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배옥석,이태순,박성대,박종욱,진동석 대한대장항문학회 2004 Annals of Coloproctolgy Vol.20 No.2
Purpose:CEA Study on the Effect of the No-touch Isolation Technique for Preventing Tumor Metastasis in Patients with Colorectal Cancer Division of Colorectal Surgery, Department of Surgery, 1Immunology and 2Clinical Pathology, School of Medicine, Keimyung University, Daegu, Korea Ok Suk Bae, M.D., Tae Soon Lee, M.D., Sung Dae Park, M.D., Jong Wook Park, M.D.1, Dong Suk Chun, M.D.2 Although the ‘No-touch’ isolation technique was introduced by Turnbull et al. in 1967, the controversy over whether or not it reduces the risk of metastasis during surgery exists even today. The aim of this study was to evaluate the effect of the ‘No-touch’ isolation technique in primary colorectal cancer surgery. Methods: The evaluation was done by comparing the levels of CEA and CEA m-RNA expression from the same draining vein before and after tumor mobilization. Blood samples from 25 patients with primary colorectal cancer were collected for analysis. At the time of surgery, the main draining vein from the tumor was isolated and ligated at the proximal end. The 1st blood samples were collected just prior to tumor mobilization, and the 2nd samples right after. Both samples were analyzed for serum CEA level and CEA mRNA expression by using reverse transcriptase polymerase chain reaction (RT-PCR). Results: The mean CEA value from draining veins after tumor mobilization (8.08±8.98 ng/ml) was significantly higher than it was before mobilization (4.17±4.98 ng/ml). CEA mRNA was detected in 16% (4/25) of the blood specimens post-mobilization, whereas it was detected in only 4% (1/25) of the pre-mobilization samples. Conclusions: The results suggest the validity of using the ‘No-touch’ isolation technique to reduce the risk of metastasis into the draining vein during mobilization. 목적: ‘No-touch’ isolation 술식은 아직까지도 술 중 전이의 위험도를 낮추는가에 대해서는 논란의 대상이 되고 있다. 이 술식의 재발률을 분석하기 위해 가장 이상적인 연구방법은 단일기관의 단일 술자에 의해 기존의 술식과 비교하여 연구하는 것이 바람직하지만, 어려움이 있다. 저자들은 대장암에서 이 술식의 종양 조작 전 혈관결찰술이 암전이 위험성을 저하시킬 수 있는가를 실험적 방법으로 확인하고자 본 연구를 시작하였다. 대상 및 방법: 25예의 대장암 환자에서 술 중 종양 조작이 이루어지기 전에 주 배액 정맥을 분리하여 결찰을 하였으며, 종양 조작 전 후에 주 배액 정맥을 통해 각각 정맥혈 채취를 하였다. 이들 정맥혈에서 혈청 CEA 수치 및 RT-PCR을 이용한 CEA m-RNA의 발현 여부를 비교 분석하였다. 결과: 종양 조작 후에 이루어진 배액 정맥혈에서의 평균 혈청 CEA 수치는 8.08±8.98 ng/ml로 종양 조작 전의 평균 혈청 CEA 수치인 4.17±4.98 ng/ml보다 유의하게 증가하였으며(P=0.035), CEA m-RNA의 발현은 종양 조작 후의 정맥혈에서 16% (4/25)로, 종양 조작 전의 정맥혈에서 4% (1/25)보다 유의하게 증가하였다(P=0.00). 결론: ‘No-touch’ isolation 술식 중 종양 조작 전 혈관결찰술은 대장암 세포전이의 위험성을 낮출 수 있는 것으로 생각이 되지만, 술 후 재발률, 사망률 등의 임상적 연구가 더 필요할 것으로 생각된다.
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CEA Expressions in Colorectal Tumor
배옥석,이태순,박성대 대한대장항문학회 2004 Annals of Coloproctolgy Vol.20 No.1
Purpose: The purpose of this research is to investigate the clinical usefulness of carcinoembryonic antigen (CEA) expression in colorectal cancer tissue. Methods: We performed immunohistochemical staining of CEA on 64 surgically resected colorectal cancer tissues obtained during the period from May 2000 to May 2001. CEA expression was detected by immunohistochemistry using a CEA monoclonal antibody. The degrees of CEA expression in the tumor cell cytoplasm and the luminal secretion of the tumor gland were grouped into positive (strongly positive) and negative groups (weakly positive) by using the Sinicrobe method and were compared with clinicopathological variables. Results: The expression rates were positive in 38 cases (59.4%) and negative in 26 cases (40.6%). The preoperative CEA level showed a higher trend in the positive group (8.23±13.7) than it did in the negative group (17.89±38.7 ng/ml), but the difference was not statistically significant. The relationships between the CEA expressions of the two groups and the clinicopathologic factors were not statistically significant. We observed CEA expression in the luminal secretion of the tumor gland in 41 cases. The expression rates in the luminal secretion were positive in 21 cases (51.2%) and negative in 20 cases (48.8%). No significant clinical difference were noted between the two groups. Conclusions: The results suggest that CEA expression may not play a role as a prognostic factor for colorectal cancer. 대장암에서 CEA의 발현 계명대학교 의과대학 외과학교실 대장항문 분과 배옥석․이태순․박성대 목적: 종양조직내의 CEA 발현의 정도가 환자의 예후예측을 위한 탐지자로서의 가능성 유무를 확인하고자 본 연구를 시작하였다. 대상 및 방법: 2000년 5월부터 2001년 5월까지 계명대학교 동산의료원 대장항문과에서 결직장암으로 수술한 환자에서 획득한 암조직 64예를 CEA항체를 이용하여 면역조직화학염색을 시행하여 암세포와, 관강 내 분비물의 발현양상을 양성 음성으로 구분후 각 환자들의 술 전 혈청 CEA치, 병기와 혈관 침범유무, 술 후 2년 내 암재발과의 관계를 분석하였다. 결과: 64예의 암조직의 발현은 양성 26예, 음성 38예였으며 술전 말초혈액 CEA치와 비교에서 음성과 양성은 각각 8.23±13.7, 17.89±38.7 ng/ml로 양성군에 증가하였으나 통계적 유의성은 없었으며 병기, 혈관침범유무, 재발 등과의 비교에서도 유의한 차이는 없었다. 관강 내 분비물의 발현에서도 임상적인 조건들과의 유의한 관계가 없었다. 결론: 대장암에서 CEA의 발현은 예후인자와의 상관관계를 확인할 수 없어서 환자의 예후예측을 위한 탐지자로서의 임상적 의의가 없는 것으로 사료된다.
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배옥석,임태진,박영관 계명대학교 醫科大學 外科學敎室同門會 1990 남경 박영관 교수 정년퇴임기념 논문집 Vol.S No.-
A clinical review was made of 65 cases of primary cancer of the extrahepatic tract and were treated surgically from January 1972 to December 1982 for 10 years department of general surgery. 1) There is a growing tendency of primary cancer of the biliary tract every year. 2) The mean age was 54 years, and it was most prevalent in the 6th decade. biliary m our 3) The male to female ratio was 1 :1.7 in gallbladder cancer and 1.9 : 1 in the extrahepatic bile duct cancer. 4) The prominant symptoms were pain . in R. U.Q. in gallbladder cancer, and jaundice in extrahepatic bile duct cancer. 5) The gallbladder should be opened and examined in the operating suite in every cholecystectomy and any suspicious lesion should be submitted for immediate histologic examination. 6) Gall stones were found in 17% of the patient with carcinoma of the gallbladder. 7) The most common histologic type was adenocarcinoma. 8) Operative mortality of biliary tract cancer was 3%. The causes of deathwere hemobilia and severe obstructive jaundice. Nineteen of thirty patients died within first six months. One patient of thirty survived. In the survivor, cancer was not noted during the operation and was diagnosed later by pathologic examination
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