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Perioperative Antibiotic Prophylaxis May Not Be Required Routinely in Thyroid Surgery
이관범,김수영,김석모,장호진,김법우,이용상,장항석,박정수,임치영 대한갑상선-내분비외과학회 2017 The Koreran journal of Endocrine Surgery Vol.17 No.4
Purpose: Although perioperative antibiotic prophylaxis is used to prevent surgical site infection (SSI), thyroid surgery is classified as a clean surgical procedure and routine use of perioperative antibiotic prophylaxis is not recommend. The purpose of this study is to evaluate the therapeutic benefits of using perioperative antibiotic prophylaxis in thyroid surgery. Methods: We evaluated medical records of 1,895 patients who underwent thyroid surgery between January 2013 and December 2013. We divided 2 groups with or without perioperative antibiotic prophylaxis. Clinical factors including sex, age, body mass index (BMI), and comorbidity and surgical factors for SSI were analyzed. Results: The male to female ratio was 1:3.3, the average age was 43 (14–82) years old. The numbers of groups without and with antibiotic prophylaxis were 593 and 1,303. Thirty-seven cases (2.0%) of postoperative complications were observed including chyle leakage, SSI, and nerve injury. The SSI was occurred in 10 patients (0.5%). Clinical factors with SSI were analyzed and there was no statistical significance between 2 groups. Conclusion: In thyroid surgery, perioperative antibiotic prophylaxis may not be required routinely once the surgical procedure underwent with aseptic condition and the patients care was performed appropriately.
Comparison between Gasless and Gas-Inflated Robot-Assisted Nipple-Sparing Mastectomy
이해민,이지아,이관범,김지예,박형석 한국유방암학회 2021 Journal of breast cancer Vol.24 No.2
Purpose: Nipple-sparing mastectomy (NSM) includes various techniques, including conventional or endoscopic mastectomies. Since the introduction of robot-assisted NSM (RANSM) in 2015, 2 main methods have been used: gasless and gas-inflated techniques. The aim of this study was to compare clinicopathologic characteristics, surgical outcomes, and postoperative complications between patients treated with gasless RANSM and those treated with gas-inflated RANSM. Methods: We conducted a retrospective study of women who underwent gasless or gasinflated RANSM with immediate breast reconstruction between November 2016 and May 2019. The indications for RANSM were early breast cancer, interstitial mastopathy, or BRCA1/2 mutation carriers. Clinicopathologic characteristics, surgical outcomes, and postoperative complications were analyzed. The severity of complications was graded using the Clavien-Dindo system. Results: A total of 58 RANSM procedures were performed in 46 women: 15 cases of gasless RANSM and 43 cases of gas-inflated RANSM. The proportion of node-negative disease was higher in the gas-inflated group (97.1%) than in the gasless group (69.2%, p = 0.016). Adjuvant radiotherapy was administered in 30.6% of the cases in the gasless group and only 5% of the cases in the gas-inflated group. Other clinicopathological factors were not significantly different between the groups. Regarding surgical outcomes, the initial incision was 1 cm longer in the gasless group (5.17 ± 0.88 cm) than that in the gas-inflated group (4.20 ± 1.05 cm; p = 0.002). The final incision was also longer in the gasless group (5.17 ± 0.88 cm) than that in the gas-inflated group (4.57 ± 1.07 cm; p = 0.040). Operation time, complication rate, and complication grade were not significantly different between the 2 groups. Conclusion: In this study, there were no significant differences in surgical outcomes or postoperative complications between gasless and gas-inflated RANSM, except for a longer incision with the gasless technique. Both techniques are reasonable options for RANSM followed by immediate reconstruction.
Development of Robotic Mastectomy Using a Single-Port Surgical Robot System
박형석,이지아,이해민,이관범,송승용,Antonio Toesca 한국유방암학회 2020 Journal of breast cancer Vol.23 No.1
Minimal invasive surgical technique has been increasingly applied to breast surgery. Since the first robot-assisted nipple-sparing mastectomy was introduced, we have been performing nipple-sparing mastectomy using multi-port robotic surgical system. Last year, the new robotic surgical system with single port was introduced. We report the development of a robotic nipple-sparing mastectomy with immediate reconstruction through a single incision using the updated single-port surgical robot system for a patient with ductal carcinoma in situ (DCIS). Breast reconstruction was performed using implants. Postoperative pathological examination revealed DCIS in both breasts. There were no major immediate complications, except for a minor skin burn on the right breast. Overall, the initial operation using the updated platform was safely performed.
김상화,김지홍,박형석,김하얀,이관범,이지아,이해민,김지예,김승일,조영업,박병우 연세대학교의과대학 2019 Yonsei medical journal Vol.60 No.11
Purpose: To validate and update a nomogram for predicting ductal carcinoma in situ (DCIS) upstaging in preoperative biopsy. Materials and Methods: Medical records of 444 preoperative DCIS patients were evaluated and used to validate a previous versionof the Severance nomogram for predicting DCIS upstaging in preoperative biopsy. Patients were divided into two groups accordingto the final postoperative pathology. Univariate and multivariate analyses with the chi-square test, Student’s t-test, andbinary logistic regression method identified new significant variables. The updated nomogram was evaluated with the C-index andHosmer—Lemeshow goodness of fit test. Results: The area under a receiver operating characteristic curve for comparison with the previous nomogram was 0.48. In postoperativepathology, the pure DCIS and invasive cancer groups comprised 345 and 99 cases, respectively. Approximately 22.3% ofpatients preoperatively diagnosed with DCIS were upstaged to invasive cancer. Significant variables in the univariate analysis wereoperation type, human epidermal growth factor receptor 2 overexpression, comedo necrosis, sonographic mass, mammographicmass, preoperative biopsy method, and suspicious microinvasion in preoperative biopsy. In multivariate analysis, operation type,sonographic mass, mammographic mass, and suspicious microinvasion were risk factors for upstaging. The updated model withthese variables showed moderate discrimination and was appropriate in the calibration test. Conclusion: The previous nomogram did not effectively discriminate upstaging of preoperative DCIS in an independent cohort. An updated version of the nomogram appears to provide more accurate information for predicting preoperative DCIS upstaging.
A Predictive Model for Distant Metastasis in Patients With Breast Cancer Based on Machine Learning
권혜진,이민형,주수연,이관범,이승아,김승기,김이삭 한국유방암학회 2023 Journal of Breast Disease Vol.11 No.2
Purpose: Breast cancer starts as a local disease, but can metastasize to distant organs. In this study, we described an easy-to-use tool for predicting distant metastases based on clinical characteristics and gene expression profiles. Methods: We performed a retrospective chart review of 326 patients with breast cancer who underwent surgery and CancerSCAN<sup>TM</sup> between January 2001 and December 2014 at the Samsung Medical Center. Additional retrospective data for 83 patients during 2015 were used for internal validation. CancerSCAN<sup>TM</sup>, a next-generation sequencing-based targeted deep sequencing analysis, was used for gene analysis, and Azure Machine Learning (ML) was used for the ML processes. Results: The no-distant metastasis group comprised 267 patients, while the distant metastasis group comprised 59. Using the Azure ML platform, a predictive model was developed with 326 cases. The area under the curve of the receiver operating characteristic curve for predictive value was 0.917. Based on the internal validation performed using 83 patients, the true-negative was 81 and the true-positive was two when a threshold value of 0.5 was applied. Conclusion: Patients with breast cancer are at risk of metastasis and experience fear throughout their lives. Our predictive model is a valuable and easy-to-access tool for identifying patients with distant metastasis and it presents a way for each institution to achieve optimal results using its variables. Further evaluation with a larger patient population will improve the reliability of this model.