• Clinical Endoscopy
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• v.55 no.2
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• pp.248-255
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• 2022

Background/Aims: Endoscopic submucosal dissection (ESD) is the preferred technique for treating early gastric cancer (EGC). However, very few studies have been conducted in South America. This study aimed to assess the efficacy and safety of ESD for EGC. Methods: We analyzed data from a prospective cohort from 2013 to 2020. A total of 152 superficial gastric neoplasms that fulfilled the absolute or expanded criteria for ESD were included. Outcomes were en bloc, R0, and curative resection rates, incidence of adverse events, and length of procedure. Results: The age of the enrolled patients was 68.4±11.3 years. The number of included patients based on the absolute and expanded indications was 150 and 2, respectively. En bloc, R0, and curative resections were achieved in 98.0%, 96.1%, and 89.5% of the cases, respectively. Bleeding and perforation were reported in 5.9% and 6.6% of the cases, respectively. Histopathological examination revealed low-grade dysplasia, high-grade dysplasia, well-differentiated adenocarcinoma, and poorly differentiated adenocarcinoma in 13, 20, 117, and 2 cases, respectively. Conclusions: Our study shows that ESD performed by properly trained endoscopists in reference centers is safe and effective, with comparable therapeutic outcomes to those reported in the Eastern series.

• Journal of Gastric Cancer
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• v.6 no.4
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• pp.244-249
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• 2006

Purpose: Tumor size has been reported to be one of the prognostic factors in the preoperative setting and 8 cm has been confirmed as a cut-off value for large gastric tumors with respect to postoperative complications. The aim of this study was to investigate the clinicopathologic features and the prognosis in patients with tumors larger than 8 cm in diameter. Materials and Methods: We retrospectively studied 2,260 patients with gastric cancer who underwent a gastrectomy from 1983 to 2001 at the Department of Surgery, Korea University College of Medicine. For a comparative analysis we divided the cases into the large and the small groups according to tumor size. The clinicopathological factors associated with large gastric tumors were analyzed by using univariate and multivariate analyses. To determine which variables were independent prognostic factors for overall survival, we applied the Cox proportional hazards model and we used P<0.05 as the cutoff value for statistical significance. Results: Univariate and multivariate analyses disclosed that tumor location (P<0.001), resection type (P<0.001), curability (P<0.001), depth of invasion (P<0.001), number of metastatic lymph nodes (P<0.001), differentiation (P<0.001) and combined resection (P<0.001) were significantly different between the two groups. The independent factors for survival identified by using the Cox proportional hazards model for large gastric tumors were nodal status (P<0.001), curative resection (P<0.001), depth of invasion (P=0.010), type of resection (P=0.018) and age (P=0.033). Conclusion: Large gastric tumors showed more aggressive local findings than their smaller counterparts. In patients with large gastric tumors, a curative resection was the most important factor for the prognosis. Therefore, we suggest that every effort should be made to do a curative gastrectomy and an accurate preoperative examination. (J Korean Gastric Cancer Assoc 2006;6:244-249)

• Journal of Gastric Cancer
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• v.18 no.3
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• pp.242-252
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• 2018

Purpose: Surgical resection for gastric adenocarcinoma is associated with significant post-operative morbidity and mortality. The aim of this study was to assess the prognostic significance of sarcopenia in patients undergoing resection for gastric adenocarcinoma with respect to post-operative morbidity and survival. Materials and Methods: A retrospective analysis was conducted on a cohort of consecutive patients who underwent surgical resection for gastric adenocarcinoma between 2008 and 2014. Patient demographics, radiological parameters, and pathological data were collected. OsiriX software (Pixmeo) was used to measure skeletal muscle area, which was normalized for height to calculate skeletal muscle index. Results: A total of 56 patients (41 male, 15 female; mean age, $68.4{\pm}11.9years$) met the inclusion criteria. Of these, 36% (20 of 56) of the patients were sarcopenic pre-operatively. Both sarcopenic and non-sarcopenic patient groups were equally matched with the exception of weight and body mass index (P=0.036 and 0.001, respectively). Sarcopenia was associated with a decreased overall survival (log-rank P=0.003) and was an adverse prognostic predictor of overall survival in multivariate analysis (hazard ratio, 10.915; P=0.001). Sarcopenia was a predictor of serious in-hospital complications in multivariate analysis (odds ratio, 3.508; P=0.042). Conclusions: In patients undergoing curative resection for gastric cancer, there was a statistically significant association between sarcopenia and both decreased overall survival and serious post-operative complications. The measurement and reporting of skeletal muscle index on pre-operative computed tomography should be considered.

• Journal of Gastric Cancer
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• v.10 no.2
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• pp.63-68
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• 2010

Purpose: Remnant gastric cancer (RGC) are generally detected at advanced stages or infiltration of adjacent organs. We retrospectively reviewed the surgical outcomes and clinicopathologic results of remnant gastric cancers that have operated during fourteen years in one institution of Korea. Materials and Methods: 34 patients who were diagnosed with RGC at Ajou University Hospital from April 1995 to October 2009 were enrolled. We analyzed the features of previous operation, and according to these results, surgical outcomes and clinicopathologic results for RGC were analyzed. Results: Of 34 patients, 20 patients had previously undergone distal gastrectomy for malignant disease, and 14 patients for benign disease. The period between previous operation and surgery for RGC in the patients underwent operation for malignant disease was shorter than that in benign patients (P<0.001). In surgical field, 31 patients (91.0%) were resected and curative resection was possible in 23 patients (67.6%). When 31 patients who underwent resection for RGC were divided into previous malignant and benign disease, there was no significantly different in terms of surgical outcomes and pathologic findings between two groups. Meanwhile, the patients who recently (after 2005) underwent surgery for RGC showed less advanced stage compared with the patients who underwent surgery before 2004. Conclusions: Resection was possible in the higher proportion (91.0%) of patients diagnosed with RGC compared with previous reports. The cause of previous operation did not effect on the surgical outcomes for surgery of RGC. Recent trend of RGC is to increase the proportion of early stage gastric cancer. Therefore, surgeons should consider curatively surgical resection for RGC the regardless of pattern of previous operation.

• Journal of Korean Neurosurgical Society
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• v.64 no.6
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• pp.975-982
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• 2021

Objective : The occurrence of posterior fossa teratomas in adulthood is extremely rare. In this study, we aimed to report our experience with two cases of posterior fossa mature teratoma in adults who underwent surgical resection. We also performed a systematic review of published papers available to date. Methods : We retrospectively reviewed the electronic medical records of patients who had onset of posterior fossa teratomas in adulthood at our institute between 1995 and 2020. We evaluated the clinical, radiographic, and pathological features of mature teratomas at the posterior fossa in adulthood. Furthermore, we searched the PubMed, EMBASE, and Web of Science database and reviewed published articles. Results : We found 507 articles on database review; of them, 102 were duplicates and 389 were excluded based on the inclusion criteria. Finally, 16 cases of posterior fossa from the web search and related articles. Subsequently, we added two cases that underwent surgery at our institute. We analyzed a total of 18 cases of mature teratomas. Headache was the most common (55.6%) symptom. The teratomas showed heterogeneous signals on magnetic resonance imaging. Thirteen patients (72.2%) had lesion at midline, five patients (27.8%) had calcification. Surgical resection was performed in all patients. No studies reported recurrence after resection. Conclusion : The occurrence of posterior fossa teratomas in adulthood is difficult to diagnose at the initial stage. Radiographic diagnosis alone can lead to misdiagnosis. Pathological confirmation is essential. Surgical resection is a curative option for posterior fossa teratomas in adulthood.

• Journal of Chest Surgery
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• v.56 no.3
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• pp.186-193
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• 2023

Background: Complete surgical excision is the only curative treatment for primary cardiac tumors. For wide excision, interatrial septal reconstruction (ISR) is commonly performed. We hypothesized that ISR may increase the risk of postoperative atrial tachyarrhythmia (AT) after surgical resection of cardiac myxoma. Methods: After excluding patients with a history of cardiac surgery and concomitant procedures unrelated to tumor resection and those with AT or permanent pacemakers, we finally enrolled 272 adult patients who underwent benign cardiac tumor surgery from 1995 to 2021 at our institution. They were divided into the ISR (n=184) and non-ISR (n=88) groups. The primary outcome was postoperative new-onset AT. Results: The study cohort predominantly consisted of women (66.2%), with a mean age of 57.2±13.6 years. The incidence of postoperative new-onset AT was 15.4%. No 30-day mortality or recurrence was observed. The cardiopulmonary bypass time and aortic cross-clamping time were significantly longer in the ISR group than in the non-ISR group (p<0.001). The median duration of hospital stay of all patients was 6.0 days (interquartile range, 5.0-7.0 days), and no significant difference was observed between the 2 groups (p=0.329). ISR was not an independent predictor of new-onset AT (p=0.248). Male sex and hypertension were found to be independent predictors of new-onset AT. Conclusion: ISR was not a significant predictor of postoperative new-onset AT. ISR might be a feasible and safe procedure for surgical resection of cardiac myxoma and should be considered if needed.

• Journal of Gastric Cancer
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• v.1 no.2
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• pp.106-112
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• 2001

Purpose: Even with excellent surgical outcome, recurrence of early gastric cancer (EGC) after a curative resection is not declining because the incidence of EGC is increasing. The aim of this study was to propose an appropriate treatment strategy by assessing the risk factors for recurrence of curatively resected early gastric cancer. Materials and Methods: Of 3662 patients who had undergone gastric resections for gastric cancer from 1987 to 1996, the cases of 1050 curatively resected EGC patients were reviewed retrospectively. Among those 1050 patients, 50 patients ($4.8\%$) were diagnosed as having recurrent cancer, which was confirmed by clinico-radiological examination or re-operation. The risk factors that determined the recurrence patterns were investigated by using univariate and multivariate analyses. Results: The mean time to recurrence was 30.9 months, and hematogenous recurrence was the most frequent type ($32.0\%$). Among the 50 recurred patients, peritoneal recurrence showed the shortest mean time to recurrence ($18.5\pm17.7$months). Between the recurred and the non-recurred patients, there was no statistically significant difference with respect to age, sex, operation type, tumor size, tumor location, gross appearance, or histological differentiation. However, depth of invasion (submucosal invasion) and nodal involvement were significantly different (P<0.001) between the two groups. Using logistic regression analyses, nodal involvement was the only significant risk factor for recurrence in early gastric cancer (P<0.001). The median survival after the recurrence had been diagnosed was 4 months. Conclusion: Although the prognosis for EGC patients is excellent and recurrence of EGC after a curative resection is rare, the time to recurrence and the patterns of recurrence in EGC patients were diverse and unpredictable, and the result after recurrence is dismal. Considering the impact of lymph node metastasis on recurrence of EGC, a systematic lymphadenectomy, rather than limited surgery, should be performed if lymph node involvement is confirmed pre- or intraoperatively. Also if the postoperative pathologic findings reveal lymph node involvement, adjuvant chemotherapy is recommended.

• Journal of Gastric Cancer
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• v.20 no.3
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• pp.328-336
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• 2020

Purpose: The standard treatment for stage IB gastric cancer is curative surgery alone, but some patients show poor survival with disease recurrence after curative surgery. The aim of this study was to identify prognostic factors of recurrence and long-term survival in patients with stage IB gastric cancer after surgery. Materials and Methods: We retrospectively reviewed data from 253 patients with stage IB gastric cancer who underwent gastrectomy between 2011 and 2016 at Kyungpook National University Chilgok Hospital and analyzed the clinicopathological characteristics associated with recurrence and survival. Results: Fourteen patients experienced recurrence with a mean follow-up of 54.1 months. Two of these patients had locoregional recurrence and 12 patients had systemic recurrence. The median interval between the operation day and the day of recurrence was 11 months (range 4-56 months). Multivariate analysis revealed that lymphatic vessel invasion (LVI) (hazard ratio [HR], 3.851; 95% confidence interval [CI], 1.264-11.732) and the elderly (age≥65) (HR, 3.850; 95% CI, 1.157-12.809) were independent risk factors for recurrence after surgery. The LVI (HR, 3.630; 95% CI, 1.105-11.923) was the independent prognostic factors for disease-specific survival (DSS). The 5-year DSS rates were 96.8% in patients who did not have LVI, and 89.3% in patients who had LVI. Conclusions: This study shows that LVI was associated with recurrence and poor survival in patients with stage IB gastric cancer after curative gastrectomy. Patients diagnosed with LVI require careful attention for systemic recurrence during the follow-up period.

• Radiation Oncology Journal
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• v.25 no.1
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• pp.34-42
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• 2007

[ $\underline{Purpose}$ ]: We performed a retrospective non-randomized clinical study of locally advanced rectal cancer, to evaluate the anal sphincter preservation rates, down staging rates and survival rates of preoperative chemoradiotherapy. $\underline{Materials\;and\;Methods}$: From January 2002 to December 2005, patients with pathologically confirmed rectal cancer with clinical stage T2 or higher, or patients with lymph node metastasis were enrolled in this study. A preoperative staging work-up was conducted in 36 patients. All patients were treated with preoperative chemoradiotherapy, and curative resection was performed for 26 patients at Hallym University Sacred Heart Hospital. Radiotherapy treatment planning was conducted with the use of planning CT for all patients. A total dose of $45.0{\sim}52.2\;Gy$ conventionally fractionated three-dimensional radiotherapy was delivered to the whole pelvis. Chemotherapy was given at the first and fifth week of radiation therapy with continuous infusion i.v. 5-FU (Fluorouracil) and LV (Leucovorine). Surgical resection was performed 2 to 4 weeks after the completion of the chemoradiotherapy regimen. $\underline{Results}$: The complete resection rate with negative resection margin was 100% (26/26). However, a pathologically complete response was not seen after curative resection. Surgery was done by LAR (low anterior resection) in 23 patients and APR (abdomino-perineal resection) in 3 patients. The sphincter preservation rate was 88.5% (23/26), down staging of the tumor occurred in 12 patients (46.2%) and down-sizing of the tumor occurred in 19 patients (73%). Local recurrence after surgical resection developed in 1 patient, and distant metastasis developed in 3 patients. The local recurrence free survival rate, distant metastasis free survival rate, and progression free survival rate were 96.7%, 87% and 83.1%, respectively. Treatment related toxicity was minimal except for one grade 3, one grade 4 anemia, one grade 3 leukopenia, and one grade 3 ileus. $\underline{Conclusion}$: Preoperative concurrent chmoradiotherapy for locally advanced rectal cancer seems to have some potential benefits: high sphincter preservation and down staging. Treatment related toxicity was minimal and a high compliance with treatment was seen in this study. Further long-term follow-up with a larger group of patients is required.

• Radiation Oncology Journal
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• v.32 no.3
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• pp.147-155
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• 2014

Purpose: This study was conducted to observe the outcomes of postoperative radiotherapy (PORT) with or without concurrent chemotherapy in resected non-small cell lung cancer (NSCLC) in single institution. Materials and Methods: From 2002 to 2013, 78 patients diagnosed with NSCLC after curative resection were treated with radiotherapy alone (RT, n = 48) or concurrent chemoradiation (CCRT, n = 30). The indications of adjuvant radiation therapy were N2 node positive (n = 31), close or involved resection margin (n = 28), or gross residual disease due to incomplete resection (n = 19). The median radiation dose was 57.6 Gy (range, 29.9 to 66 Gy). Results: Median survival time was 33.7 months (range, 4.4 to 140.3 months). The 5-year overall survival (OS) rate was 49.5% (RT 46% vs. CCRT 55.2%; p = 0.731). The 3-year disease-free survival rate was 45.5% (RT 39.4% vs. CCRT 55.3%; p = 0.130). The 3-year local control rate was 68.1% (RT 64.4% vs. CCRT 77.7%; p = 0.165). The 3-year DMFS rate was 56.1% (RT 52.6% vs. CCRT 61.7%; p = 0.314). In multivariate analysis, age ${\geq}66$ years and pathologic stage III were significant poor prognostic factors for OS. Treatment failure occurred in 40 patients. Four patients had radiologically confirmed grade 3 radiation pneumonitis. Conclusion: In NSCLC, adjuvant RT or CCRT after curative surgery is a safe and feasible modality of treatment. OS gain was seen in patients less than 66 years. Postoperative CCRT showed a propensity of achieving better local control and improved disease-free survival compared to RT alone according to our data.