Panel Discussion

Mee Joo Kang(강미주) 대한외과학회 2014 대한외과학회 학술대회 초록집 Vol.2014 No.11

췌장 구상돌기암의 임상양상

강미주(Mee Joo Kang),이승은(Seung Eun Lee),황대욱(Dae Wook Hwang),임창섭(Chagn-Sup Lim),장진영(Jin-Young Jang),이건욱(Kuhn Uk Lee),김선회(Sun-Whe Kim) 한국간담췌외과학회 2008 한국간담췌외과학회지 Vol.12 No.3

Purpose: The pancreatic uncinate process is defined as the portion of the pancreatic head that lies behind the SMV and SMA. In spite of its peculiar anatomical characteristics, there are few reports addressing the clinicopathologic features of uncinate process carcinoma (UPCa). The purpose of this study was to explore the clinical characteristics of UPCa and to compare them with the characteristics of carcinomas located in other parts of the pancreatic head (non-UPCa). Methods: We retrospectively reviewed the medical records of 380 patients (127 UPCa and 253 non-UPCa) treated for pancreatic head cancer at Seoul National University Hospital between January 2002 and December 2007. The patient demographics, clinical presentation, radiologic details, surgical data, and long-term survival rates were evaluated. The clinical characteristics were analyzed according to tumor location. Results: Jaundice was less common in UPCa (56/127, 44.1% vs. 150/253, 59.3%; p=0.006). Duodenal obstruction (12/127, 9.4% vs. 11/253, 4.3%; p =0.049) and SMA invasion (56/127, 44.1% vs. 58/253, 23.0%; p<0.001) were more frequent in UPCa. Resectability (38/127, 30.0% vs. 117/253, 46.2%; p=0.002) and curative resection rate (29/127, 22.8% vs. 90/253, 35.6%; p=0.001) were significantly lower in UPCa. The overall 3-year survival rate (7.7% vs. 17.9%; p=0.019) and 3-year survival rate after curative resection (0% vs. 35.9%; p=0.012) were lower in UPCa. Conclusion: UPCa less frequently caused jaundice, but more frequently caused duodenal obstruction. Frequent invasion into the SMA led to lower resectability and curative resection rates. Even in cases of R0 resection, long-term survival in the setting of UPCa was lower than that seen in the setting of non-UPCa, which suggests other unknown prognostic factors.

간내결석증의 최근 치료경험 및 장기 치료성적 분석

임창섭(Chang-Sup Lim),장진영(Jin-Young Jang),이승은(Seung Eun Lee),강미주(Mee Joo Kang),김선회(Sun-Whe Kim) 한국간담췌외과학회 2010 한국간담췌외과학회지 Vol.14 No.1

Purpose: Treatment of hepatolithiasis is difficult because of the high recurrence rate, and the long-term outcome is not satisfactory. We reviewed clinical outcomes to determine the optimal treatment modalities for hepatolithiasis. Methods: Between 1981 and 2005, 648 patients with hepatolithiasis were treated at our institute. Changing patterns of treatment modalities and outcomes were analyzed for the periods: 1st (1981∼1985; n=159), 2nd (1986∼1990; n=100), 3rd (1991∼1995; n=111), 4th (1996∼2000; n=141), and 5th (2001∼2005; n=137). Clearance and recurrence rates according to the treatment modalities and associated malignancies were analyzed in patients for the most recent 10 years. Results: During the past 25 years, hepatectomy as a treatment for hepatholithiasis has increased in frequency and become the major treatment modality in the recent 10 years, while choledocholithotomy and drainage procedures have decreased in frequency. With improvement in operative clearance and post-operative lithotripsy, the final clearance rate improved from 79.0% to 91.3%. In the most recent 10 years, the final clearance rate of hepatectomy, choledocholithotomy, cholangioenterostomy, and PTCS was 97.1%, 82.0%, 78.8%, and 100%, respectively, and the recurrence rate was 34.7%, 15.4%, 17.0%, and 42.9%, respectively. Twenty-six patients (47.2%) had recurrences within 2 years, and 12 patients (21.8%) had recurrences after 5 years. Cholangiocarcinomas occurred in 10 patients (3.6%). The diagnosis of cholangiocarcinoma was established pre-operatively in 2 patients, post-operatively in 4 patients, and during the follow-up period in 4 patients. Conclusion: In the treatment of hepatolithiasis, hepatectomy has a high clearance rate and a low recurrence rate. To reduce the recurrence rate, complete stone clearance without residual stones seems to be of utmost importance. Suspicion of malignancy and long-term follow-up are needed in the management of patients with hepatolithiasis.

췌장의 비기능성 내분비 종양의 임상병리학적 특성 및 예후인자

박수민(Soo Min Park),장진영(Jin-Young Jang),강미주(Mee Joo Kang),윤유석(Yoo-Seok Yoon),한호성(Ho-Seong Han),조재영(Jai Young Cho),이승은(Seung Eun Lee),이경분(Kyoung Bun Lee),한인웅(In Woong Han),김선회(Sun-Whe Kim) 한국간담췌외과학회 2011 한국간담췌외과학회지 Vol.15 No.1

Purpose: Nonfunctioning endocrine tumors of the pancreas have no specific symptoms. Therefore, diagnosis is usually delayed and the malignancy rate at the time of diagnosis is reported to be higher than 50%. However, it is difficult to discriminate malignant from benign nonfunctioning endocrine tumors preoperatively. The purpose of this study was to investigate clinical characteristics of nonfunctioning endocrine tumors of the pancreas, including predictive factors of malignancy and prognostic factors affecting long-term survival. Methods: Between 1992 and 2010, clinicopathological data of 53 patients with nonfunctioning endocrine tumors proven by surgical pathology were reviewed retrospectively. Results: Of the 53 patients, mean age was 54 years-old and the male to female ratio was 1 : 1.2 Median follow up was 32.1 months. At the time of diagnosis, liver metastasis was detected in 4 patients. Curative resection was achieved in 49 patients, and 17% of them had recurrence, which was most common in liver. The overall 5-year survival rate was 85.1%. Both the WHO classification (p<0.001) and AJCC staging (p<0.001) correlated well with long-term survival. Univariate analysis revealed preoperative body weight loss (p<0.001), weak enhancement at the early arterial phase (p=0.043), lymph node metastasis (p<0.001), liver metastasis (p=0.001), perineural invasion (p=0.001), or lymphovascular invasion (p=0.010) as prognostic factors. Conclusion: Nonfunctioning endocrine tumor of the pancreas has favorable survival outcomes. Lymph node metastasis (p<0.001), liver metastasis (p=0.001), perineural invasion (p=0.001), and lymphovascular invasion (p=0.010) are poor prognostic factors.

담관낭 환자에서 발생한 담도계 암의 특징 분석

윤관(Kwan Yoon),장진영(Jin-Young Jang),이승은(Seung Eun Lee),강미주(Mee Joo Kang),임창섭(Chang-Sup Lim),안영준(Young Joon Ahn),김선회(Sun-Whe Kim) 한국간담췌외과학회 2009 한국간담췌외과학회지 Vol.13 No.4

Purpose: Choledochal cysts are rare congenital or acquired cystic dilatations of the intra- or extra-hepatic bile ducts. The mechanism of carcinogenesis in choledochal cyst has not been clearly elucidated, although stasis of bile and reflux of pancreatic juice appear to be important factors. The aim of this study was to identify the clinical risk factors predicting development of biliary tract cancers in patients with choledochal cyst. Methods: The study subjects included 170 consecutive patients who underwent surgery for choledochal cysts at Seoul National University Hospital between December 1980 and May 2008. We analyzed the demographic characteristics, clinical symptoms, laboratory findings, type of choledochal cysts, pathologic characteristics, and long-term outcomes of the patients with associated biliary tract cancers. Results: Out Of 170 patients with choledochal cysts, combined biliary tract cancers ware identified in 29 patients, which included extrahepatic bile duct (n=15; 51.7%), gallbladder (n=12; 41.4%), and ampulla of Vater cancers (n=2; 6.9%). There were no significant differences in gender, clinical symptoms (abdominal pain, jaundice, and abdominal masses), laboratory findings (leukocytosis, hyperbilirubinemia, and increased alkaline phosphatase), and Todani classification of choledochal cysts between the two groups with or without combined biliary tract cancer. Multivariate analysis revealed that age ≥41 years and pancreatico-choledochal type APBDU were associated with the development of biliary tract cancers in patients with choledochal cysts. Conclusion: Age ≥41 years and pancreatico-choledochal type APBDU were associated with the development of biliary tract cancers in patients with choledochal cysts. Therefore, the possibility of associated biliary tract cancers should be considered when planning surgical management for patients with these risk factors.

췌장 신경내분비 종양의 임상병리학적 특성 및 예후

류지영(Ji Young Rhu),장진영(Jin-Young Jang),강미주(Mee Joo Kang),정우현(Woo Hyun Jung),장지훈(Jihoon Chang),신용찬(Yong Chan Shin),김선회(Sun-Whe Kim) 대한종양외과학회 2014 Korean Journal of Clinical Oncology Vol.10 No.2