• The Journal of the Korean bone and joint tumor society
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• v.14 no.2
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• pp.140-145
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• 2008

After limb salvage operation becomes popular, reconstruction method of epi-metaphyseal osteosarcoma is relatively standardized though it may be operator's matter of preference. Most limb salvage techniques presently used are prosthesis reconstruction and osteoarticular allograft. In the case of prosthesis, it is very stable and shows good postoperative functional score, however, finally, it has a weak point of requirement for removal procedure due to failure. In the long run, allograft reconstruction has a good merit. But, it has a weak point of difficulties in securing the demanded size and shape. Allograft reconstruction should be performed only in the case of safe margin and established indication. In limb salvage operation, intercalary reconstruction is useful method in diaphyseal osteosarcoma, however, in metaphyseal osteosarcoma, the indication is not confirmed. We treated 17 year old osteosarcoma patient with localized in the tibial medial condyle with proximal medial condylectomy and pasteurized bone reconstruction in the conviction of safe surgical margin. We report this case because we guess if this procedure may be applied to premature patients, despite failure hemiarthroplasty can be tried successfully.

• Journal of Life Science
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• v.30 no.6
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• pp.563-569
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• 2020

Oncoplastic surgery (OPS) combines oncologically safe tumor resection with aesthetically satisfying reconstruction of defects using established plastic surgery techniques. OPS is characterized by initial excision as extensive as is beneficial for oncological safety, and, once sufficient resection is complete, displacement or replacement techniques are selected based on remnant volume. The size of the lesion and the individual patient are important factors when considering the appropriate approach, and when pre-operative imaging, including MRI, is used to determine the technique, the complete removal of cancer cells by permanent pathology is essential. A frozen section is used during the operation to reduce the reoperation rate, but it is difficult to cover the entire margin surface theoretically and even harder in practice. A recent report about adequate margins has empowered OPS in its oncological safety. Considering the patients to whom each modality could be applied, basic breast volume is an important factor, and this is influenced by ethnic differences. In Europe or the US, for example, the average breast size is 36D (600 ㎤) and reduction mammoplasty is predominantly used. However, the average size of patients in our institution is 33A (300 ㎤), and so quite different approaches are selected in most cases. New techniques involving radiofrequency and fluorescence have been proposed as safe and easily accessible ways of reducing complications.

• Radiation Oncology Journal
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• v.26 no.4
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• pp.204-212
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• 2008

Purpose: This study was performed to evaluate the disease-free survival and risk factors of recurrence in early breast cancer patients who have undergone breast conserving surgery and radiation therapy. Materials and Methods: From March 1997 to December 2002, 77 breast cancer patients who underwent breast conserving surgery and radiation therapy were reviewed retrospectively. The median follow-up time was 58.4 months (range $43.8{\sim}129.4$ months) and the mean subject age was 41 years. The frequency distribution of the different T stages, based on the tumor characteristics was 38 (49.3%) for T1, 28 (36.3%) for T2, 3 for T3, 7 for T is and 1 for an unidentified sized tumor. In addition, 52 patients (67.5%) did not have axillary lymph metastasis, whereas 14 patients (18.1%) had $1{\sim}3$ lymph node metastases and 3 (0.03%) had more than 4 lymph node metastases. The resection margin was negative in 59 patients, close (${\leq}2\;mm$) in 15, and positive in 4. All patients received radiation therapy at the intact breast using tangential fields with a subsequent electron beam boost to the tumor bed at a total dose ranging from 59.4 Gy to 66.4 Gy. Patients with more than four positive axillary lymph nodes received radiation therapy ($41.4{\sim}60.4\;Gy$) at the axillary and supraclavicular area. Chemotherapy was administered in 59 patients and tamoxifen or fareston was administered in 29 patients. Results: The 5 year overall survival and disease-free survival rates were 98.08% and 93.49%, respectively. Of the 77 patients, a total of 4 relapses (5.2%), including 1 isolated supraclavicular relapse, 1 supraclavicular relapse with synchronous multiple distant relapses, and 2 distant relapses were observed. No cases of local breast relapses were observed. Lymph node metastasis or number of metastatic lymph nodes was not found to be statistically related with a relapse (p=0.3289) nor disease-free survival (p=0.1430). Patients with positive margins had a significantly shorter disease-free survival period (p<0.0001) and higher relapse rates (p=0.0507). However, patients with close margins were at equal risk of relapse and disease-free survival as with negative margins (p=1.000). Patients younger than 40 years of age had higher relapse rates (9.3% vs. 0%) and lower disease-free survival periods, but the difference was not statistically significant (p=0.1255). The relapse rates for patients with tumors was 14% for tumor stage T2, compared to 0% for tumor stage T1 tumors (p=0.0284). A univariate analysis found that disease-free survival and relapse rates, T stage, positive resection margin and mutation of p53 were significant factors for clinical outcome. Conclusion: The results of this study have shown that breast conservation surgery and radiation therapy in early breast cancer patients has proven to be a safe treatment modality with a low relapse rate and high disease-free survival rate. The patients with a positive margin, T2 stage, and mutation of p53 are associated with statistically higher relapse rates and lower disease-free survival.

• Journal of Gastric Cancer
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• v.7 no.4
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• pp.206-212
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• 2007

Purpose: The number of laparoscopy assisted distal gastrectomies (LADG) is gradually increasing for the treatment of early gastric cancer (EGC) patients as a surgical modality for improving quality of life. However, there are few reports on laparoscopy-assisted total gastrectomy (LATG), mainly because this procedure is performed relatively infrequently, and the procedure is more complicated than LADG. This study was performed to evaluate the technical feasibility, safety, and surgical results of LATG with lymphadenectomy through a review of our experience. Materials and Methods: From July 2003 to June 2007, 77 LATG with Roux-en-Y esophagojejunostomy were performed for patients with a preoperative diagnosis of EGC. The clinicopathological features and surgical outcomes were analyzed. Results: There were 49 males and 28 females in the study with a mean age of 61 years (range $30{\sim}85$ years). The mean operation time was 210 minutes (range $100{\sim}400$ minutes) and the operation time was gradually decreased as the case numbers increased. There were 13 operative morbidities (16.9%) and no operative mortalities. The restoration of bowel motility was noted at 3.2 postoperative days; a soft diet was started at 4.4 postoperative days and the duration of hospital stay was 10 days. There were 20 mucosal lesions, 32 submucosal lesions, 15 proper muscle lesions, 7 subserosal lesions and 3 serosal lesions. A total of 20 patients were treated by D2 lymph node dissection, 55 patients were treated by D1+$\beta$ lymph node dissection, and two patients were treated by D1+$\alpha$ lymph node dissection. The mean number of retrieved lymph nodes was 42 (range $11{\sim}86$). Lymph node metastases were noted in 12 patients. Conclusion: This study indicated LATG could be applied safely and effectively for patients with EGC. However, a prospective study comparing laparoscopy-assisted versus open gastrectomy for short-term and long-term surgical outcome is needed.

• Journal of Gastric Cancer
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• v.1 no.1
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• pp.24-31
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• 2001

Purpose: Despite knowledge of the adverse effects of resection-line disease, surgeons continue to perform inadequate resections. This demonstrates the need for a more aggressive approach to assessment of resection margins at operation. Materials and Methods: Seven hundred fifteen gastric cancer patients who were operated on at our hospital from 1992 to 1998 were included in this analysis. Various clinicopathological factors, including resection-line involvement, were ascertained from the surgical and histopathological records. Results: Of the 715 evaluable patients, 27 patients ($3.8\%$) had involvement of one or both resection lines; in 10 patients the proximal resection line only, in 16 the distal resection line only, and 1 both resection lines were involved. Presence of resection-line involvement was significantly associated with T3 and T4 stage, N (+) stage, M (+) stage, type of operation (total gastrectomy), tumor location (entire stomach), size$\geq$11 cm), and gross type of tumor (Borrmann 4 type). When performing a distal subtotal gastrectomy, no involvement was found when the cranial and caudal distances between the lesion and the line of transection was equal to or greater than 2 cm and 3 cm, respectively, for early cancer and 7 cm and 3 cm, respectively, for advanced cancer. When performing a total gastrectomy for upper 1/3 or middle 1/3 gastric cancer, no involvement was found when the cranial distances between the lesion and the line of transection were equal to or greater than 3 cm and 4 cm, respectively, without distinction of the presence of serosal invasion. Conclusions: The difference in survival between positive and negative margin patients is limited to the group of patients with curative surgery. An important principle of treatment is that the entire tumor must be removed with a 3 cm distal margin and a 2- to 7 cm margin depending on the location and the depth of wall invasion of the tumor, to provide histologically negative margins.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1983.05a
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• pp.14.4-15
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• 1983

The laryngeal carcinoma is the most frequent malignant tumor in the E.N.T. field. In the surgical treatment of laryngeal carcinoma, in 1873, Billroth performed the first total laryngectomy, and in 1863, H. B. Sands performed the first partial laryngectomy. Recently general advances (antibiotic therapy, blood trasfusion, and safer anesthesia) result in the improvement of postoperative prognosis. Because the laryngeal lymphatic system has the characteristic compartmentation, this serves the anatomic basis for performing the partial laryngectomy. Although the indications of partial laryngectomy are different from that of total laryngectomy, the partial laryngectomy has the advantage of not only removal of all malignant disease, but also maximum preservation of respiratory, phonatory, and sphincteric function of the larynx. In the latest, surgical treatment decreased the frequency of recurrence, and also increased the 5 year survival rate with combination of the chemotherapy and radiation therapy. The authors have experienced 8 cases of partial laryngectomy for laryngeal carcinoma at the department of otolaryngology, Korea University Hospital from 1980 to 1982. Among the total 8 cases, 2 cases were involved only in the epiglottis, 2 cases in the anterior 1/3 of both vocal cords with ant. comissure, 2 cases in the middle 1/3 of Lt. vocal cord, 1 case in the anterior 1/3 of Rt. vocal cord with ant. comissure, and another 1 case in the Rt. ventrical. So authors report these cases with review of the literature.

• Journal of Chest Surgery
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• v.35 no.10
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• pp.724-729
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• 2002

Although variable surgical methods of sympathetic nerve for palmar hyperhidrosis are curative and safe therapeutic options, they have some limitations such as compensatory sweating and anhidrosis of hand in long term satisfaction rate. Material and Method: Therefore, we tried to decrease severity of compensatory sweating and prevent excessive dryness of hand through selective division of rami communicantes of thoracic sympathetic ganglia distributed to the hands(ramicotomy). Result: In postoperative results, about half of the patients maintained humidity of hands and most of them showed no more than mild degree of compensatory sweating. Conclusion: Therefore, ramicotomy of thoracic sympathetic ganglia can be recommended as selective and physiologic surgical method for palmar hyperhidrosis.

• Journal of Yeungnam Medical Science
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• v.20 no.2
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• pp.105-116
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• 2003

Definitely, treatment for gastric cancer is primarily surgical. Detection in early stage of disease and complete surgical resection is the best way to cure gastric cancer. If surgery is planned, careful preoperative evaluation and corrections of physiologic and psychologic abnormalities are essential to reduce perioperative morbidity or mortality. Basic principle of gastrectomy for gastric cancer is an en bloc resection of tumor with adequate margins of normal tissue and with regional lymph nodes and omental tissues. To complete these principles, regional lymph nodes and all omental tissues should be removed altogether during performing various types of gastric resection. The lymph node dissection is one of the most effective procedures for gastric cancer to achieve curative resection. The basic types of gastric resection are distal subtotal gastrectomy and total gastrectomy according to the condition of primary lesions and the status of lymph node metastases. When the primary lesion is located near the esophagogastric junction, it is sometimes hard for a surgeon to select adequate surgical method. Postoperative quality of life in a patient has become a very important factor to be considered in every step of surgical therapy. With increasing incidence of early gastric cancer, a number of surgical trials for limited surgery or endoscopic procedures have been performed, but the long-term clinical results should be carefully analyzed to define the clinical relevance of these new techniques. For patients with disseminated gastric cancer, a palliative procedure can be performed to improve quality of life of patients and to avoid immediate death due to the cancer-related complications.

• Journal of Chest Surgery
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• v.36 no.3
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• pp.175-181
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• 2003

Primary chest wall tumors originate from soft tissue, bone or cartilage of the chest wall and it comprises 1∼2% of all primary tumors. Resection of tumor is often indicated for chronic ulceration or pain, and long-term survival might be achieved after surgery depending on the histology and the surgical procedure. Material and Method: Retrospective study of 125 primary chest wall tumors (86 benign, 39 malignant) operated between Sep. 1976 to Mar 2001 were reviewed and their clinical outcomes were analyzed. Follow-up data were collected at the outpatient clinic. Result: All patients with benign tumors were treated by excision without recurrence or death, and most malignancies were treated by wide resection. Malignant fibrous histiocytoma and chondrosarcoma constituted 46.2% of the malignant neoplasm. There was no operative death. The overall 3-year survival for patients with primary malignant neoplasm was 76.0%, and the 10-year survival was 60.5%. All deaths were disease-related and the tumor recurred in 11 patients. There was no significant difference in survival between patients with resection margins less than 4 cm and those with resection margins greater than 4 cm. Conclusion: Chest wall resection offers excellent results for benign chest wall tumors and substantial long-term survival for malignant diseases. Safe resection margin of 4 cm or more did not correlate with the survival rate although the tumor recurrence correlated with poor survival.

• Journal of Chest Surgery
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• v.39 no.12 s.269
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• pp.953-956
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• 2006

Surgical resection is the most effective treatment in operable lung cancers. However, less invasive local treatments are being applicated to the patients having high surgical risk due to their poor general condition. Cryosurgery is known to be highly effective and safe in the treatment of liver and prostate cancers and it is also being applicated in the treatment of lung cancers, especially with the excision of tracheal mass and lung parenchymal cancers. In our hospital, we have tried a less Invasive method, the cryotherapy, to a patient who had a newly developed lung cancer at his right lower lobe after he had been treated with right upper lobe resection and left upper lobe resection due to bilateral lung cancels. After the treatment, he is being followed up at our out patient department for 2 years. Here, we present the method and result that have been applicated in this case.