• Title/Summary/Keyword: cancer surgery

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Evaluation of Different Methods of Gastroenterostomy after Distal Gastrectomy for Gastric Carcinoma (위선암 환자의 원위부 위절제 후 위공장문합의 방법의 선택에 따른 임상 양상의 차이에 관한 고찰)

  • Choi, Eun-Hye;Lee, Jong-Myeong
    • Journal of Gastric Cancer
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    • v.9 no.4
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    • pp.215-222
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    • 2009
  • Purpose: Billroth II gastroenterostomy is a typical reconstruction method after distal gastrectomy for gastric carcinoma, but it has problems, especially frequent reflux esophagitis. Various methods have been tried to address this problem. Among them are Braun enteroenterostomy and Roux-en-Y gastroenterostomy, which are performed separately according to the size of the gastric remnant. The aim of our study was to determine whether these applications are compatible. Materials and Methods: Between September 2003 and April 2007, we performed Roux-en-Y gastroenterostomy operations (14 patients) when the size of the gastric remnant was <10%, Braun enteroenterostomy (17 patients) when the size was between 10 and 20%, and Billroth II gastroenterostomy (14 patients) when the size was between 20 and 40% after subtotal gastrectomy for gastric cancer by a single surgeon at our hospital. We analyzed the results of each treatment. We evaluated the symptoms and endoscopic findings using questionnaires and hospital records. To evaluate nutritional states, we reviewed albumin and hemoglobin levels and body weight changes. Results: All operations were performed safely mortality was 0% and postoperative complications were 8.9%. On endoscopy, reflux gastritis was observed to occur in 7.63%, 18.65% and 40.0%, respectively, of patients who had undergone Roux-en-Y, Braun and Billroth II operations (P=0.13). Reflux esophagitis was observed in 1 patient in the Roux-en-Y group and 1 patient in the Braun group. Endoscopic gastrostasis was observed in 2 patients in the Roux-en-Y group, one of which was thought to cause reflux esophagitis. Patients in the Roux-en-Y group and Braun groups ingested a lower volume of food than did those in the Billroth II group (respectively, 7.1%, 0.0% and 28.7%) and complained less of postprandial discomforts (respectively, 14.3%, 23.5% and 57.1%) and reflux symptoms (respectively 0.0%, 11.8% and 42.9%). Conclusion: The application of Braun enteroenterostomy and Roux-en-Y gastroenterostomy to the small gastric remnant may be effective for reducing reflux symptoms and abdominal discomfort after distal gastric resection. We recommend Roux-en-Y gastroenterostomy when the size of the gastric remnant is <10%, and Braun anastomosis in the others. It will need to be determined which reconstructive procedure is better for many different conditions.

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Postoperative Radiotherapy for Locally Advanced Gastric Cancer (국소적으로 진행된 위암의 수술후 방사선 치료성적)

  • Lee Myung Za;Chun Ha Chung;Kim Insoon;Chung Tejune
    • Radiation Oncology Journal
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    • v.15 no.2
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    • pp.113-119
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    • 1997
  • Purpose : Radical gastrectomy is main treatment of gastric cancer. But the result is not satisfactory with surgery alone. Most of pattern of failure remain locoregional recurrence. To improve 5 year survival postoperative chemotherapy with or without radiotherapy has been used. We analyzed patients with stage III and IV stomach cancer who had radical operation and received postoperative radiation therapy combined with or without chemotherapy retrospectively. Material and Method : From March 1985 to June 1993, 68 patients treated with curative resection and received postoperative adiuvant radiotherapy with 36Gy or more were evaluated. Median age was 60 years(range 28-66 yrs) . Patients were followed from 3 to 133 months with median follow up of 48 months. Thirty seven patients had non signet ring adenocarcinoma, 29 signet ring cell, 2 other cell. Patients with stage IIIA, IIIB, IV disease were 19, 25 and 24 respectively Chemotherapy was given to all patients except two. Results : Five-year overall survival and disease-free survival rate were 36.6% and 33.6%, respectively. Prognostic factor affecting survival were assessed. High ratio of jnvolved/dissected Iymph node, signet ring histology showed Poor Prognosis with statistical significance. Presence of residual tumor after surgery, stageIV. split course of radiation therapy, age, number of involved Iymph node, number of Iymph node dissection and grade of tumor affected survival without statistical significance, Type of chemotherapy did not affect survival. Recurrence was documented in 34 patients. High recurrence was seen in omentum and peritoneum with 23.5%, and remnant stomach, anastomosis site, A-loop and I-loop had also high recurrence with 13.2%. In field locoregional recurrence was 20.7% and total distant metastases were 39.7%. Total intraabdominal failure was 47.1% and extraabdominal failure was 13.2%. Treatment toxicity was considered to be acceptable. 22.1% of patients had grade 3 and only 1 patient had grade 4 leukopenia. Six Patients(8.8%) had weigh loss more than 10%. Conclusion : Treatment toxicity was acceptable with combined treatment with chemotherapy and radiotherapy. Locoregional recurrence was relatively low compared to distant failure with addition of irradiation. Peritoneal and omental seeding was high Five-rear surival was increased with combined modality. Radiation may eradicate minimal residual disease and improve survival, To evaluate role of radiation Prospective randomized study employing chemotherapy alone and chemotherapy plus radiation is necessary. Futhermore to reduce intraabdominal failure, role of intraabdominal chemotherapy in addition to combined chemotherapy plus radiation has to be explored.

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Prognostic Usefulness of Maximum Standardized Uptake Value on FDG-PET in Surgically Resected Non-small-cell Lung Cancer (수술로 제거된 비소세포폐암의 예후 예측에 있어 FDG-PET 최대 표준화 섭취계수의 유용성)

  • Nguyen Xuan Canh;Lee Won-Woo;Sung Sook-Whan;Jheon Sang-Hoon;Kim Yu-Kyeong;Lee Dong-Soo;Chung June-Key;Lee Myung-Chul;Kim Sang-Eun
    • Nuclear Medicine and Molecular Imaging
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    • v.40 no.4
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    • pp.205-210
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    • 2006
  • Purpose: FDG uptake on positron omission tomography (PET) has been considered a prognostic indicator in non-small cell lung cancer (NSCLC). The aim of this study was to assess the clinical significance of maximum value of SUV (maxSUV) in recurrence prediction in patients with surgically resected NSCLC. Materials & methods: NSCLC patients (n=42, F:M =14:28, age $62.3{\pm}12.3$ y) who underwent curative resection after FDG-PET were enrolled. Twenty-nine patients had pathologic stage 1, and 13 had pathologic stage II. Thirty-one patients were additionally treated with adjuvant oral chemotherapy. MaxSUVs of primary tumors were analyzed for correlation with tumor recurrence and compared with pathologic or clinical prognostic indicators. The median follow-up duration was 16 mo (range, 3-26 mo). Results: Ten (23.8%) of the 42 patients experienced recurrence during a median follow-up of 7.5 mo (range, 3-13 mo). Univariate analysis revealed that disease-free survival (DFS) was significantly correlated with maxSUV (<7 vs. $\geq7$, p=0.006), tumor size (<3 cm vs. $\geq3$ cm, p=0.024), and tumor tell differentiation (well/moderate vs. poor, p=0.044). However, multivariate Cox proportional analysis identified maxSUV as the single determinant for DFS (p=0.014). Patients with a maxSUV of $\geq7$(n=10) had a significantly lower 1-year DFS rate (50.0%) than those with a maxSUV of <7 (n=32, 87.5%). Conclusion: MaxSUV is a significant independent predictor for recurrence in surgically resected NSCLC. FDG uptake can be added to other well-known factors in prognosis prediction of NSCLC.

Arm Morbidity after Breast Cancer Treatments and Analysis of Related Factors (유방암 환자의 상지 부작용과 관련 요인)

  • Chun Mi Son;Moon Seong Mi;Lee hye Jin;Lee Eun-Hyun;Song Yeoung Suk;Chung Yong Sik;Park Hee Bung;Kang Seung Hee
    • Radiation Oncology Journal
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    • v.23 no.1
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    • pp.32-42
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    • 2005
  • Purpose : To evaluate the incidence of arm morbidity following breast cancer surgery including axillary dissection and to identify related factors. Materials and Methods : One hundred and fifty nine patients were studied using a self-report questionnaire and a clinical examination. Lymphedema, reduction of range of motion in shoulder joint and subjective symptoms (pain, impaired arm movement, numbness, stiffness) were evaluated. As related factors, demographic, oncologic characteristics and types of treatment were analysed. Results : The incidence of lymphedema ($\geqq$2 cm difference comparing to unaffected arm) was $6.3\%$, $10.7\%$, $22.5\%$ and $23.3\%$ at each 10 cm, 20 cm, 30 cm, and 40 cm from wrist. Reduction of range of motion in shoulder joint ($\geqq$ 20 degree difference comparing to unaffected arm) was noted In more than 1/3 patients for flexion, abduction and internal rotation. Especially the reduction of range of motion in internal rotation was severe ($>50\%$ reduction) in 1/3 patients. Approximately 50 to $60\%$ of patients complained impaired arm movement, numbness, stiffness and pain. Body mass index (BMI) was the significant risk factor for lymphedema. Conclusion : Lymphedema was present in 1/3 of patients and the common sites of edema were 30 cm 40 cm proximal from the wrist. Also most severe reduction of range of motion in shoulder joint was with internal rotation. There needs weight control for lymphedema because BMI was the significant risk factor for lymphedema. Also rehabilitation program for range of motion especially internal rotation In shoulder joint should be developed.

Clinical Significance of the Aortic Node in Non-small Cell Lung Cancer of the Left Upper Lobe (좌상엽에 발생한 비소세포형 폐암에서 Aortic Node의 의의)

  • 김대준;김길동;이기종;정경영
    • Journal of Chest Surgery
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    • v.36 no.11
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    • pp.846-851
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    • 2003
  • Background: To clarify the clinical significance of the aortic nodes in resected non-small cell lung cancer of the left upper lobe. Material and Method: One hundred fifty six patients with resected non-small cell lung cancer of the left upper lobe were studied. Patients who received preoperative induction therapy, non-curative operation or defined as operative mortality were excluded from this study. Result: In N2 left upper lobe tumors, aortic nodes comprised 52.7% of the metastatic mediastinal lymph nodes. In single station N2 disease, a frequently metastasized station was aortic node (64.3%). 5-year actuarial survival according to the N status was 65.0% in N0, 30.4% in N1, and 17.9% in N2. There was no statistically significant difference in survival between N1 and N2 diseases (p=0.06). The patients with metastasis to aortic node alone had a comparatively good prognosis (5-year survival: 35.6%) than other N2 diseases (5-year survival: 4.6%) (p=0.01) and had a similar survival outcome as N1 diseases (p=0.97). Considering the aortic node as N1 node, 5-year survival according to the N status was 65.0% in N0, 31.2% in N1, 4.6% in N2 and significant survival difference was observed between N1 and N2 disease (p=0.00). In multivariate analysis, the male sex (hazard ratio 6.892, p=0.011) and the involvement to the aortic node alone (hazards ratio 2.799, p=0.009) were the significant factors affecting postoperative survival. Conclusion: According to the our data, involvement to the aortic node alone in left upper lobe tumors should be grouped with N1 disease because this combined category reflects the surgical outcome more accurately.

The Results of Radiation Therapy in Non-Small Cell Lung Cancer (비소세포성 폐암에서의 방사선 치료 결과)

  • Kay Chul-Seung;Jang Hong-Seok;Gil Hack-Jun;Yoon Sei-Chul;Shinn Kyung-Sub
    • Radiation Oncology Journal
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    • v.12 no.2
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    • pp.175-184
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    • 1994
  • From March 1983 through January 1990, two hundred sixty six patients with non-small cell lung cancer were treated with external radiation therapy at the Department of Therapeutic Radiology, Kangnam St. Mary's Hospital, Catholic University Medical College. A retrospective analysis was performed on eligible 116 patients who had been treated with radiation dose over 40 Gy and had been able to be followed up. There were 104 men and 12 women. The age ranged from 33 years to 80 years (median ; 53 years). Median follow up period was 18.8 months ranging from 2 months to 78 months. According to AJC staging system, there were 18($15.5\%$) patients in stage II, 79($68.1\%$) patients in stage III and 19($16.4\%$) patients in stage IV. The Pathologic classification showed 72($62.8\%$) squamous cell carcinomas, 16($13.8\%$) adenocarcinomas, 7($6\%$) large cell carcinomas, 5($4\%$) undifferentiated carcinomas, and 16($13.8\%$) un-known histology. In Karnofsky performance status, six ($5.2\%$) patients were in range below 50, 12($10.4\%$) patients between 50 and 60, 46($39.6\%$) patients between 60 and 70, 50($44.0\%$) patients between 70 and 80 and only one ($0.8\%$) patient was in the range over 80. Sixty ($51.7\%$) patients were treated with radiation therapy (RT) alone. Thirty three ($28.4\%$) patients were treated in combination RT and chemotherapy, twenty three ($19.8\%$) patients were treated with surgery followed by postoperative adjuvant RT and of 23 Patients above, five ($4.3\%$) patients, were treated with postoperative RT and chemotherapy. Overall response according to follow-up chest X-ray and chest CT scans was noted in $92.5\%$ at post RT 3 months. We observed that overall survival rates at 1 year were $38.9\%$ in stage II, $27.8\%$ in stage III, and $11.5\%$ in stage IV, and 2 year overall survival rates were $11.1\%$ in stage II, $20.8\%$ in stage III and $10.5\%$ in stage IV, respectively. We evaluated the performance status, radiation dose, age, type of histology, and the combination of chemotherapy and/or surgery to see the influence on the results fellowing radiation therapy as prognostic factors. Of these factors, only performance status and response after radiation therapy showed statistical significance (P<0.05)

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APOPTOTIC EFFECT IN COMBINATION OF CYCLOSPORIN A AND TAXOL ON ORAL SQUAMOUS CELL CARCINOMA CELL LINE THROUGH THE PI-3 KINASE/AKT1 PATHWAY (구강 편평세포암종 세포주에서 Cyclosporin A와 Taxol 투여시 PI-3 kinase/Akt1 Pathway에 의한 세포사멸 병용효과)

  • Kim, Kyu-Young;Lee, Jae-Hoon
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.33 no.5
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    • pp.426-436
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    • 2007
  • Oral cancer take up 2-6% of all carcinomas and squamous cell carcinoma, which is the most common type in oral cancer, has a poor prognosis due to its high metastasis and recurrence rates. In treating oral cancer, chemotherapy to the primary, metastasized and recurrent lesion is a very important and useful treatment, even though its widespread usage is limited due to high general toxicity and local toxicity to other organs. Taxol, a microtubule stabilizing agent, is an anticancer drug that induces cell apoptosis by inhibiting depolymerization of microtubules in between the metaphase and anaphase of the cell mitosis. Recently, its effectiveness and mechanism on various tumor has been reported. However, not much research has been done on the application of Taxol to oral squamous cell carcinoma. Cyclosporin A, which is an immunosuppressant, is being used on cancers and when co-administered with Taxol, effectiveness of Taxol is enhanced by inhibition of Taxol induced multidrug resistance. In this study, Cyclosporin A with different concentration of Taxol was co-administered to HN22, the oral squamous cell carcinomacell line. To observe the cell apoptosis and the mechanisms that take part in this process, mortality evaluation of tumor cell using wortmannin, c-DNA microarray, RT-PCR analysis, cytometry analysis and western blotting were used, and based upon the observation on the effect and mechanism of the agent, the following results were obtained: 1. The HN22 cell line viability was lowest when $100{\mu}M$ of Wortmannin and $5{\mu}g/ml$ of Taxol were co-administered, showing that Taxol participates in P13K-AKT1 pathway. 2. In c-DNA microarray, where $1{\mu}g/ml$ of cyclosporine A and 3mg/ml of Taxol were co-administered, no up regulation of AKT1, PTEN and BAD c-DNA that participate in cell apoptosis was observed. 3. When $1{\mu}g/ml$ of Cyclosporin A was applied alone to HN22 cell line, no difference was found in AKT1, PTEN and BAD mRNA expression. 4. Increased AKT1, mRNA expression was observed when $3{\mu}g/ml$ of Taxol was applied alone to HN22 cell line. 5. When $1{\mu}g/ml$ of Cyclosporin A and Taxol($3{\mu}g/ml\;and\;5{\mu}g/ml$) were co-administered to HN22 cell line, PTEN mRNA expression increased, whereas AKT1 and BAD mRNA decreased. 6. As a result of cytometry analysis, in the group of Cyclosporin A($1{\mu}g/ml$) and Taxol($3{\mu}g/ml$) co-administration, increased Annxin V was observed, which shows that apoptosis occurred by deformation of plasma membrane. However, no significant difference was observed with vary ing concentration. 7. In western blot analysis, no caspase 3 was observed in the group of Cyclosporin A($1{\mu}g/ml$) and Taxol($3{\mu}g/ml$) co-administration. From the results of this study, it can be concluded that synergistic effect can be observed in combination therapy of Taxol and Cyclosporin A on oral squamous cell carcinoma cell line, where decreased activity of the cell line was observed. This resulted in decreased AKT1 and BAD mRNA and increased PTEN mRNA expression and when wortmannin and Taxol were co-administered, the viability decreased which confirms that Taxol decreases the viability of tumor cell line. Hence, when Taxol and cyclosporine A are co-administered, it can be assumed that cell apoptosis occurs through AKt1 pathway.

The Expression of MUC1 and CD44s in Non-small Cell Lung Cancer (비소세포폐암에서 MUC1과 CD44s의 발현)

  • Park, Hye-Kyung;Lee, Ji-Seok;Lee, Jun-Hee;Lee, Jung-Wook;Kim, Yun-Seong;Lee, Min-Ki;Kim, Young-Dae;Lee, Hyung-Ryu;Kim, Kun-Il;Lee, Chang-Hun;Park, Soon-Kew
    • Tuberculosis and Respiratory Diseases
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    • v.52 no.2
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    • pp.117-127
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    • 2002
  • Backgroud : MUC1 mucin is a heavily glycosylated large glycoprotein and is expressed aberrantly in carcinoma. CD44 is polymorphic family of cell surface glycoproteins participating in cell-cell adhesion and modulation of the cell-matrix interaction. MUC1 mucin and CD44 expression have been implicated in a tumor invasion and metastasis in certain malignancies. In this study, the expression of MUC1 and the standard form of CD44 (CD44s) was examined in non-small cell lung cancer (NSCLC). Methods : Immunohistochemical staining using monoclonal antibodies including MUC1 glycoprotein and CD44s was performed on 80 NSCLC surgical specimens. The association between MUC1 and CD44s expression and the histological type and tumor stage was investigated. Results : Depolarized MUC1 expression in more than 10% of cancer cells was found in 12 (27.9%) out of 43 squamous cell carcinomas (SCCs) and 12 (32.4%) out of 37 adenocarcinomas (ACs). It was not associated with the tumor histological type and the TNM-stage in SCCs. Depolarized MUC1 expression correlated with the N-stage in ACs (p=0.036). CD44s was expressed in 36 (83.7%) out of 43 SCCs and 14 (37.8%) out of 37 ACs. Reduced CD44s expression correlated with the N-stage (p=0.031) and the TNM-stage (p=0.006) in SCCs. Conclusions : Depolarized MUC1 expression was related to the nodal stage in NSCLC adenocarcinoma. Reduced CD44s expression was related to nodal involvement and the TNM-stage in squamous cell carcinoma. This suggests that MUC1 and CD44s expression in NSCLC might play important roles in tumor progression and cap be used as prognostic variables.

A Study on Anastomotic Complications after Esophagectomy for Cancer of the Esophagus : A Comparison of Neck and Chest Anastomosis (식도암 수술후 문합부 합병증에 관한 연구 - 경부문합과 흉부문합 간의 비교-)

  • 이형렬;김진희
    • Journal of Chest Surgery
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    • v.32 no.9
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    • pp.799-805
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    • 1999
  • Background: Leakage, stricture formation, and tumor recurrence at the anastomotic site are serious problems after esophagectomy for cancer of the esophagus or cardia. The prevalence of these postoperative complications may be affected by whether an anastomosis is made in the neck or in the chest, therefore a comparison was made between anastomoses made at these two sites. Material and Method: Between 1987 and 1998, 36 patients with cancer of the esophagus underwent transthoracic esophagectomy with cervical(NA, n=20) or thoracic anastomosis(CA, n=16). The tumors were staged postoperatively(stage IIA, n=13; s tage IIB, n=7; stage III, n=16) and were located in the middle thoracic(n=22) or lower thoracic esophagus and cardia(n=14). Result: The overall operative mortality was 8.3%(5% for NA group, 12.5% for CA group). The anastomotic leak rate for the NA group was 15.0% and 12.5% for the CA group. The anastomotic leak rate differed according to the manual(27.3%) or stapled(8.0%) techniques(p < 0.05). The median proximal resection margins in the NA and CA groups were 9.6 cm and 5.8 cm, and the corresponding rates of anastomotic tumor recurrence were 5.3% and 28.6%(p < 0.05). The prevalence of benign stricture formation (defined as moderate/severe dysphagia) was higher in the NA group(36.8%) than in the CA group(21.4%). When an anastomosis was made by the stapled technique, smaller size of the staple increased the prevalence of stricture formation - 41.7% with 25-mm staple and 9.1% with 28-mm staple(p < 0.05). Conclusion: Wider resection margin could decrease the anastomotic tumor recurrence, and the stapled technique could decrease the anastomotic leak. The prevalence of benign stricture was higher in the cervical anastomosis but the anastomotic leak and smaller size(25-mm) of the staple should be considered as risk factors.

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Role of Postoperative Radiotherapy for Patients with Pathological Stage III Non-Small-Cell Lung Cancer after Curative Resection (근치적 절제술 후 병기3의 비소세포성 폐암에서 수술 후 방사선 치료의 역할)

  • Kim, Mi-Young;Wu, Hong-Gyun;Kim, Hak-Jae;Heo, Dae-Seog;Kim, Young-Whan;Kim, Dong-Wan;Lee, Se-Hoon;Kim, Joo-Hyun;Kim, Young-Tae;Kang, Chang-Hyun
    • Radiation Oncology Journal
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    • v.29 no.1
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    • pp.44-52
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    • 2011
  • Purpose: To evaluate the outcomes and prognostic factors of postoperative radiotherapy (PORT) for patients with pathological stage III non-small-cell lung cancer (NSCLC) at a single institution. Materials and Methods: From 2000 to 2007, 88 patients diagnosed as having pathologic stage III NSCLC after curative resection were treated with PORT. There were 80 patients with pathologic stage IIIA and eight patients with pathologic stage IIIB in the AJCC 6th staging system. The majority of patients (n=83) had pathologic N2 disease, and 56 patients had single station mediastinal LN metastasis. PORT was administered using conventional technique (n=76) or three-dimensional conformal technique (n=12). The median radiation dose was 54 Gy (range, 30.6 to 63 Gy). Thirty-six patients received chemotherapy. Radiation pneumonitis was graded by the Radiation Therapy Oncology Group system, and other treatment-related toxicities were assessed by CTCAE v 3.0. Results: Median survival was 54 months (range, 26 to 77 months). The 5-year overall survival (OS) and disease free survival (DFS) rates were 45% and 38%, respectively. The number of metastatic lymph nodes was associated with overall survival (hazard ratio, 1.037; p-value=0.040). The 5-year locoregional recurrence free survival (LRFS) and distant metastasis free survival (DMFS) rates were 88% and 48%, respectively. Multiple stations of mediastinal lymph node metastasis was associated with decreased DFS and DMFS rates (p-value=0.0014 and 0.0044, respectively). Fifty-one relapses occurred at the following sites: 10 loco-regional, 41 distant metastasis. Grade 2 radiation pneumonitis was seen in three patients, and symptoms were well tolerated with anti-tussive medication. Grade 2 radiation esophagitis was seen in 11 patients. There were no grade 3 or more severe complications associated with PORT. Conclusion: Our retrospective data show that PORT for pathological stage III NSCLC is a safe and feasible treatment and could improve loco-regional control. The number of metastatic lymph nodes and stations of mediastinal lymph node metastasis were analyzed as prognostic factors. Furthermore, efforts are needed to reduce distant metastasis, which is a major failure pattern of advanced stage NSCLC.