• Journal of Chest Surgery
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• v.41 no.2
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• pp.253-259
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• 2008

Background: The incidence of cervical esophageal cancer is low compared with that of thoracic esophageal cancer, and the role of surgery for cervical esophageal cancer is limited compared with that of radiotherapy or chemotherapy. This study was carried out to determine the outcome of surgery for cervical esophageal cancer. Material and Method: We analyzed retrospectively medical records of 43 patients who had undergone curative surgical resection for cervical esophageal cancer from January 1989 to December 2002. Follow-up loss was absent and the last follow-up was carried out in February 28, 2004. Result: The mean age was 60 years old and the male to female ratio was 40:3. Histologic types were squamous cell carcinoma 42 patients and malignant melanoma 1 patient. The methods used for esophageal reconstruction were gastric pull-up 32 patients, free jejunal graft 7 patients and colon interposition 4 patients. Postoperative complications occurred in 31 patients (72%), and operative mortality occurred in 7 patients (16%). Pathologic stages were I 3, IIa 14, IIb 1, III 19, and IVa 6 patients. Tumor recurrence occurred in 16 patients (44%), and the 3 and 5-year survival rates were 29.3% and 20.9%. Conclusion: The reported surgical results for cervical esophageal cancer showed somewhat high operative mortality, postoperative complication rates and recurrence rates and a low long-term survival rate. It is suggested that multimodality treatment including surgery is needed for the treatment of cervical esophageal cancer because radiotherapy or chemotherapy without surgery could not relieve dysphagia or resolve the tumor completely.

• Journal of Chest Surgery
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• v.31 no.11
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• pp.1081-1084
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• 1998

Background: Esophageal surgery in esophageal cancer has low curative resection rate and its resut has not improved even after the extended lymphnode dissection. To evaluate the effectiveness of cervical lymph node dissection, we compare the node of cervical lymph node metastasis in patients esophageal cancer. Materials and methods: We studied a series of 32 patients who underwent operation for thoracic esophageal carcinoma at our institution. The 25 patient who underwent curative surgery were divided into two groups. Both groups A and B underwent transthoracic esophagectomies with mediastinal and abdominal lymphadenectomies only, but group B also underwent bilateral lower neck node dissection. Results: The rate of operative complications did not differ significantly between two groups. No operative and hospital mortalities were noted in either group. However, the mean anesthetic time was significantly longer in group B(mean: 90 minutes). Neck node metastasis was revealed in 27% of group B. Conclusions: Therfore, neck node dissection is meaningful for surgical treatment of the thoracic esophageal carcinoma. The longterm survival rate should be compared later.

• Journal of Chest Surgery
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• v.34 no.2
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• pp.156-161
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• 2001

배경: 식도암의 절제술에 있어 식도 위 문합술은 중대한 합병증, 즉 문합부 누출, 양성협착, 종양의 재발 등을 유발한다. 수술 후 재원기간동안 환자가 느끼는 주관적인 증상과 합병증이 식도와 위장관의 문합부 위치에 따라 달라질 수 있으므로 서로간에 비교분석할 필요가 있겠다. 대상 및 방법: 1995년 1월부터 1999년 5월까지 식도암 근치술로 식도 위 문합술을 시행 받은 55명의 환자를 대상으로 문합위치에 따라 경부문합한 23명의 환자와 흉부문합을 한 32명의 환자를 비교 분석하였다. 절제술 후 AJCC분류에 따라 I기 5명, II기 27명, III기 23명으로 판정되었으며, 종양이 상흉부에 위치한 경우 3명, 중흉부 34명, 하흉부 18명이었다. 조직학적으로 55명의 환자 2명의 선암을 제외하고 53명이 편평상피세포암이었다. 55명 전원이 남자였으며 평균연령은 경부문합의 경우 59세였고, 흉부문합은 55세였다. 경부 문합의 경우 1명의 staple봉합을 제외하고 나머지 22명이 수봉합을 하였으며, 흉부문합술의 경우는 9명이 수봉합, 23명이 staple봉합을 하였다. 결과: 수술 후 사망자는 경부문합 1명, 흉부문합 2명이었다. 경부 문합환자의 경우 23명 중 15명에서 호흡기, 소화기등의 합병증 46례가 발생하였고, 흉부 문합환자의 경우 32명중 13명에서 합병증 37례가 발생하였다. 경부문합환자는 중등도 혹은 심한 연하곤란을 나타내는 경우가 11명에서 있었으며, 흉부문합환자는 2명에서 나타났다. 또한 수술 후 20일 이후까지 재원한 경우는 경부문합환자 18명, 흉부문합환자는 13명이었다. 결론: 식도암에서 식도 위 문합술의 경우 호흡기, 소화기, 감염등의 합병증이 발생하였으며, 특히 호흡기 합병증에 의한 사망률이 높았다. 문합부 누출은 staple봉합보다 수봉합에서, 흉부문합보다 경부문합에서 빈도가 높았다. 경부문합의 경우 문합부 누출률이 높고, 연하곤란을 많이 호소하며 재원기간이 의미있게 길었다.

• Journal of Gastric Cancer
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• v.7 no.4
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• pp.200-205
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• 2007

Purpose: The aim of this study was to analyze the post operative outcome of reconstruction with using the stomach after performing total pharyngolaryngoesophagectomy in patients with hypopharyngeal cancer or cervical esophageal cancer. Materials and Methods: We conducted a retrospective chart review of 23 patients who underwent gastric pull up for esophageal substitution at the Department of Surgery, Yonsei University College of Medicine, between January 1991 and December 2006. All the patients had transhiatal esophagectomy performed without thoracotomy. Results: There were seventeen males and six females with a median age of 58.1 years (range: 40-70 years). 19 cases were hypopharyngeal cancer, 13 cases had cancer in the pyriform sinus, 15 cases had cancer in the postcricoid area and one case had cancer in the glottic area. The rest were cervical esophageal cancers. The pathologic result was squamous cell carcinoma in all cases. The median total follow-up period was 33 months (range: 1-62 months) and there were two (8.6%) postoperative deaths: one was due to carotid rupture and the other was due to hepatic failure with liver metastasis. The complications were leakage in 1 patient (4.4%), pneumothorax in 1 patient (4.4%) and pneumonia in 1 patient (4.4%). Conclusion: The use of stomach for esophageal reconstruction has many benefits for treating hypopharyngeal cancer or cervical esophageal cancer, So, we made sure there was a sufficient length for the anastomosis after pharyngolaryngoesophagectomy and a rich blood supply from the stomach. There was a low incidence of the leakage at the anastomotic site, along with a low incidence of stenosis and bleeding.

• Korean Journal of Bronchoesophagology
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• v.10 no.1 s.19
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• pp.21-24
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• 2004

• Korean Journal of Bronchoesophagology
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• v.10 no.1 s.19
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• pp.28-34
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• 2004

• Journal of Chest Surgery
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• v.37 no.4
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• pp.356-363
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• 2004

Esophageal cancer is an aggressive disease with a poor prognosis. Recently, every effort has been made to improve the long term survival, but the general prognosis for patients with this disease remains poor. In this study, we reviewed 8 years of experiences with esophageal cancer patients managed in our department at Dong-A University Hospital and evaluated the effectiveness of cervical lymph node dissection performed selectively. Material and Method: From January 1995 to August 2003, 70 patients underwent esophagectomy for esophageal cancer in our department. Among them, 51 patients who underwent curative resection, had no double primary tumors and no neoadjuvant therapy were analyzed retrospectively. In most patients, intrathoracic esophagectomy and cervical esophago-gastrostomy was performed. Since 1997, 3-field lymph node dissection was performed selectively. Result: There were 46 men and 15 women. The median age was 60 years. The tumor was located in the upper third part in 10 patients (19%), middle third in 21 (41%), and lower third in 20 (40%). Majority of the patients (90%) had squamous cell carcinoma. Cervical anastomosis was made in 41 patients, and intrathoracic anastomosis in 10. 2-field lymph node dissection was done in 40 patients, and 3-field lymph node dissection in 11. The pathologic staging were as follows: stage I in 9 patients (17.6%), IIA in 20 (39.2%), IIIB in 7 (13.7%), III in 11 (21.6%), IVA in 2 (3.9%), and IVB in 2 (3.9%). The in-hospital mortality was 3.9% (2 patients) and complications occurred in 24 patients (47%). Overall actuarial 1, 3, and 5-year survival rates were 74.4%, 48.4%, and 48.4% including operative mortality. The 4-year survival rate did not differ significantly between 3-field lymph node dissection group (50.5%) and 2-field lymph node dissection group (48.9%). In 3-field lymph node dissection group, the respiratory complications were more frequent and operative time was significantly longer. Conclusion: We think that curative resection for esophageal cancer can be performed with acceptable mortality, and aggressive surgical approach may improve the long term survival. even for advanced stages. Effectiveness of 3-field lymph node dissection needs further investigations.

• Proceedings of the KTCVS Conference
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• 1996.10a
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• pp.103-103
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• 1996

• Journal of Chest Surgery
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• v.30 no.4
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• pp.449-452
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• 1997

We managed surgically a case of local recurrence in esophageal cancer Twenty month after transthoracic subtotal esophagectomy and csophago-gastrostomy, he su(fared from dysphagia. Chest CT and percutaneous needle aspiration biopsy showed . Local recurrence involving residual esophagus, thyroid gland, posterior membraneous portion of trachea. We did cervical esophagectomy, laryngectomy thyroidectomy, partial resection of trachea and reconstruction with free jejunal antograft successfully.

• Proceedings of the KOR-BRONCHOESO Conference
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• 2003.09a
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• pp.108-108
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• 2003

식도 천공의 치료는 최근 치료법의 발전에도 불구하고 여전히 난해한 문제이다. 이 환자들은 천공의 원인이나 위치, 심한 정도가 다양한 이질적인 군이며, 반수 이상이 이미 식도에 기존의 질환을 가지고 있어 문제를 더욱 복잡하게 한다. 따라서 절대적이고 획일적인 치료방법은 아직 확립되어 있지 않으며 많은 다양한 방법들이 제시되고 있다. 2002년 11월부터 2003년 7월까지 총 8명의 환자가 식도 천공으로 동아대학교병원 흥부외과에서 치료를 받았으며, 원인별로는 의인성(iatrogenic) 손상이 6례, 자발성(spontaneous) 손상이 2례였고 부위별로는 경부가 3례, 흥부가 5례였다. 의인성 손상에는 내시경 검사중 정상 경부 식도에 발생한 1례, 부식성 식도협착 환자의 풍선 확장술과 스텐트 삽입시 흉부 식도에 발생한 경우가 각각 1례씩, 외상성 경추손상의 수술시 정상 경부 식도에 발생한 경우가 2례, 선천성 식도폐쇄증(esophageal atresia)의 술후 문합부 누출이 생긴 경우가 1례 있었으며, 자발성 손상에는 하부식도에 발생한 기압성(barogenic) 손상 1례와 상흉부 식도암 천공 1례가 있었다. 경부 식도 천공 3례는 모두 경부 배액(drainage)과 식이용 장루술(feeding jejunostomy)을 시행하였고, 부식성 식도협착이 있던 환자 2례는 식도절제술과 흉부내 식도-위 문합을 시행하였으며, Boerhaave씨 증후군 환자는 1차 봉합술, 술후 문합부 유출이 있었던 환자와 식도암 천공이 있었던 환자는 식도절제 및 경부 식도루(esophagostomy), 배액용 위루(gastrostomy), 식이용 장루술을 시행하였다. 모든 환자는 패혈증 등의 심각한 합병증으로의 진행 없이 회복되었다. 현재 위장관의 연속성이 유지 혹은 복원된 환자는 경구식이 중이며 그 외의 환자들은 장루를 통해 영양을 공급하며 식도재건술을 기다리고 있다. 식도 천공은 최근 항생제의 사용, 과영양요법(hyperalimentation), 술후 환자관리의 개선 등으로 치료에 많은 발전이 있었으나, 치료 방침에 있어서는 여전히 논란이 있으며 높은 사망률을 보이는 난제로 남아있다. 비록 일반적인 지침이 도움이 되겠지만, 치료 방침은 환자 개개인의 상황에 따라 적절하게 선택해야 하며, 임상경과에 따라 언제라도 방침을 변경할 수 있는 유연함이 필요하리라 생각한다.