• 대한두경부종양학회지
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• 제14권1호
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• pp.46-53
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• 1998

Background: Hypopharyngeal cancer represents about one-third the incidence of laryngeal cancer which is the most common cancer in head and neck area. Although there have been numerous reports regarding its clinical and statistical characteristics, more precise and ample data should be collected and analyzed in this country. Objectives: This study was designed to evaluate the pattern and patient's profile of the hypopharyngeal cancer, and we reviewed the treatment outcomes to search for an index of treatment modalities. Materials and Methods: The authors retrospectively analyzed 73 cases of hypopharyngeal cancer treated at Yonsei Medical Center during the 10-year period from 1985 to 1994. Five-year survival rate was calculated according to the primary site, clinical stage and treatment modality. Results: The incidence was predominated in male by 9 to 1 and peak incidence was 6th and 7th decades. Pyriform sinus was the main primary site(80.8%) followed by posterior hypopharyngeal wall(13.7%) and postcricoid area(5.5%). Advanced stage cancers(87.7%) were more common than early stage cancers. Radiotherapy(60.3%) was the most commonly used as primary treatment modality. Neck node metastasis was early occurred even in early stage cancers(61.5%), and overall rate of neck node metastasis was 69.9%. All surgical cases received procedures more than total laryngectomy and partial pharyngectomy. The most common cause of death was primary failure(81.5%) and it was highest in radiotherapy group. Five-year survival rate was significantly high in surgery group(90.9%). The overall 5-year survival rate of hypopharyngeal cancer was 30.3%. Conclusion: High index of suspicion should be required for early diagnosis. Also, surgery may be recommended for the primary treatment modality in advanced stage cancers.

• 대한두경부종양학회지
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• 제18권1호
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• pp.36-40
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• 2002

Background and Objectives: To determine if laser endoscopic microsurgery is a reliable and appropriate approach in the treatment of laryngeal carcinomas. Materials and Methods: Retrospective study of 62 patients treated with CO2 laser from June 1988 to November 2000 at Seoul National University Hospital for laryngeal squamous cell carcinoma. All patients were treated with curative intention. Fifty three untreated patients with laryngeal carcinoma (39 glottic and 14 supraglottic carcinoma patients) had primary carbon dioxide laser microsurgery. Nine radiation failure patients were treated. Postoperative radiotheray was done for 17 patients. Neck dissection was performed simultaneously for 4 supraglottic cases with cervical nodal metastasis. Mean follow-up duration was 40 months. Results: In primary laser surgery group, distribution of tumors (American Joint Committee on Cancer, 1997) were 38 cases with Tl, 13 cases with T2, 2 cases with T3. Cure rate was 88.7%(47/53) and local control rate was 92.5%(49/53). Larynx was preserved in 94%(50/53) of patients. The overall 5-year survival rate(Kaplan-Meier) was 81.5%. In radiation failure group, 56% of patients were recurred after laser surgery. Conclusion: Laser surgery could be a better treatment modality for early laryngeal cancers and selected advanced cases. Additional radiation therapy should be considered if resection margin is not satisfactory.

• 대한두경부종양학회지
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• 제1권1호
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• pp.87-94
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• 1985

A total of eighty five cases with supraglottic carcinoma treated by radical radiotherapy in Yonsei Cancer Center between Jan. 1974 and Dec. 1980, was observed through retrospective analysis. This study is concerned wi th patients selection for irradiation alone or combined treatment with surgery. Emphasis is directed to the analysis of effectiveness of radical radiotherapy instead of partial laryngectomy in T-1, T-2 and early T-3 lesion. A satisfactory control of laryngeal disease and preservation of a normal voice ranging from 100% for $T_1N_0$ lesions, 61.1% for $T_2N_0$ to 50% for $T_3N_0$. But 47.1% of cases with node metastasis on admission had poor results to irradiation suggesting of necessicity of combined treatment. 5 year recurrence-free survivals was 43.3% in all cases with supraglottic carcinoma treated by irradiation alone, although it was 87.5% in T-1 and 51.8% in T-2.

• Radiation Oncology Journal
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• 제12권3호
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• pp.323-329
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• 1994

Purpose: In supraglottic cancer, radiation therapy is used to preserve the laryngeal function but combined surgery and radiation therapy is required in advanced stage. The authors Present the results of radiation therapy alone and combined surgery Plus Postoperative radiation therapy for supraglottic cancer. Methods and Materials: A retrospective analysis was done for 43 patients with squamous cell carcinoma of the supraglottic larynx who were treated from Feburary 1982 to December 1991, in the Department of Radiation Oncology, Korea University Hospital. Patient distribution according to the AJCC staging system was as follows: I, 3($7.0\%$); II, 7($16.3\%$); III, 17($39.5\%$); IV, 16($37.2\%$). Patients' age ranged from 30 to 72 years(median 62). Follow up durations were from 21 to 137 months(median 27). Seventeen patients($39.5\%$) were treated by radiation therapy alone with radiation doses of 6840-7380 cGy and 26 patients($60.5\%$) were treated with surgery plus postoperative irradiation with doses of 5820-6660 cGy. Results: Overall five-year survival rate for all stage was $51.8\%$, with $100\%$ for Stage I and II, $47.3\%$ for Stage III, and $29.2\%$ for Stage III. The difference of the survival rate by stage was statistically significant(p=0.0152). Five-year survival rates were $100\%$ for locally confined tumor in the supraglottic larynx, $37.5\%$ for transglottic extension, $26.7\%$ for hypopharynx extension, and only two of 5 patients with both transglottic and hypopharynx extension were alive(p=0.0033). Five-year survival rates by neck node status were as follows: $55.0\%$ for NO, $64.3\%$ for N1, $50.0\%$ for N2, and all 2 of N3 were died of disease. Overall survival rate for radiation therapy alone group was $42.8\%$, and it was $56.7\%$ for surgery plus postoperative radiation therapy group with no statistically significant difference(p=0.5215). In Stage I and II, all Patients survived. In Stage III and IV, 5-year survival rate for radiation therapy alone group was $28.5\%$ and $43.4\%$ for surgery plus postoperative irradiation group(p=0.5103). Local control rate was $58.8\%$(10/17) for radiation therapy alone group and $73.1\%$ (19/26) for surgery plus postoperative irradiation group. Three patients from surgery plus postoperative radiation therapy group developed distant metastasis in lungs. Conclusion: Treatment results of radiation therapy alone was excellent in early stage supraglottic cancer. In advanced stage, even the difference was statistically not significant, the result of postoperative radiation therapy group was superior compared with radiation therapy alone group. Since 1992, concomitant chemoradiotherapy with hyperfractionated radiotherapy is being used to improve the result of the treatment and preserve the laryngeal function in advanced stage supraglottic cancer.

• Journal of Chest Surgery
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• 제37권8호
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• pp.665-671
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• 2004

배경: 흉부 식도암에서의 림프절 전이는 식도암이 점막하층에만 국한된 경우라도 흔하게 발견된다고 보고되고 있다. 림프절 전이가 수술 후의 예후에 큰 영향을 주고 있음에도 불구하고 조기식도암의 림프절 전이 양상은 완전히 조사되어 있지 않으며 림프절 절제술의 역할에 대해서도 여전히 의견이 분분하다. 대상 및 방법: 저자는 1995년 12월부터 2001년 8월까지 수술한 표층부(T1)식도암 환자 44예를 대상으로 림프절 전이의 양상을 후향적으로 연구하였다. 결과: 총 44예의 환자 중에서 림프절 전이는 총 10예(22.7%)에서 있었다. 식도암의 침윤 정도에 따라 볼 때 상피성 점막층에 국한된 경우 3예 중 0예, 점막고유 점막층까지 침윤된 경우 4예 중 0예, 근육성 점막층까지 침윤된 경우 4예 중 2예, 그리고 점막하층까지 침윤된 경우 33예 중 8예에서 림프절 전이가 발견되었다. 반회후두신경 림프절 전이는 5예, 복강내 림프절 전이가 8예에서 있어 흉부내 림프절 전이 3예보다 흔히 있었다. 수술사망은 없었고 병원사망이 점막고유층 환자에서 1예, 만기사망이 점막하식도암 환자에서 1예 있었다. 병원사망을 제외한 3년 생존율은 점막식도암이 100%, 점막하식도암은 97.0% (32/33예)였다(p＞0.05). 림프절 전이가 없는 환자들의 3년 생존율은 100%, 림프절 전이가 있는 환자들은 90.0% (9/10예)였다(p＞0.05). 결론: 표층부(T1) 식도암은 수술적 절제 후 생존율이 우수하다. 그러나 표층부(T1) 식도암에서 근육성 점막층 이상의 침윤이 있는 암에서는 림프절전이가 있을 수 있으며 특히 반회후두신경 림프절과 복강내 림프절 등 원격 림프절에도 빈번한 전이가 관찰되므로 광범위한 림프절 절제술이 필요하다고 생각된다.

• 대한두경부종양학회지
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• 제10권2호
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• pp.178-184
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• 1994

저자들은 1985년부터 1992년까지 연세대학교 의과대학 영동세브란스병원에서 치료한 병기 $T_1$성문암 환자 30례를 대상으로 임상적 분석을 시행하여 다음과 같은 결과를 얻었다. 1) 병기 $T_1$성문암의 경우 남여의 비는 29:1로 남자가 대부분이었으며, 60대에 호발하였다. 2) 전례가 편평상피암이었으며 조직학적 분화도가 좋았던 경우가 13례, 중간 분화도이었던 경우가 17례이었다. 3) 초치료로 방사선치료를 한 경우 25.9%에서 재발이 있었으며, 부분후두적출술을 시행한 2례중 1례에서 재발이 있었다. 4) 재발한 경우, 전례에서, 원발부위의 재발이었고 경부재발이 동반된 경우가 1례있었으며, 1년이내 재발이 흔하였다. 5)원발부위 재발의 경우 전연합(anterior commissure)에서 재발이 빈발하였다. 6) 5년 생존율은 81.5%로 이는 병기간, 병리조직학적으로 유의한 차이는 없었다.

• 대한기관식도과학회지
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• 제10권1호
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• pp.41-45
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• 2004

Tracheostomy and endotracheal intubation are often performed in patients with acute and chronic respiratory failure. Recently, the incidence of iatrogenic tracheal stenosis has increased. Tracheal resection and end-to-end anastomosis would be one of the most physiologic treatment options for severe tracheal stenosis. Also, this treatment can be applied to the management of trachea invaded by thyroid cancer and tracheal neoplasm. The authors aimed to analyze the outcomes of end-to-end anastomosis of trachea following segmental resection in tracheal stenosis and tracheal invasion of cancer that we have recently experienced. Materials and methods Authors retrospectively studied 19 cases treated by tracheal resection with end-to-end anastomosis between Feburuary 1996 and January 2003. 12 patients had tracheal stenosis, 6 patients had tracheal invasion by thryroid cancer and 1 patient had tracheal cancer. We analyzed the direct causes of tracheal stenosis, preoperative vocal cord function, operation technique, early and delayed postoperative complications, and the outcome of end-to-end anastomois. Result Decannulation without significant aspiration was achieved in 16 cases($89.5\%$). A 27 year-old man could not be decannulated because of restenosis. A 62 year-old woman could not be decannulated because of bilateral vocal cord palsy. Conclusion End-to-end anastomosis is a safe and effective surgical method for tracheal stenosis. Case selection for end-to-end anastomosis and preservation of recurrent laryngeal nerve during operation is very important.

• 대한두경부종양학회지
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• 제11권2호
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• pp.167-172
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• 1995

Pharyngocutaneous fistula(PCF) is one of the complications following total laryngectomy in laryngeal and hypopharyngeal cancer. Fistula lead to delayed wound healing, more serious complications such as carotid blow-out, prolonged hospitalization, significant patient morbidity and occasional mortality. Identification of patients at high risk for fistula formation, appropriate preventive measures, and appropriate management are the head and neck surgeon's responsibility. So we analyzed the clinical data of pharyngocutaneous fistula which was developed after total laryngectomy. Following results were obtained: 1) Occurrence of PCF increases with salvage surgery compared to curative surgery. 2) Early detection and effective management of PCF are the key factors to decreasing the hospitalization period. 3) Constructing a pharyngostoma seems to be an ideal method of preventing dangerous complications and ultimately closing the fistula. 4) Simultaneous reconstruction is necessary in the high risk group.

• Archives of Plastic Surgery
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• 제36권5호
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• pp.611-616
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• 2009

Purpose: The rate of fistulas occuring followed by resection of oral cavity, oropharyngeal, hypopharyngeal, and laryngeal cancer are reported to be 9 ~ 23% according to various documents. Neglected treatment of the fistula can result in a setback in proper treatment with restrictions in oral intake leading to delayed return to daily life. Furthurmore, in severe cases, it may injure important vessels and adjacent structures of the neck area. The author reviewed previously reported cases of treatment methods for fistulas recurring after diverse head and neck operations and with sharing the treatment experiments of our patients, we tried to present a treatment algorism for different fistula types. Methods: Our study was based on retrograde analysis of 64 patients who were clinically diagnosed with fistula after operation for cancer of the head and neck from 1997 to 2008 at Severance Hospital. Their primary sites of cancer were 8 oral cavity, 22 oropharynx, 25 hypopharynx, and 9 larynx. The patients were aged 45 to 75 years and the male to female ratio was 11 to 1. The patient's operation records and progress notes were evaluated for determination of degree of fistula and treatment methods. Results: Most fistulas were clinically suspected after postoperative 5 days and symptoms noted for detection of the fistula were erythema, purulent discharge, edema, tenderness, and fluctuation. The fistula was definitely diagnosed at postoperative 2 weeks with barium test and treatment method ranging from conservative management to operative procedure were applied to each patients. Total 21 patients were managed with conservative protocol. In 15 cases, direct repair of the fistula was done and more stable repair of the fistula was possible with using of TachoComb$^{(R)}$. Pharyngostoma was performed in 14 patients. Among them, 4 patients healed spontaneously, 5 patients were taken direct closure, 4 patients were taken pectoralis major musculocutaneous flap, and one patient was taken esophageal transfer. The other 14 patients were taken 11 pectoralis major musculocutaneous flaps and 3 free flaps without pharyngostoma formation. Conclusion: Fistula is a troublesome complication resulting after resection of head and neck cancer. Early detection and adequate treatment according to the period and condition of the fistula may prevent further complications and reduce the pain of the patient.

• 대한후두음성언어의학회지
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• 제29권2호
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• pp.98-102
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• 2018

Background and Objectives : Detection of vascular abnormalities in vocal cord (VC) leukoplakia is important for the diagnosis of neoplastic change of the mucosa. The aim of this study was to investigate the value of i-scan in the differential diagnosis of VC leukoplakia based on visualization of abnormal vascular features. Material and Methods : Fifty-two patients with leukoplakia were enrolled in the study. Images of their larynx obtained using conventional white light endoscopy and an i-scan-enhanced endoscopy (Pentax DEFINA EPK-3000 Video Processors, with Pentax VNLJ10) were reviewed. The microvascular features of the lesions and vascular changes were analyzed and the results were compared with the histopathologic diagnosis. Results : Among the 52 leukoplakia patients, 7 (13.5%) patients had squamous hyperplasia, 10 (19.3%) mild dysplasia, 2 (3.8%) moderate dysplasia, 14 (26.9%) severe dysplasia, 4 (7.7%) carcinoma in situ, and 15 (28.8%) invasive squamous cell carcinoma on histopathologic examination. Using i-scan-enhanced endoscopy, abnormal vascular change with neoplastic neoangiogenesis was detected in most cases of malignant VC lesion [severe dysplasia : 9/14 (64.3%), carcinoma in situ: 2/4 (50.0%), and invasive squamous cell carcinoma : 11/15 (73.4%)]. Conclusion : i-scan-enhanced endoscopy is a useful optical technique for the diagnosis of VC leukoplakia. Our results suggest that i-scan may be a promising diagnostic tool in the early detection of laryngeal cancer.