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단일 기관에서 경험한 신 세포암의 췌장 전이 치료 경험
차장호(Jang Ho Cha),박준성(Joon Seong Park),황호경(Ho Kyung Hwang),김재근(Jae Keun Kim),윤동섭(Dong Sup Yoon),이우정(Woo Jung Lee),지훈상(Hoon Sang Chi) 한국간담췌외과학회 2009 한국간담췌외과학회지 Vol.13 No.2
Introduction: Renal cell carcinoma (RCC) is a relative rare tumor, accounting for approximately 3% of adult malignancies. Renal cell carcinoma has a high metastatic potential and is renowned for its ability to spread to almost any organ of the body. Pancreas is a rare site for metastasis from other primary cancers. Moreover, pancreatic metastasis is difficult to differentiate and may be misdiagnosed as a primary pancreatic cancer. The aim of this study was to review our cases of renal cell carcinoma that had metastasized to the pancreas after radical nephrectomy. Methods: We did a retrospective review of the records of 4 patients with pathologically confirmed RCC that had metastasized to the pancreas after radical nephrectomy. Results: Our group of 4 patients consisted of 2 men and 2 women. Their average age was 58.7 years (± 10.51 years). The locations within the pancreas were the head, in 2 (50.0%) and the body/tail in 2 (50.0%) patients. The pancreatic metastases were treated by pancreaticoduodenectomy in 2 patients, and by distal pancreatectomy in 2 patients. Median survival duration was 109.0 (± 67.3 months) "Median" is associated with an interquartile range (25% to 75%). The number 67.3 appears to be a standard deviation which is associated with the "mean". Conclusions: RCC is an unpredictable tumor that may result in a late metastasis even from an early stage. Aggressive surgical management of pancreatic lesions offers a chance of long-term survival.
김혜운(Hye Un Kim),류제규(Je Kyu Ryu),최새별(Sae Byeol Choi),황호경(Ho Kyoung Hwang),김경식(Kyung Sik Kim),윤동섭(Dong Sup Yoon),이우정(Woo Jung Lee) 한국간담췌외과학회 2009 한국간담췌외과학회지 Vol.13 No.1
Acinar cell carcinoma (ACC) is a very rare type of pancreatic cancer that makes up less than 1% of all pancreatic cancers. The prognosis of ACC is very poor and the mean survival interval is only 18-19 months. The only effective treatment is currently early radical resection. Materials and methods: To determine ACC`s clinical characteristics and the treatment efficacy, we conducted a retrospective chart review to study the clinical characteristics, laboratory findings, pathology and treatment responses of 10 ACC patients among 3042 pancreatic cancer patients who were diagnosed in Severance Hospital and Kangnam Severance Hospital of Yonsei University, College of Medicine from 1988.01.01 to 2008.12.31. Results: The 10 ACC patients were 6 males and 4 females. The mean age of the 10 ACC patients was 53.2 years. The most of the patients (7/10) complained the pain on the epigastric area and there was no jaundice in 8 patients (80%). Unfortunately, regional or distant metastases were founded in 8 patients (80%) at the time of the first diagnosis. The initial mean CA19-9 level was increased to 73.5 U/ml (range: 0.1~350.0 U/ml). Six of 10 patients underwent radical surgery and 4 of 10, including 1 with open and closure, were treated with conservative treatment. The median survival interval was 22.4 months with operative treatment and 1.5 months with conservative treatment. The median overall survival interval was 19.4 months. The median disease free survival was 17 months. The liver was the most common recurrent site (3 cases). Conclusions: An early radical resection is currently the best and only treatment for ACC, but in rare cases, post-operative adjuvant chemotherapy shows hopeful results and so this requires more study.
간세포암 근치적 절제 후 발생한 간외 재발암의 위험인자 분석
이형순(Hyung Soon Lee),최기홍(Gi Hong Choi),황호경(Ho Kyung Hwang),강창무(Chang Moo Kang),최진섭(Jin Sub Choi),이우정(Woo Jung Lee) 한국간담췌외과학회 2010 한국간담췌외과학회지 Vol.14 No.4
Purpose: A few studies have been reported on extrahepatic metastasis after curative resection for hepatocellular carcinoma (HCC). We investigated the patterns of extrahepatic recurrence and we identified the risk factors for extrahepatic recurrence after curative resection for HCC. Methods: We retrospectively reviewed 587 patients who underwent surgical resection with a curative aim from January 1998 to December 2007 in the Yonsei University Health Care System. Among the 571 patients, 291 (51.0%) patients developed recurrence. Sixty five patients initially presented with extrahaptic recurrence. The patients with extrahepatic recurrence were divided into Group A (peritoneal recurrence) and Group B (non-peritoneal extrahepatic recurrence). Results: Group A had higher rates of intraoperative bleeding>1,500 ml and perioperative transfusion too. On the multivariate analysis, perioperative transfusion, satellite nodule and the tumor size were the independent risk factors for Group A. The Edmondson-Steiner grade, satellite nodule and the tumor size were the independent risk factors for Group B. The 1, 3 and 5-year overall survival rates after curative resection for the patients with extrahepatic recurence were 83.1%, 48.9% and 27.4%, respectively. The recurrence patterns and treatment modalities did not affect the overall survival after treatment for extrahepatic recurrence. Conclusion: A perioperative transfusion was found to be a different risk factor for peritoneal recurrence, as compared to those risk factors for non-peritoneal extrahepatic recurrence. Therefore, efforts by physicians to decrease intraoperative bleeding may prevent peritoneal recurrence after performing curative resection for HCC.
근치적 절제술을 시행한 바터씨 팽대부암에서 Ki-67과 VEGF의 예후인자로서의 가능성
김국진(Kuk Jin Kim),홍순원(Soon Won Hong),박준성(Joon Seong Park),황호경(Ho Kyung Hwang),김재근(Jae Keun Kim),김경식(Kyung Sik Kim),최진섭(Jin Sub Choi),윤동섭(Dong Sup Yoon),이우정(Woo Jung Lee),지훈상(Hoon Sang Chi) 한국간담췌외과학회 2008 한국간담췌외과학회지 Vol.12 No.3
Purpose: Ampulla of Vater cancer has a more favorable prognosis and survival than other malignant periampullary tumors. The pathologic staging of ampulla of Vater carcinoma is a key determinant of the patient’s prognosis. However, we have often encountered patients in whom the course of their disease differed substantially from what would be predicted based on their clinical staging, which highlights the need to consider additional predictive factors. We applied an immunohistochemical technique to examine the expression of Ki-67 and VEGF in radicallyresected ampulla of Vater carcinomas, and then compared the status of expression with several clinicopathologic factors. Methods: Sixty-four patients who underwent curative resection for ampulla of Vater cancer between January 1992 and December 2006 at the Yonsei University College of Medicine were reviewed. The relationships between the expression of molecular markers and clinicopathologic factors were determined. Results: There was no relationship between the clinicopathologic characteristics and the expression of molecular markers in patients with ampulla of Vater cancer. Among the clinicopathologic characteristics, lymph node metastasis was identified as an independent factor of survival after curative resection for ampulla of Vater carcinoma. Conclusion: Measurement of Ki-67 and VEGF in patients with ampulla of Vater carcinoma may have an important role in identifying the poor prognostic group.
유행랑(Haeng Rang Ryu),박준성(Joon Seong Park),황호경(Ho Kyung Hwang),김재근(Jae Keun Kim),김경식(Kyung Sik Kim),최진섭(Jin Sub Choi),윤동섭(Dong Sup Yoon),이우정(Woo Jung Lee),지훈상(Hoon Sang Chi) 한국간담췌외과학회 2008 한국간담췌외과학회지 Vol.12 No.4
Purpose: Although laparoscopic surgery has become more popular, its technical difficulties have limited the applications of this technique to liver surgery. We report here on our experience with liver resection with perfoming laparoscopic assisted and DaVinci robot assisted hepatectomy. Methods: We retrospectively evaluated 40 patients who underwent laparoscopic assisted and DaVinci robotic assisted hepatectomy at the Yonsei University Health System from January 2002 to January 2008. Results: Thirty patients (75%) had malignancy and ten patients (15%) had benign disease. We performed Lt. hepatectomy (7.5%), wedge resection (17.5%), segmentectomy (30%) and Lt. lateral segmentectomy (45%). The rate of conversion to laparotomy was due to intraoperative bleeding was 10%. The complication and mortality rates were 7.5% and 0%, respectively. Conclusion: Laparoscopic and DaVinci robot hepatectomy showed a reduced time to oral intake, a shortened hospital stay and a smaller incisional scar compared to open surgery. So, laparoscopic and DaVinci robot hepatectomy should be performed in selected patients as the postoperative status of the patients is better than that with performing open hepatectomy.
하지 동맥경화증의 수술 전 진단에서 고식적 혈관조영술과 다중검출 나선식 컴퓨터 혈관조영술의 비교
이강율(Kang Yool Lee),김일명(Il Myung Kim),유병욱(Byung Ook You),윤진(Jin Yoon),박상수(Sang Su Park),신동규(Dong Gue Shin),강성구(Sung Gu Kang),황호경(Ho Kyung Hwang),이성아(Sung A Lee) 대한외과학회 2008 Annals of Surgical Treatment and Research(ASRT) Vol.74 No.4
Purpose: We performed this study to assess the suitability of conventional angiography (CA) vs. multi-detector row helical CT angiogram (MD-CTA) as a method of preoperative diagnostic imaging for low extremity arterial surgery. Methods: From February 2004 to September 2006, 23 patients (4 claudicants, 19 limb-threatening ischemia) were studied with CA and MD-CTA preoperatively. The site and degree of stenotic or occlusive lesions in arterial segments from the renal artery to the dorsalis pedis artery were compared with both methods. We also compared the surgical inflow and outflow site changes in preoperative planning based on CA and MD-CTA and the final outcome. Additional diagnostic value and test-related complications were also analyzed. Results: The median age of patients was 68 years old (range: 43∼89 years), with a male to female ratio of 1.3:1. Twenty-three patients had CA after an MD-CTA scan. One hundred fifty lesions were detected in these patients. The total ratio of consistency for occlusion in CA vs. MD-CTA was 69.6%. Three patients received amputation treatment and eleven patients received a bypass operation. The agree ment between the preoperative plan based on MD-CTA and the final operation was 100%, even in critical limb ischemia. There were no serious complications related to the tests. Conclusion: These findings suggest that MD-CTA is an adequate preoperative imaging study of infrainguinal arterial surgery and may be substituted for conventional angiography without any serious complications.