studies can be done to define the selection criteria for NAC after surgery, institutional criteria for NAC should consider the ability of the surgeon and institutional capacity.</P>
Lim, Myong Cheol,Kang, Sokbom,Song, Yong Jung,Park, Sae Hyun,Park, Sang-Yoon The Korean Academy of Medical Sciences 2010 JOURNAL OF KOREAN MEDICAL SCIENCE Vol.25 No.7
<P>We performed a retrospective study to evaluate the feasibility and safety of extensive upper abdominal surgery (EUAS) in elderly (≥65 yr) patients with advanced ovarian cancer. Records of patients with advanced epithelial ovarian cancer who received surgery at our institution between January 2001 and June 2005 were reviewed. A total of 137 patients including 32 (20.9%) elderly patients were identified. Co-morbidities were present in 37.5% of the elderly patients. Optimal cytoreduction was feasible in 87.5% of the elderly while 95.2% of young patients were optimally debulked (<I>P</I>=0.237). Among 77 patients who received one or more EUAS procedures, 16 (20.8%) were elderly. Within the cohort, the complication profile was not significantly different between the young and the elderly, except for pleural effusion and pneumothorax (<I>P</I>=0.028). Elderly patients who received 2 or more EUAS procedures, when compared to those 1 or less EUAS procedure, had significantly longer operation times (<I>P</I>=0.009), greater blood loss (<I>P</I>=0.002) and more intraoperative transfusions (<I>P</I>=0.030). EUAS procedures are feasible in elderly patients with good general condition. However, cautious peri-operative care should be given to this group because of their vulnerability to pulmonary complications and multiple EUAS procedures.</P>
Appendectomy in retrograde order for complete removal of endometriosis.
Lim, Myong Cheol,Song, Yong Jung,Lee, Dong Ock,Jung, Dae Chul,Yoo, Chong-Woo,Park, Sang-Yoon Parthenon Pub 2009 Gynecological endocrinology Vol.25 No.12
<P>Endometriosis frequently involves the intestines. Appendectomy would be often required as part of complete removal of endometriosis. We present a patient with endometriosis who required very difficult appendectomy. For complete removal of endometriosis, hysterectomy, bilateral salpingooophorectomy, low anterior resection and accompanying pelvic peritonectomy were performed through a mid-line incision. Unexpectedly, the appendiceal tip was attached to peri-hepatic tissue with the appendix adhered to the surrounding peritoneum and bowel. Completion of the appendectomy was possible in retrograde order after extension of the surgical incision above the umbilicus. Our findings suggest that preoperative image evaluation for location or position of the appendix might be helpful in patients with suspected endometriosis to offer correct counselling, obtaining adequate consent, determining the optimal surgical approach and scheduling opportune intraoperative consultation by a colorectal surgeon.</P>
Incidence of cervical, endometrial, and ovarian cancer in Korea, 1999-2010
Lim, Myong Cheol,Moon, Eun-Kyeong,Shin, Aesun,Jung, Kyu-Won,Won, Young-Joo,Seo, Sang Soo,Kang, Sokbom,Kim, Jae-Weon,Kim, Joo-Young,Park, Sang-Yoon Asian Society of Gynecologic Oncology; Korean Soci 2013 Journal of Gynecologic Oncology Vol.24 No.4
<P><B>Objective</B></P><P>To investigate the recent incidence of and trends in cervical, endometrial, and ovarian cancer in Korean females.</P><P><B>Methods</B></P><P>Data from the Korea Central Cancer Registry between 1999 and 2010 were analyzed. Age-standardized rates (ASRs) and annual percent changes (APCs) were calculated.</P><P><B>Results</B></P><P>The absolute incidence rates of the three major gynecologic cancers increased: 6,394 in 1999 to 7,454 in 2010. The ASR for gynecologic cancer was 23.7 per 100,000 in 1999 and decreased to 21.0 in 2010 (APC, -1.1%; 95% confidence interval [CI], -1.53 to -0.70) due to a definitive decrease in the incidence of cervical cancer (APC, -4.3%). Endometrial cancer has been definitively increasing (APC, 6.9% during 1999-2010), especially in females <30 years old (APC, 11.2%) and in females ≥80 years old (APC, 9.5%). The incidence of ovarian cancer is increasing gradually (APC, 1.5%).</P><P><B>Conclusion</B></P><P>ASRs and APC for gynecologic cancers overall are decreasing due to the decrease in the incidence of cervical cancer. However, the incidence of endometrial and ovarian cancer has been increasing.</P>