• Journal of Gastric Cancer
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• v.8 no.4
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• pp.225-231
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• 2008

Purpose: Laparoscopic gastric resection (LGR) is increasingly being used instead of open gastric resection (OGR) as the standard surgical treatment for gastric submucosal tumors. Yet there are few reports on which technique shows better postoperative outcomes. This study was performed to compare these two treatment modalities for gastric submucosal tumors by evaluating the postoperative outcomes. We also provide an analysis of the learning curve for LGR. Materials and Methods: Between 2003.4 and 2008.8, 103 patients with a gastric submucosal tumor underwent either LGR (N=78) or OGR (n=25). A retrospective review was performed on a prospectively obtained database of 103 patients. We reviewed the data with regard to the operative time, the blood loss during the operation, the time to the first soft diet, the postoperative hospital stay, the tumor size and the tumor location. Results: The clinicopatholgic and tumor characteristics of the patients were similar for both groups. There was no open conversion in the LGR group. The mean operation time and the bleeding loss were not different between the LGR group and the OWR group. The time to first soft diet (3.27 vs. 6.16 days, P<0.001) and the length of the postoperative hospital stay (7.37 vs. 8.88 days, P=0.002) were shorter in the LGR group compared to the OGR group. The tumor size was bigger in the OGR group than that in the LGR group (6.44 vs. 3.65 cm, P<0.001). When performing laparoscopic gastric resection of gastric SMT, the surgeon was able to decrease the operation time and bleeding loss with gaining more experience. We separated the total cases into 3 periods to compare the operation time, the bleeding losses and the complications. The third period showed the shortest operation time, the least bleeding loss and the fewest complications. Conclusion: LGR for treating a gastric submucosal tumor was superior to OGR in terms of the postoperative outcomes. An operator needs some experience to perform a complete laparoscopic gastric resection. Laparoscopic resection could be considered the first-line treatment for gastric submucosal tumors.

• Journal of Gastric Cancer
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• v.8 no.2
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• pp.104-109
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• 2008

Purpose: To investigate the clinicopathlogical characteristics and the surgical methods for gastric submucosal tumors in Korea, the Information Committee of the Korean Gastric Cancer Association performed a nationwide survey. Materials and Methods: Data on 878 patients who underwent resection from 2005 to 2006 were collected from medical records obtained from 47 institutes. Diagnosis, demographics, symptoms, tumor factors (location, size, degree of malignancy) and operative factors (surgicalmethod and approach, mortality) were analyzed. Results: Gastrointestinal stromal tumors (GISTs) were the most common cancers (n=586, 66.8%), followed by leiomyomas (n=97, 11.1%), schwannomas (n=70, 8.0%), ectopic pancreas (n=67, 7.8%) and carcinoids (n=16, 1.8%). The mean age of patients was 56.0 years and the male to female ratio was 1:1.18. Only 40.9% of the patients had symptoms at the time of diagnosis, such as abdominal pain, dyspepsia and bleeding. Gastric submucosal tumors were most frequently located in the upper third of the stomach and 55.4% of the GISTs (n=319) and 84.5% of the leiomyomas (n=84.5%) were located in the upper third of the stomach. Wedge resection (n=726, 82.8%) was the most common operative method, and laparoscopic surgery was performed in 388 patients (44.2%). Only one patient (0.1%) died within 30 days of surgery. A total of 115 patients withGISTs (21.1%, 115/544) had a high risk of malignancy and 41 patients (8.3%, 45/495) received adjuvant imatinib mesylate therapy. Conclusion: The survey showed that about two-thirds of the patients with a gastric submuscoal tumor (SMT) had a GIST, and about one-half of the patients underwent laparoscopic resection. These data presented in the nationwide survey could be used as a fundamental resource for gastric submucosal tumors in Korea.

• Journal of Chest Surgery
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• v.38 no.8 s.253
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• pp.589-593
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• 2005

Esophageal schwannoma is very rare and almost of all cases are diagnosed as esophageal submucosal tumor preoperatively. Final diagnosis is made by postoperative immunohistochemical (IHC) staining of the surgical specimen. We experienced two cases of esophageal submucosal tumor, one was 63 year old female suffering from three months of dysphagia and another was 39 year old female complaining of two months of intermittent dysphagia. Two esophageal tumors were completely removed by esophagectomy and enucleation through right thoracotomy respectively. Postoperative IHC staining demonstrated S-100 positive without mitotic figures and confirmative diagnosed was made as benign esopphageal schwannoma.

• Journal of Chest Surgery
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• v.38 no.1 s.246
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• pp.76-79
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• 2005

The coexistence of mesenchymal tumor and carcinoma in the esophagus is extremely rare. We report a case of squamous cell carcinoma located at the mucosal surface over leiomyoma of the esophagus. A 76-year-old man with complaints of 3 months onset of odynophagia was diagnosed preoperatively as squamous cell carcinoma over submucosal tumor with calcification. Esophagectomy and esophagogastrostomy were performed through the right thoracotomy and upper median laparotomy. The patient is doing well without evidence of recurrence in the 25 months after resection. We discuss the pathogenesis and possible relations between the two tumors.

• Korean Journal of Psychosomatic Medicine
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• v.26 no.1
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• pp.68-75
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• 2018

Objectives : Since pain in cancer patients is an important factor that greatly affects the quality of life and prognosis, many attempts have been actively made to reduce the pain. Despite continuous effort on reducing pain after Endoscopic submucosal dissection (ESD), research has not been done on psychological factors as much as on biological factors affecting pain. The objective of this study is to investigate the psychological factors affecting postoperative pain in gastric tumor patients who underwent gastric ESD. Methods : 91 gastric tumor patients who visited National Health Service Ilsan Hospital in Korean between May 2015 and June 2016, and received ESD were evaluated. Baseline characteristics including sociodemographic factors, anxiety, depression, and resilience were evaluated before the procedure. Multivariate logistic regression was done to analyze factors affecting postoperative pain. Results : The group with high postoperative pain showed lower alcohol consumption and higher depressive symptom scores than the group with low postoperative pain. Also, the group with high postoperative pain showed lower total resilience score with lower subtotal scores in self-control and positive item. Multivariate logistic regression analysis of the postoperative pain showed that patients with lower score in self-control of resilience [odd ratio (OR), 0.911 ; 95% CI, 0.854-0.971, p=0.004) reported more pain after ESD. Conclusions : This study showed that patients with lower self-control ability of resilience felt more pain after ESD. Among the psychological factors evaluated in this study, resilience of an individual seems to have effect on pain.

• Journal of Chest Surgery
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• v.33 no.11
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• pp.922-924
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• 2000

양성 신경초종(benign schwannoma)이 식도를 포함한 위장관계에 발생하는 경우는 매우 드물다. 이러한 양성식도 신경초종은 확진을 위해 면역 조직 화학적 염색을 필요로 한다. 정기 신체 검진상 우연히 발견된 66세여자 환자의 식도 점막하 종양에 대해 우측 후측부 개흉을 통한 종양 적출을 시행하였으며, 술후 면역 조직 화학적 병리 검사를 통하여 식도의 양성 신경초종임을 확인하였고, 환자는 술후 1년째 재발없이 외래 추적 관찰을 받고 있다.

• Journal of Chest Surgery
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• v.36 no.3
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• pp.206-210
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• 2003

Hemangiomas in the esophagus comprise less than 3% of all benign esophageal neoplasms. They are frequently small and easily treated with resection via either endoscopy or thoracotomy. We report a cavernous hemangioma occurred in the distal esophagus successfully treated with circumferential myomectomy.

• Journal of Gastric Cancer
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• v.6 no.2
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• pp.76-83
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• 2006

Purpose: Endoscopic incision and submucosal dissection (EISD) is a technique that is being implemented for the resection of gastric adenomas and early gastric cancer (EGC). Since EISD requires a high degree of skill and experience, and due to its association with a moderate risk of gastrointestinal bleeding, its use has been limited. The objective of this study is to investigate the clinical benefits of EISD based upon clinical data on the EISD procedure. Materials and Methods: This study was conducted at Soonchunhyang University Hospital and it included 179 gastric adenoma and early gastric carcinoma lesions from 164 patients who had undergone an EISD from February 2003 to May 2005. Results: Among the total of 179 lesions, the distributions of EGC and adenomas were 70.3% (126/179) and 23.4% (42/179) respectively. The sizes of lesions were divided into 10 mm or less, $11{\sim}20\;mm,\;21{\sim}30\;mm$ and greater than 31 mm and each rates are 10.0% (18/179), 46.3% (83/179), 30% (50/179) and 15.0% (28/179). Among 120 cases which could be measured depth of lesion in according to pathologic findings, m1 (0.8%, 1/120), m2 (38.3%, 46/120), m3 (25%, 57/120), sm1 (11.7%, 14/120), sm2 (1.6%, 2/120) were diagnosed as early stages of gastric cancer. The complete resection rate was 85.2% (150/176) and en-bloc resection rate was 96.0% (169/176). Complications as such as perforation and bleeding developed in 4.4%(8/179) and 21.2% (38/179), respectively. Conclusion: EISD is an effective in the endoscopic treatment for gastric adenoma and early gastric cancers. However, further evaluation of this method and long-term follow-up will be necessary for an evaluation of the recurrence rate after resection of a tumor.

• Journal of Korea Multimedia Society
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• v.13 no.7
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• pp.1044-1050
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• 2010

Endoscopic ultrasonography is a medical procedure in endoscopy combined with ultrasound to obtain images of the internal organs. It is useful to have a predictive pathological manifestation since a doctor can observe tumors under mucosa. However, it is often subjective to judge the degree of malignant degeneration of tumors. Thus, in this paper, we propose a feature analysis procedure to make the pathological manifestation more objective so as to improve the accuracy and recall of the diagnosis. In the process, we extract the ultrasound region from the image obtained by endoscopic ultrasonography. It is necessary to standardize the intensity of this region with the intensity of water region as a base since frequently found small intensity difference is only to be inefficient in the analysis. Then, we analyze the spot region with high echo and calcium deposited region by applying LVQ algorithm and bit plane partitioning procedure to tumor regions selected by medical expert. For detailed analysis, features such as intensity value, intensity information included within two random points chosen by medical expert in tumor region, and the slant of outline of tumor region in order to decide the degree of malignant degeneration. Such procedure is proven to be helpful for medical experts in tumor analysis.

• Journal of Digestive Cancer Research
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• v.2 no.1
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• pp.24-27
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• 2014

A 42-year-old female was referred to our department after find out submucosal tumor type lesion on cardia at local clinics. She experienced no specific symptom. On gastroscopy, two distinct neoplasms were detected. One of which was located in the cardia anterior wall of the stomach with the size of 2.0×1.1 cm, and the other one was localized in the cardia posterior wall of the stomach and its size was 1.5×1.2 cm. We performed endoscopic submucosal dissection. Pathological evaluation revealed the diagnosis of gastrointestinal stromal tumor (GIST) at the cardia anterior wall and malignant lymphoma from the mass localized cardia posterior wall of the stomach. We would like to report these rare synchronous tumors which were successfully treated by endoscopic resection in the same patient