The Clinicopathologic Features and Recurrence of Resection-Line Involvement of Gastric Cancer after Gastrectomy

Choi, Seong-Hee,Lee, Hyeong-Geun,Choi, Min-Gew,Noh, Jae-Hyung,Sohn, Tae-Sung,Bae, Jae-Moon,Kim, Sung 대한위암학회 2010 Journal of gastric cancer Vol.10 No.3

Purpose: The purpose of this study was to analyze the clinical courses of patients with gastric cancer and positive resection margins after a gastrectomy for gastric cancer who did not undergo subsequent surgery. Materials and Methods: Among 4,452 patients who underwent surgery for gastric cancer from January 2001 to December 2007, 20 patients with positive resection margins after gastrectomy for gastric cancer who did not undergo subsequent surgery were included. The recurrence patterns were confirmed by postoperative computed tomography and gastroscopy, which were performed on a planned schedule. All recurrence patterns after gastrectomy were classified as loco-regional, peritoneal, or distant metastases. Results: The patients with confirmed recurrence all had advanced stage cancer (III-IV), and the recurrence sites were variable. However, peritoneal and distant recurrences were more common than loco-regional recurrences. The patients with loco-regional recurrence also had peritoneal and/or distant recurrence. Conclusions: Patients with gastric cancer and a positive resection margin showed more frequent peritoneal and distant metastases than loco-regional recurrence. In addition, patients with loco-regional recurrence also had peritoneal and distant recurrence. A positive resection margin of gastric cancer was related with poor histological differentiation, diffuse type, and advanced stage (III-IV).

위 절제술 후 절제연 양성군의 임상병리학적 특성과 재발

최성희,Hyeong Geun Lee,Min Gew Choi,Jae Hyung Noh,Tae Sung Sohn,배재문,Sung Kim 대한위암학회 2010 Journal of gastric cancer Vol.10 No.3

Purpose: The purpose of this study was to analyze the clinical courses of patients with gastric cancer and positive resection margins after a gastrectomy for gastric cancer who did not undergo subsequent surgery. Materials and Methods: Among 4,452 patients who underwent surgery for gastric cancer from January 2001 to December 2007, 20patients with positive resection margins after gastrectomy for gastric cancer who did not undergo subsequent surgery were included. The recurrence patterns were confirmed by postoperative computed tomography and gastroscopy, which were performed on a planned schedule. All recurrence patterns after gastrectomy were classified as loco-regional, peritoneal, or distant metastases. Results: The patients with confirmed recurrence all had advanced stage cancer (III–IV), and the recurrence sites were variable. However,peritoneal and distant recurrences were more common than loco-regional recurrences. The patients with loco-regional recurrence also had peritoneal and/or distant recurrence. Conclusions: Patients with gastric cancer and a positive resection margin showed more frequent peritoneal and distant metastases than loco-regional recurrence. In addition, patients with loco-regional recurrence also had peritoneal and distant recurrence. A positive resection margin of gastric cancer was related with poor histological differentiation, diffuse type, and advanced stage (III–IV).

대장암의 근치적 절제술 후 발생한 복막 재발의 위험 인자

강병모(Byung Mo Kang),최규석(Gyu Seog Choi),임경훈(Kyoung Hoon Lim),박인자(In Ja Park),전수한(Soo Han Jun) 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.79 No.5

Purpose: Peritoneal recurrence after curative resection of colorectal cancer has been considered to be a lethal condition and to be suitable for palliative chemotherapy. Recently, aggressive approaches such as cytoreductive surgery and perioperative intraperitoneal chemotherapy were introduced for peritoneal malignancies to improve survival. The aim of this study is to identify the risk factors of peritoneal recurrence after curative resection of colorectal cancer and to determine the indication of early postoperative intraperitoneal chemotherapy (EPIC). Methods: From January 1997 to December 2007, a total of 2,320 patients’ records with curative resection for colorectal cancer were collected through the prospective colorectal cancer registry protocol in Kyungpook National University Hospital, Korea. Of those, a total of 1,929 patients were included for analysis of the relationship between perioperative clinicopathologic variables and peritoneal recurrence. Results: The study group was composed of 1,086 men and 843 women with a mean age of 61.1. In multivariate analysis, preoperative level of serum CA19-9>37 U/㎖ (odd ratio [OR] 3.217; 95% confidence interval [95% CI] 1.525∼6.788), right colon cancer (OR 2.524; 95% CI 1.158∼5.502), pT4 tumor (OR 2.131; 95% CI 1.009∼4.502) and positive apical lymph node (OR 3.045; 95% CI 1.023∼9.066) were independent risk factors of peritoneal recurrence after curative resection of colorectal cancer. Conclusion: In colorectal cancer patients with increased preoperative serum levels of CA19-9, right-sided location, serosal exposure or invasion of adjacent organ, and positive apical lymph node, more scrupulous surveillance for peritoneal recurrence was necessary during the postoperative follow-up period. In selective patients with risk factors of peritoneal recurrence, more aggressive strategies for management, such as EPIC, were able to be considered under the acceptable general condition and life-expectancy.

지속성 외래 복막투석환자에서 Kocuria varians에 의해 발생한 재발성 복막염 1예

류우선 ( Woo Sun Rou ),이효근 ( Hyo Keun Lee ),곽이경 ( Yee Gyung Kwak ),한상엽 ( Sang Youb Han ),한금현 ( Kum Hyun Han ) 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.4

Kocuria species are the normal flora of skin, mucosa and oropharynx, and can be the causative organisms of complications associated with intravenous catheterization, ambulatory peritoneal dialysis, and ventricular shunt. We report a case of relapsing peritonitis by Kocuria varians in a patient undergoing continuous ambulatory peritoneal dialysis (CAPD). A 62 year old woman was admitted to the hospital with a complaint of abdominal pain and a turbid peritoneal dialysate. The patient was treated with a combination of intraperitoneal antibiotics. A culture of the peritoneal dialysate revealed K. varians, and the patient was discharged after she showed improvement with the treatment. Although the organism was sensitive to the administered antibiotics, the patient experienced 2 episodes of peritonitis. This continuing recurrence could be attributed to an insufficient treatment period or biofilm formation. Therefore, the patient underwent further treatment with intraperitoneal antibiotics and showed no recurrence for 1 year thereafter. This is the first report of relapsing peritonitis by K. varians. Although peritonitis caused by rare pathogens has been described recently, K. varians is known to have a low pathogenecity and occurs rarely. The findings in this case emphasize the importance of careful consideration on the rare pathogen and administration of the appropriate antibiotics for a sufficient duration.

Contrast-Enhanced Ultrasound and Computed Tomography Findings of Recurrent Ovarian Steroid Cell Tumor Presenting with Peritoneal Seeding: A Case Report

임아란,이영환,김혜원,이한아,최금하 대한영상의학회 2013 대한영상의학회지 Vol.69 No.5

We present ultrasonography and computed tomography (CT) findings of a case of recurrent ovarian steroid cell tumor presenting with peritoneal seeding in a 45-year-old woman. On abdominal ultrasonography, there were multiple hypoechoic round masses in the peritoneal cavity including the perihepatic area. Contrast-enhanced ultrasonography showed intense homogenous enhancement on the arterial phase and delayed prolonged enhancement of the masses. CT revealed multiple peritoneal solid masses with strong enhancement. Five years ago, the patient had been diagnosed with a steroid cell tumor of the left ovary. At that time, the CT showed a well-enhancing, lobulating, large solid mass at the left adnexa. Imaging findings of the peritoneal masses suggested peritoneal seeding from the preexisting ovarian steroid cell tumor. For treatment of the metastatic lesions in the perihepatic area, ultrasonography-guided radiofrequency ablation (RFA) was performed, and debulking surgery for the peritoneal masses was done. Six months later, complete ablation of the perihepatic metastases by RFA and a marked decrease in the peritoneal metastases by surgery were found on the follow-up CT.? 45세 여자 환자에서 복막 파종으로 재발한 난소의 스테로이드 세포 종양의 초음파 검사와 전산화단층촬영을 포함한 영상의학적 소견을 보고하고자 한다. 복부 초음파 검사에서 복강 내에 원형의 저에코로 보이는 종괴들이 다수 발견되었고, 조영증강 초음파 검사와 역동적 조영증강 전산화단층촬영에서 동맥기에서 지연기까지 강하고 균질한 조영증강을 보였다. 5년 전, 환자는 좌측 난소의 스테로이드 세포 종양으로 수술적 치료를 받은 기왕력이 있었으며, 당시 전산화단층촬영에서 좌측 부속기에 조영증강이 매우 잘 되는 분엽형 종괴와 다량의 복수가 관찰되었다. 복강 내 종괴의 영상의학적 소견은 난소 스테로이드 세포 종양에서 재발한 복막 파종을 시사했다. 간 주변에 위치한 전이 병변에 대해 초음파 유도하 고주파소작술을 시행하였고, 그 외의 복막 전이 병변에 대한 용적축소술을 시행하였다. 6개월 후 전산화단층촬영에서 고주파소작술과 수술을 통한 복막 전이 병변의 성공적인 치료를 확인할 수 있었다.

간경변증에 동반된 특발성 세균성 복막염의 재발빈도 및 예견인자

백순구(Soon Koo Baik),권상옥(Sang Ok Kwon),박의련(Eui Ryun Park),김준명(Jun Myeong Kim),이용규(Yong Gyu Lee),최윤종(Yeun Jong Choi),김일희(Il Hoi Kim),이동기(Dong Ki Lee) 대한내과학회 1998 대한내과학회지 Vol.54 No.6

Objectives: Spontaneous bacterial peritonitis (SBP) is a frequent and severe complication of cirrhosis. In the most recently published studies, the prevalence of SBP among hospitalized cirrhotics with ascites has been estimated to be around 10-15%, the mortality rate related to this complication being more than 50%. SBP is thought to appear as a consequence of the impaired defensive mechanisms against infection present in cirrhotic patients, such as depressed reticuloendothelial system phagocytic activity, impaired leukocyte function, reduced serum compliment levels, and low antibacterial activity of ascitic fluid. It has proposed that ascitic fluid opsonin capacity is directly correlated to ascitic protein concentration and that this explains an observed predisposition to infection in patients with low ascitic fluid protein concentration. This present study aims to investigate the frequency of the recurrence of SBP in u large series of cirrhotic patient who recovered from the first episode of SBP and to identify any possible predictors of recurrent SBP. Method: We reviewed records of chart in 312 consecutive cirrhotics with ascites patients treated in our hospital between January, 1988 and August, 1995. Results: The incidence of SRP was 21.8% (68 cases) and showed 80.9% in male, 19.1% in female. Seven- teen (25%) of the 68 patients included in the study after the resolution of their first episode of SBP developed one or more episodes of SBP during follow-up. SBP recurred once in 16 of these patients, twice in 1 patients. The cumulative probability of SBP recurrence was 47.1% at 6 months, 64.7% at 12 months, and 82% at 18 months of follow-up. This study reveals that neither ascitic fluid total protein nor the severity of liver disease(Child's class) predicts the occurence of recurrant SBP. Conclusion: We conclude that the occurrence of recurrent SBP is unrelated to the type of liver disease, and severity of liver disease did not predict the presence of recurrent SBP. Also, ascitic fluid total protein ≤1.0 g/dl, prothrombin time 45% may not be a sensitive predictor of recurrent SBP.

Long-term survival after intraperitoneal chemotherapy with paclitaxel-cisplatin for recurrent primary peritoneal cancer resistant to multiple lines of intravenous chemotherapy

허혜정,김기동,김효진,서동훈,노재홍,김용범 대한산부인과학회 2019 Obstetrics & Gynecology Science Vol.62 No.4

The long-term survival of heavily pretreated patients with primary peritoneal cancer (PPC) is uncommon. Here, wereport on a patient with PPC refractory to multiple lines of intravenous chemotherapy, namely, a combined regimenof paclitaxel and carboplatin, and single regimens of topotecan, docetaxel, cisplatin, and gemcitabine. However,after intraperitoneal (IP) chemotherapy with paclitaxel-cisplatin, the patient’s condition improved, and she has beenprogression-free for more than 4 years. Interestingly, before the IP chemotherapy, the recurrences were limited to theperitoneal cavity. These results suggest that IP recurrence might be a predictor of a good response to IP chemotherapy.

복막 전이가 의심되는 위암 환자에서 진단적 복강경 검사의 의의와 역할

송선춘,이상림,조용관,한상욱 대한위암학회 2009 Journal of gastric cancer Vol.9 No.2

목적: 위암의 복막재발 또는 암종증을 확진하기 위해서는 개복 수술 및 생검이 필요하다. 최근 시험적 개복술 대신 진단적 복강경 검사가 많이 시행되고 있으나 위암 환자에서 복막재발을 진단하기 위해 시험적 개복술 대신 진단적 복강경 검사로 대체한 것에 관한 연구는 아직 보고된 바가 적다. 이에 복막전이가 의심되는 위암환자에서 시행된 진단적 복강경 검사를 분석하여 그 역할과 유용성에 대해 검토하고자 한다. 대상 및 방법: 2004년 2월부터 2009년 3월까지 복막전이가 의심되어 진단적 복강경 검사를 시행 받은 총 45명의 위암 환자들에 대해 안전성과 정확도를 평가하였다. 결과: 총 45명의 연구 대상 환자들에서 남자는 26명(57.8%), 여자는 19명(42.2%)이었고 전체 평균 연령은 49.3세(25∼74세)였다. 총 검사시간은 평균 44.1±26.9분, 술 후 재원기간은 평균 2.7±2.8일이었다. 45명 중 검사상 양성으로 나온 사람은 35명이었으며, 음성으로 나온 10명 중 위음성은 3명이었다. 검사 관련 합병증은 1건이었으며, 검사 관련 사망자는 없었다. 민감도는 진단적 복강경 검사의 경우 92.1%, 이학적 검사 29.7%, 복부 CT 86.5%, PET CT 69.2%, CEA 검사는 18.8%였다. 결론: 진단적 복강경 검사는 비교적 짧은 시술 시간과 재원기간, 낮은 합병증 발생율을 보여 시험적 개복술에 비해 안전한 검사이다. 또한 다른 검사에 비해 민감도가 높아 위암환자에서 복막 재발 및 암종증 여부를 확인하는데 효과적인 검사 방법으로 사료된다.

재발성 상피성 난소암 및 원발성 복막 암종증 환자에서의 Topotecan/Platinum 복합요법의 효용성과 독성

유항조 ( Hang Jo You ),김용만 ( Yong Man Kim ),이신화 ( Shin Wha Lee ),이정남 ( Jung Nam Lee ),김대연 ( Dae Yeon Kim ),서대식 ( Dae Shik Suh ),김종혁 ( Jong Hyeok Kim ),김영탁 ( Young Tak Kim ),남주현 ( Joo Hyun Nam ),목정은 ( Jun 대한산부인과학회 2008 Obstetrics & Gynecology Science Vol.51 No.1

Objective: The aim of this study was to evaluate the efficacy and toxicity of topotecan, camptothecin analogue topoisomerase I inhibitor, as the combination therapy with platinum in patients with recurrent epithelial ovarian carcinoma and primary peritoneal carcinomatosis. Method: In this study, patients who were treated with topotecan between January 2000 and June 2007 at Asan Medical Center, Seoul, Korea were reviewed. Fifty-one patients with recurrent ovarian carcinoma and peritoneal carcinomatosis were included. These patients` data were analyzed by review of medical records and pathologic and laboratory reports retrospectively. Response was assessed by Response Evaluation Criteria in Solid Tumors (RECIST) criteria for patients with measurable disease and CA-125 response criteria for patients with non-measurable disease. The toxicities were evaluated according to NCI CTC (Common Toxicity Criteria) version 3.0. Results: The mean age of patients was 53.4 years (ranged between 37 and 69). Forty-four patients had been evaluated by RECIST criteria. The overall response rate was 22.8% (10/44). Platinum-sensitive patients showed more favorable response rate (26.9%) than platinum-resistant patients (16.7%), however, it was not significant statistically (p=0.425). Platinum-sensitive group had significantly longer response duration (12.14 vs. 3.33 months, p=0.022) and time-to-progression (11.34 vs. 7.33 months, p=0.042) than platinum-resistant group. Heavily pretreated group, three or more prior regimens were used, had no significant differences from another group. The most common adverse effect of topotecan in combination with platinum was hematologic toxicity; grade 3/4 neutropenia was 30.6%, anemia was 42.7%, and thrombocytopenia was 8.37% in total 265 cycles of chemotherapy, however, it was tolerable. Conclusion: Topotecan in combination with platinum is considered as effective regimen with acceptable toxicity in treating recurrent epithelial ovarian carcinoma and primary peritoneal carcinomatosis who have failed previous treatment with platinum-containing chemotherapy.

지속성 외래 복막투석 환자에서 대장암과 연관되어 발생한 재발성 복막염

윤병갑 ( Byeong Kab Yoon ),이선영 ( Sun Young Lee ),박근호 ( Gun Ho Park ),이승우 ( Seoung Woo Lee ),송준호 ( Joon Ho Song ),김문재 ( Moon Jae Kim ) 대한신장학회 2004 Kidney Research and Clinical Practice Vol.23 No.4