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갑상선 수질암의 단일 기관의 25년간 임상 경험과 RET 원 종양유전자 검사 결과 분석
정종주,이용상,강상욱,성태연,이승철,남기현,장항석,정웅윤,박정수,Jong Ju Jeong,Yong Sang Lee,Sang- Wook Kang,Tae-Yon Sung,Seung Chul Lee,Kee-Hyun Nam,Hang-Seok Chang,Woong Youn Chung,M.D. and Cheong Soo Park,M.D. 대한갑상선-내분비외과학회 2009 The Koreran journal of Endocrine Surgery Vol.9 No.1
Purpose: Medullary thyroid carcinoma (MTC) is a rare thyroid tumor and its clinical course is quite variable. The aim of this study was to retrospectively analyze our clinical and laboratory data for 25 years to review the clinicopathologic characteristics, the operation methods, the tumor recurrence and the prognosis of medullary thyroid carcinoma. We also reevaluate the limits of the previous diagnostic and treatment modalities. The positivity for and the location of the RET mutation are also evaluated. Finally, we want to contribute to a systemic approach for the diagnosis, treatment, patient management and clinical study of medullary thyroid carcinoma. Methods: We conducted a retrospective review of the records of 77 patients with MTC that were seen at our hospital from 1982 to 2007. The medical records were reviewed for the demographic data, the laboratory data and the clinical course, the treatment, the long-term outcome and the RET proto-oncogene mutation. The mean follow-up period was 69.6 months (range: 6∼201). Results: There were 50 females and 27 males. The mean patient age was 44.2 years (range: 1∼80). There were 16 cases of the sporadic form (79.2%) and 16 cases of the hereditary form. At diagnosis, 73 patients (94.8%) had local disease and 4 patients (5.2%) had distant metastasis. The patients with the hereditary form were younger than the patients with the sporadic form (P=0.004), and they had more muticentric (P=0.002) and bilateral tumor (P<0.001). The initial surgery consisted of total thyroidectomy in 74 patients (96.1%), and lateral neck dissection in 41 patients (53.2%) (therapeutic: 23, prophylactic: 18), except for 3 cases with less than total thyroidectomy. Forty-four patients (57.1%) achieved a long-term remission state, 13 patients (16.9%) had biochemical persistent disease, and 20 patients (26.0%) had metastasis. The 5- and 10-year survival rates were 86.5% and 74.1% respectively. On univariate analysis, tumor size (more than 2 cm), extracapsular invasion, involvement of the neck nodes and distant metastasis at the time of diagnosis were the significant prognostic factors of persistent or recurrence disease. Conclusion: Patients with MTC generally have a favorable outcome. The presence of distant metastasis at the time of diagnosis is predictive of persistent or recurrence disease by multivariate analysis. In order to achieve an early diagnosis and administer prompt treatment, we suggest that optimal RET oncogene screening and counseling should be performed for medullary patients and their relatives. (Korean J Endocrine Surg 2009;9:1-6)
종격동 전이를 보이는 갑상선암 환자에서 Robot-assisted Lymph Node Dissection을 병행한 1예
정종주,이용상,강상욱,성태연,이승철,남기현,장항석,정웅윤,백효채<SUP>1<,SUP>,박정수,Jong Ju Jeong,Yong Sang Lee,Sang- Wook Kang,Tae-Yon Sung,Seung Chul Lee,Kee-Hyun Nam,Hang-Seok Chang,Woong Youn Chung,Hyo Chae Paik,<SUP>1<,SUP> and 대한갑상선-내분비외과학회 2008 The Koreran journal of Endocrine Surgery Vol.8 No.2
정종주,이용상,홍순원<SUP>1<,SUP>,강상욱,성태연,이승철,남기현,장항석,정웅윤,박정수,Jong Ju Jeong,M,D,Yong Sang Lee,M,D,Soon Won Hong,M,D,<SUP>1<,SUP>,Sang-Wook Kang,M,D,Tae Yon Sung,M,D,Seung Chul Lee,M,D,Kee-Hyun Nam,M,D,Hang-Seok 대한갑상선-내분비외과학회 2007 The Koreran journal of Endocrine Surgery Vol.7 No.4
Purpose: Warthin-like papillary carcinomawas named owing to its close histologic resemblance to a tumor encountered in salivary gland, and this tumor is a variant of papillary thyroid carcinoma. Among the variants of papillary thyroid carcinoma, the tall cell variant and diffuse sclerosing variant have more aggressive behavior than the classic papillary carcinoma. But Warthin-like papillary carcinoma arises in a background of thyroiditis and it behaves in an indolent fashion. Since then, a few case have reported in Korea. We report here on the clinicopathologic features of five cases of warthin-like papillary carcinoma. Methods: From Jan. 1996 to Feb. 2008, five patients who were diagnosed with Warthin-like papillary thyroid carcinoma at YUMC were retrospectively reviewed. Results: All 5 patients whose pathologic features were warthin-likepapillary thyroid carcinoma were women (age range: 34∼60 years). The tumor size ranged from 0.6 to 2.4 cm. 3 tumors were confined to the thyroid, but 2 tumors had invaded the strap muscles. 3 of the 5 tumors arose in a background of lymphocytic thyroditis. Central nodal metastases were identified in 2 cases. But no lateral nodal or distant metastasis had occurred. The mean duration of follow-up was 16.5 months (range: 5∼50 months). 1 patient died because of lung cancer, and there was no recurrence for the other 4 cases during the follow-up period. Conclusion: Although the long-term follow-up data on patients with Warthin-like papillary carcinoma is not available, the clinicopathologic data does not show that Warthin-like papillary carcinoma is any more aggressive than the usual papillary carcinoma. (Korean J Endocrine Surg 2007;7: 257-259)
갑상선 절제 수술 후 Guardix-SG<SUP>Ⱂ</SUP>의 유착방지 효과
박재현,정종주,강상욱,남기현,장항석,정웅윤,박정수,Jae Hyun Park,M.D.,Jong Ju Jeong,M.D.,Sang Wook Kang,M.D.,Kee Hyun Nam,M.D.,Hang Seok Chang,M.D.,Woong Youn Chung,M.D. and Cheong Soo Park,M.D. 대한갑상선-내분비외과학회 2009 The Koreran journal of Endocrine Surgery Vol.9 No.3
Purpose: Postoperative adhesion of the surgical field seems to be troublesome not only to the patients, but also to the surgeons. Guardix-SG<SUP>Ⱂ</SUP> is a poloxamer/alginate mixture that reduced the incidence of postoperative adhesions when it is added to the abdominal surgery in animal models and also in clinical trials. This study was a randomized, prospective, double-blinded study to evaluate the antiadhesive efficacy and safety of Guardix-SG<SUP>Ⱂ</SUP> after total thyroidectomy. Methods: A total of 89 patients who underwent total thyroidectomy between July 2008 and February 2009 in Severance Hospital and Gang-Nam Severance Hospital were randomized to either the Guardix-SG<SUP>Ⱂ</SUP> treatment group (n=45) or the non-treatmentcontrol group (n=44). The patients were asked about their clinical symptoms (hypesthesia or paresthesia on the operative site (SN) and swallowing discomfort (SW)) by using a questionnaire, and the swallowing function was evaluated using Marshmallow Esophagography by one physician. The clinical symptoms and Marshmallow Esophagography were scored according to the results of assessment. The most severe state was scored as 0 and normal was scored as 3. Results: The scores of the clinical symptoms (SN and SW) were 2.67 and 2.49 in the treatment group, and 2.09 and 1.80 in the control group, respectively, at the postoperative 6th week (P=0.001, <0.001). The scores of the Marshmallow Esophagography were 2.93 in the treatment group and 2.73 in the control group (P=0.033). Abnormal findings were seen in 2 patients (4.4%) in the treatment group and in 10 patients (22.7%) in the control group (P=0.014). Conclusion: Guardix-SG<SUP>Ⱂ</SUP> seems to be effective in preventing adhesion after thyroidectomy. Further studies involving a larger number of subjects will be needed to make an application guideline. (Korean J Endocrine Surg 2009;9: 127-132)
액와접근법을 이용한 무기하 내시경적 갑상선 절제술: 634예에 대한 수술 결과
강상욱,정종주,윤지섭<SUP>1<,SUP>,성태연,이승철,이용상,남기현,장항석,정웅윤,박정수,Sang-Wook Kang,Jong Ju Jeong,Ji-Sup Yoon,<SUP>1<,SUP>,Tae Yon Sung,Seung Chul Lee,Yong Sang Lee,Kee-Hyun Nam,Hang Seok Chang,Woong Youn Chung,and Ch 대한갑상선-내분비외과학회 2008 The Koreran journal of Endocrine Surgery Vol.8 No.1
이용상,정종주,윤지섭,남기현,장항석,정웅윤,박정수,Yong Sang Lee,M.D.,Jong Ju Jeong,M.D.,Ji-Sup Yun,M.D.,Kee-Hyun Nam,M.D.,Hang Seok Chang,M.D.,Woong Youn Chung,M.D. and Cheong Soo Park,M.D. 대한갑상선-내분비외과학회 2007 The Koreran journal of Endocrine Surgery Vol.7 No.3
Although breast carcinoma has a predilection for metastasis to auxiliarylymph nodes, auxiliary nodal metastasis from papillary thyroid carcinoma is extremely rare, and to our knowledge, only 6 cases have been reported worldwide. Here, we report an extremely rare case of auxiliary lymph node metastasis from papillary thyroid carcinoma. A 41-year-old woman presented with palpable masses in her left axilla. Fourteen years previously, she had presented with a 3.0-cm sized mass in the left supraclavicular fossa, which was found to be metastatic papillary thyroid. At that time, she underwent a total thyroidectomy along with a left modified radical neck dissection. Histopathologic examination at that time revealed the presence two papillary microcarcinoma of the thyroid and multiple metastatic nodes in the left lateral neck (5 of 32, T1N1bM0). Following her recent presentation, imaging studies, including magnetic resonance imaging and positron emission tomography, revealed the presence of a small metastatic focus in the left upper lung and multiple metastatic nodes in the left auxiliaryregion. She underwent a wedge resection of the lung mass and a left radical auxiliarylymph node dissection. Histopathologic findings confirmed that both lesions were metastatic poorly differentiated papillary thyroid carcinomas. (Korean J Endocrine Surg 2007;7:168-172)
갑상선 수술의 해부학적 지표로서의 Zuckerkandl 결절의 중요성
윤지섭,정종주<SUP>1<,SUP>,이용상<SUP>1<,SUP>,남기현<SUP>1<,SUP>,정웅윤<SUP>1<,SUP>,장항석<SUP>1<,SUP>,박정수<SUP>1<,SUP>,Ji-Sup Yun,Jong Ju Jeong,<SUP>1<,SUP>,Yong Sang Lee,<SUP>1<,SUP>,Kee Hyun Nam,<SUP>1<,SUP>,Woong You 대한갑상선-내분비외과학회 2007 The Koreran journal of Endocrine Surgery Vol.7 No.4
Purpose: Zuckerkandl's tubercle (ZT) of the thyroid gland is a well-documented anatomical structure. This study evaluated the anatomical relationship of the ZT in terms of the recurrent laryngeal nerve (RLN) and the superior parathyroid gland (SP). Methods: The study included 325 patients (ten patients with benign tumors and 315 patients with malignancies) who underwent thyroid surgery between February and June 2007. Tubercles were classified according to size: Grade 0 (unrecognizable), Grade I (≤ 5 mm), Grade II (6∼10 mm) and Grade III (>10 mm). The incidence and size of the ZT and its positional relationship to the RLN and SP were investigated during thyroid surgery. Results: ZTs were identified in most patients (right thyroid 89.3%, left thyroid 85.6%). The percentageof tubercles according to grade and location was as follows: Grade 0, right thyroid 10.7% and left thyroid 14.4%; Grade I, right thyroid 7.9% and left thyroid 11.1%; Grade II, right thyroid 43.5% and left thyroid 38.5%; Grade III, right thyroid 37.9% and left thyroid 35.9%. The most common RLN course was in a groove between the ZT and the main body of the thyroid. Most of the SPs are situated cranial to the ZTs and were located at the 1 or 2 o'clock position (96.1%) in the left thyroid and at the 10 or 11 o'clock position (95.2%) in the right thyroid. A greater distance between the ZT and the SP was seen with a decreasing size of the ZT. Conclusion: The ZT was identified during most thyroidectomies, and there was a constant relationship between the ZT and either the RLN or SP. Therefore, identification of the ZT and an understanding of the relationship between the ZT and either the RLN or SP are essential for the performance of safe thyroid surgery. (Korean J Endocrine Surg 2007;7:237-241)
측경부 림프절 청소술을 요하는 갑상선암 환자에서 척수부신경 상측 림프절 청소술이 필요한가?
성태연,윤지섭,정종주,이용상,남기현,정웅윤,장항석,박정수,Tae Yon Sung,M,D,Ji-Sup Yun,M,D,Jong Ju Jeong,M,D,Yong Sang Lee,M,D,Kee-Hyun Nam,M,D,Woong Youn Chung,M,D,Hang Seok Chang,M,D,and Cheong Soo Park,M,D 대한갑상선-내분비외과학회 2007 The Koreran journal of Endocrine Surgery Vol.7 No.2
Purpose: Controversy still exists concerning the extent of neck nodedissection in thyroid carcinoma patients. A modified neck dissection is usually performed for the treatment of thyroid carcinoma patients with positive lateral neck nodes. When performing a neck dissection, removal of the nodes superior to the spinal accessory nerve (level IIB) is difficult and time consuming. This study was performed to determine whether level IIB node dissection is always necessary in therapeutic neck dissection for metastatic papillary thyroid carcinoma. Methods: A total of 200 neck dissections were performed in 175 papillary thyroid carcinoma patients with positive lateral neck nodes between September 2005 and June 2007. The patterns of lateral neck metastasis were analyzed with respect to neck level, but the level IIB nodes were studied as separate specimens. Potential factors predicting level IIB node metastasis were also evaluated. Results: The most common site of metastasis was level III, showing 95.0% (190/200), followed by level IV 66.0% (132/200), level IIA 54.0% (108/200), and level V 15.5% (31/200). Level IIB metastases were seen in 12 necks (6.0%) and seen only in the necks with positive level IIA nodes. In 11 of the 12 necks, the primary tumors were located in the upper pole of the thyroid. Conclusion: Level IIB node dissection is not necessary when there is no level IIA metastasis. Even when there is level IIA metastasis, level IIB node dissection is not always necessary, unlessthe primary tumors are located in the upper pole of the thyroid. (Korean J Endocrine Surg 2007;7:88-93)
갑상선암에 대한 로봇 보조 내시경적 갑상선 절제술; 100예에 대한 초기 경험
강상욱 ( Sang-wook Kang ),정종주 ( Jong Ju Jeong ),윤지섭 ( Ji-sup Yun ),성태연 ( Tae Yon Sung ),이승철 ( Seung Chul Lee ),이용상 ( Yong Sang Lee ),남기현 ( Kee-hyun Nam ),장항석 ( Hang Seok Chang ),정웅윤 ( Woong Youn Chung ) 대한갑상선학회 2008 International Journal of Thyroidology Vol.1 No.2
Background and Objectives: Various surgical procedures have been performed using surgical robot in recent years and most reports proved that application of robotic technology for surgery is technically feasible and safe. The aim of this study is to introduce our technique of robot-assisted endoscopic thyroid surgery and demonstrate its utility in the surgical management of thyroid cancer. Materials and Methods: From October 4<sup>th</sup> 2007 through March 14<sup>th</sup> 2008, 100 patients with papillary thyroid cancer underwent robot-assisted endoscopic surgeries using a gasless trans-axillary approach. This novel robotic surgical approach allowed adequate endoscopic access for thyroid surgeries. All the procedures were completed successfully using the da Vinci surgical system (Intuitive Surgical, Sunnyvale, California, USA). We used four robotic arms with this system; a 12 mm telescope and three 5 mm instruments. The 3-dimensional magnified visualization obtained by the dual-channel endoscope and tremor-free instruments controlled by robot system helped surgeon do sharp and precise endoscopic dissection. Results: We performed 84 less-than total and 16 total thyroidectomies with ipsilateral central compartment node dissection. Mean operation times was 136.5 min. (range 79∼267 min.) in which the actual time for thyroidectomy with lymphadenectomy (console time) was 60.0 min. (range 25∼157 min). The average number of lymph nodes resected was 5.3 (range 1 to 28). There was no serious complication. Most patients could go home within 3 days after surgery. Conclusion: Our technique of robotic-assisted endoscopic thyroid surgery using a gasless trans-axillary approach is feasible, safe and promising for the selected patients with thyroid cancer. We suggest application of robotic technology for endsocopic thyroid surgeries could overcome the limitations of conventional endoscopic surgeries in the surgical management of thyroid cancer.