• Journal of Gastric Cancer
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• 제1권1호
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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.

• Journal of Gastric Cancer
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• 제2권3호
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• pp.157-162
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• 2002

Purpose: The prognosis of stage IV gastric cancer is very grave. However, some of these patients survive long periods after surgery. This study was undertaken to investigate various clinico-pathological profiles related to the prognosis for these long-term survivors. Materials and Methods: One hundred fifty-five patients with stage IV gastric cancer who underwent a gastric resection from 1992 to 1997 at Hanyang University Hospital were evaluated. Thirty-three patients who survived more than 5 years after surgery were designated as long-term survivors (LTS); on the other hand, one hundred twenty-two patients who died within 5 years after surgery were named as short-term survivors (STS). Results: The rate of the patients with T4, preoperative serum level of CA19-9 greater than 37 U/g protein, and peritoneal dissemination was lower for the LTS than in for the STS (P=0.002, P=0.045, and P=0.0000, respectively). Tumors were smaller (7.3 cm vs. 8.9 cm, P=0.030) and metastatic lymph node were fewer (19.7 vs. 28.8, P=0.019) for the LTS than for the STS. Curative surgery ($\76\%\;vs.\;\46\%$, P=0.002) and a subtotal gastrectomy ($\76\%\;vs.\;46\%$, P=0.026) were performed more frequently for the LTS than for the STS. From a univariate survival analysis, depth of invasion, distant metastasis, extent of gastric resection, postoperative chemotherapy, and curability were statistically significant factors. From a multivariate survival analysis, curability, depth of invasion, and extent of gastric resection were independent prognostic factors. Conclusions: If feasible, we have to exert our efforts to achieve curative surgery although the tumor is considered to be a stage IV gastric cancer. Thereafter, multi-modality treatments including chemotherapy can be considered to improve the prognosis.

• Journal of Chest Surgery
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• 제55권3호
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• pp.214-224
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• 2022

Background: Studies of the prognostic role of circulating tumor cells (CTCs) in early-stage non-small cell lung cancer (NSCLC) are still limited. This study investigated the prognostic power of CTCs from the pulmonary vein (PV), peripheral blood (PB), and bone marrow (BM) for postoperative recurrence in patients who underwent curative resection for NSCLC. Methods: Forty patients who underwent curative resection for NSCLC were enrolled. Before resection, 10-mL samples were obtained of PB from the radial artery, blood from the PV of the lobe containing the tumor, and BM aspirates from the rib. A microfabricated filter was used for CTC enrichment, and immunofluorescence staining was used to identify CTCs. Results: The pathologic stage was stage I in 8 patients (20%), II in 15 (38%), III in 14 (35%), and IV in 3 (8%). The median number of PB-, PV-, and BM-CTCs was 4, 4, and 5, respectively. A time-dependent receiver operating characteristic curve analysis showed that PB-CTCs had excellent predictive value for recurrence-free survival (RFS), with the highest area under the curve at each time point (first, second, and third quartiles of RFS). In a multivariate Cox proportional hazard regression model, PB-CTCs were an independent risk factor for recurrence (hazard ratio, 10.580; 95% confidence interval, 1.637-68.388; p<0.013). Conclusion: The presence of ≥4 PB-CTCs was an independent poor prognostic factor for RFS, and PV-CTCs and PB-CTCs had a positive linear correlation in patients with recurrence.

• Clinical Endoscopy
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• 제56권6호
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• pp.778-789
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• 2023

Background/Aims: Hybrid endoscopic submucosal dissection (ESD), in which an incision is made around a lesion and snaring is performed after submucosal dissection, has some advantages in colorectal surgery, including shorter procedure time and preventing perforation. However, its value for rescue resection in difficult colorectal ESD cases remains unclear. This study evaluated the utility of rescue hybrid ESD (RH-ESD). Methods: We divided 364 colorectal ESD procedures into the conventional ESD group (C-ESD, n=260), scheduled hybrid ESD group (SH-ESD, n=69), and RH-ESD group (n=35) and compared their clinical outcomes. Results: Resection time was significantly shorter in the following order: RH-ESD (149 [90-197] minutes) >C-ESD (90 [60-140] minutes) >SH-ESD (52 [29-80] minutes). The en bloc resection rate increased significantly in the following order: RH-ESD (48.6%), SH-ESD (78.3%), and C-ESD (97.7%). An analysis of factors related to piecemeal resection of RH-ESD revealed that the submucosal dissection rate was significantly lower in the piecemeal resection group (25% [20%-30%]) than in the en bloc resection group (40% [20%-60%]). Conclusions: RH-ESD was ineffective in terms of curative resection because of the low en bloc resection rate, but was useful for avoiding surgery.

• Radiation Oncology Journal
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• 제32권1호
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• pp.7-13
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• 2014

Purpose: To evaluate the results of postoperative radiotherapy in patients with extra-hepatic bile duct cancer (EHBDC) and identify the prognostic factors for local control and survival. Materials and Methods: Between January 2001 and December 2010, we retrospectively reviewed the cases of 70 patients with EHBDC who had undergone curative resection and received postoperative radiotherapy. The median radiation dose was 50.4 Gy (range, 41.4 to 54 Gy). The resection margin status was R0 in 30 patients (42.9%), R1 in 25 patients (35.7%), and R2 in 15 patients (21.4%). Results: The 5-year rates of overall survival (OS), event-free survival (EFS), and locoregional control (LRC) for all patients were 42.9%, 38.3%, and 61.2%, respectively. The major pattern of failure was distant relapses (33 patients, 47.1%). A multivariate analysis showed that the postradiotherapy CA19-9 level, radiation dose (${\geq}50$ Gy), R2 resection margins, perineural invasion, and T stage were the significant prognostic factors for OS, EFS, and LRC. OS was not significantly different between the patients receiving R0 and R1 resections, but was significantly lower among those receiving R2 resection (54.6%, 56.1%, and 7.1% for R0, R1, and R2 resections, respectively). Conclusion: In patients with EHBDC who had undergone curative resection, a postoperative radiotherapy dose less than 50 Gy was suboptimal for OS and LRC. Higher radiation doses may be needed to obtain better LRC. Further investigation of novel therapy or palliative treatment should be considered for patients receiving R2 resection.

• Journal of Gastric Cancer
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• 제11권1호
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• pp.46-54
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• 2011

Purpose: There are few studies that have focused on the predictors of recurrence after gastrectomy for gastric carcinoma. This study analyzed the patients who died of recurrent gastric carcinoma and we attempted to clarify the clinicopathologic factors that are associated with the timing of recurrence. Materials and Methods: From June 1992 to March 2009, 1,795 patients underwent curative gastric resection at the Department of Surgery, Hanyang University College of Medicine. Among them, 428 patients died and 311 of these patients who died of recurrent gastric carcinoma were enrolled in this study. The clinicopathologic findings were compared between the 72 patients who died within one year after curative gastrectomy (the early recurrence group) and the 92 patients who died 3 years after curative gastrectomy (the late recurrence group). Results: Compared with the late recurrence group, the early recurrence group showed an older age, a more advanced stage, a poorly differentiated type of cancer and a significantly higher tendency to have lymphatic invasion, vascular invasion and perineural invasion.Especially in the gastric cancer patients with a more advanced stage (stage III and IV), the early recurrence group was characterized by a significantly higher preoperative serum carcino embryonic antigen level, perineural invasion and a relatively small number of dissected lymph nodes. Conclusions: The clinicopathologic characteristics of recurrent gastric cancer are significantly different according to the stage of disease, and even in the same stage. For the early detection of recurrence after curative surgery, it is important to recognize the clinicopathological factors that foretell a high risk of recurrence. It is mandatory to make an individualized surveillance schedule according to the clinicopathologic factors.

• Journal of Gastric Cancer
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• 제11권3호
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• pp.162-166
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• 2011

Purpose: Endoscopic resection is widely accepted as standard treatment for early gastric cancer (EGC) without lymph node metastasis. The procedure is minimally invasive, safe, and convenient. However, surgery is sometimes needed after endoscopic mucosal resection (EMR)/endoscopic submucosal dissection (ESD) due to perforation, bleeding, or incomplete resection. We evaluated the role of surgery after incomplete resection. Materials and Methods: We retrospectively studied 29 patients with gastric cancer who underwent a gastrectomy after incomplete EMR/ESD from 2006 to 2010 at Korea University Hospital. Results: There were 13 incomplete resection cases, seven bleeding cases, three metachronous lesion cases, three recurrence cases, two perforation cases, and one lymphatic invasion case. Among the incomplete resection cases, a positive vertical margin was found in 10, a positive lateral margin in two, and a positive vertical and lateral margin in one case. Most cases (9/13) were diagnosed as mucosal tumors by endoscopic ultrasonography, but only three cases were confirmed as mucosal tumors on final pathology. The positive residual tumor rate was two of 13. The lymph node metastasis rate was three of 13. All lymph node metastasis cases were submucosal tumors with positive lymphatic invasion and no residual tumor in the gastrectomy specimen. No cases of recurrence were observed after curative resection. Conclusions: A gastrectomy is required for patients with incomplete resection following EMR/ESD due to the risk of residual tumor and lymph node metastasis.

• Journal of Digestive Cancer Research
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• 제4권2호
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• pp.92-98
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• 2016

The barcelona clinic liver cancer (BCLC) staging systemis regarded as the optimal staging system to predict prognosis and guide treatmentfor hepatocellular carcinoma (HCC) .According to the BCLC classification, only patients with BCLC A stage should undergo liver resection. In contrast, patients with intermediate-advanced HCC should be scheduled for palliative therapies,such as transcatheter arterial chemoembolization (TACE) and target therapy, even if the lesion is resectable. More and more studies report good short-term and long-term outcomes in patients with intermediate-advanced HCC treated by radical resection and many patients benefited from curative resection. The aim of this review was to evaluate the role of surgery beyond the BCLC recommendations. A revision of the BCLC algorithm should be proposed.

• Journal of Chest Surgery
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• 제28권12호
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• pp.1144-1149
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• 1995

Adenocarcinoma involving esophago-gastric junction[EGJ is usually originated from the gastric cardia and it presents unique clinical manifestations, requires special surgical care, and bears a much poor prognosis. We analyse the clinical data of 109 adenocarcinoma involving EGJ operated between August, 1987 and March, 1994. Curative resection of primary tumor including esophagus and lymph node dissection was possible on 102 cases[93.5% . Among these cases, 89 cases were advanced state over the stage III. The operative mortality was 1.8% and postoperative morbidity was 16.5%. The overall 3 year and 5 year survival rate was 48.5%, 34.1% each, and median survival was 27.5 month in the curative resected cases. The treatment failure was mainly distant metastsis including lymph node, except one local recurrence.Among many factors influencing long term results of resected adenocarcinoma involving EGJ, the only effort a surgeon can make is to attain completeness of tumor removal by dissecting all involved lymph node and ensuring adequate tumor free margins of both esophageal and cardiac side.

• Journal of Gastric Cancer
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• 제9권3호
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• pp.71-77
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• 2009

내시경 절제술은 림프절 전이의 위험도가 낮은 조기위암에 대한 근치적 국소 치료로 받아들여지고 있다. 최근 조기위암의 림프절 전이에 대한 연구결과들과 내시경 수기 및 부속기구의 발전에 기초하여 내시경 절제의 적용 범위는 확대되는 추세이다. 현재 조기위암의 내시경 절제의 확대 적응증으로는 궤양이 동반되지 않는 경우의 점막암이나, 궤양이 동반된 3 cm 이하의 점막암, 궤양이 없는 3 cm 이하의 미분화 점막암, 3 cm 이하의 궤양을 동반하지 않은 분화가 좋은 미세점막하암으로 림프혈관 침범이 없는 경우이다. 이 중 미분화암은 분화가 좋은 암과 비교하여 다른 생물학적 행태를 가진다는 관점에서 내시경 절제의 확대 적응증으로 포함하는 것에 있어 논란이 있는 상태이다. 따라서, 본 종설에서는 미분화 조기위암의 생물학적 행태와 내시경 절제술 결과에 기초하여 미분화 조기위암에서의 내시경 절제술 적용에 관하여 논해보고자 한다.