Outcomes of selective surgery in patients with suspected small bowel injury from blunt trauma

Hyoung-Chul Park,Jong Whan Kim,Min Jeong Kim,Bong Hwa Lee 대한외과학회 2018 Annals of Surgical Treatment and Research(ASRT) Vol.94 No.1

Purpose: The role of initial conservative therapy with selective surgery for patients with suspected blunt bowel injury by radiologic evaluation is less clear. The aim of the study is to assess the outcomes of patients who received initial conservative therapy with selective delayed surgery, compared to emergency surgery. Methods: During this 8-year study, a total of 77 patients who were hemodynamically stable were enrolled, in which computed tomography verified suspected bowel injury from blunt trauma (mesenteric hematoma, mesenteric fat infiltration, bowel wall thickening, and free fluid without solid organ injury) was managed with either initial conservative therapy with selective delayed surgery (group A; n = 42) or emergency surgery (group B; n = 35). The clinical outcomes including the rate of negative or nontherapeutic exploration and postoperative complications, between the groups were compared. Results: The enrolled patients had a mean age of 41 years including 51 men and 26 women. No difference in the clinical characteristics was found between the groups. In group A, 18 patients underwent delayed surgery and 24 recovered without surgery. Among patients who underwent surgery, 3 (17%) underwent negative or nontherapeutic explorations. In group B, 13 (37%) underwent negative or nontherapeutic explorations. Postoperative complications occurred in 21 patients and there was no difference between the groups. Conclusion: Initial conservative therapy with selective delayed surgery did not increased severe postoperative complications and had a low rate of negative or nontherapeutic surgical explorations in hemodynamically stable patients with suspected blunt bowel injury.

후두육아종의 치료

주준범,홍석중,강보현,김영진,유승주,김상윤,남순열 대한기관식도과학회 2001 大韓氣管食道科學會誌 Vol.7 No.1

Background and Objectives: Larynx granuloma is a exophytic inflammatory mass and may result from gastroesophageal reflux disease and a traumatic or prolonged endotracheal intubation. There has been a controversy in the treatment of larynx granuloma. Our aim of study is to know the results of the conservative management and surgery for larynx granuloma. Materials and Methods : We have reviewed and analyzed medical records of 71 Patients who were diagnosed and treated as larynx granuloma in Asan medical center from 1989 to 2000 retrospectively. And questionnaires on present patient's status were answered via telephone. Results : Forty four cases were treated by conservative management and 29 cases were treated by surgery. The total Percentages of improvement after treatment were 85.7 o/o after conservative management and 75.9% after surgery. In intubation granuloma percentages of improvement were 86.4% after conservative management and 73% after surgery. In contact granuloma percentages of improvement were 85% after conservative management and 78.5% after surgery. Conclusion : Resolution and treatment periods are longer in contact granuloma compared to intubation granuloma in the groups of conservative management. (P<0.05) There is no significant difference of their outcome between conservative management and surgery. (P>0.05) Although this study is retrospective, conservative management is the first treatment in the management of larynx granuloma.

요추 유합술 전후 고려해야 할 사항

박상민,서승표,백종민,권기연,장해동,임수택,최소침습 척추치료 연구그룹 대한척추외과학회 2023 대한척추외과학회지 Vol.30 No.3

Study Design: Review article. Objectives: The purpose of this study was to review the perioperative considerations for lumbar fusion surgery. Summary of Literature Review: With an aging population, degenerative lumbar spine diseases are on the rise. The number of patients who have comorbidities and undergo complex lumbar spine surgery is also increasing. There are many points to consider before and after lumbar fusion surgery. Materials and Methods: Review of the relevant articles. Results: In spine surgery, conservative treatment is often considered before surgical treatment because symptoms often improve with conservative treatment. If conservative treatment fails, surgical treatment is then considered. Once the decision to operate has been made, the patient's past medical history is taken, and medical conditions are assessed before surgery. The severity of osteoporosis is also assessed to determine the surgical approach. If severe osteoporosis is present, osteoporosis treatment may be considered first, and if it is very severe, various pedicle screw fixation techniques should be considered. Finally, a multidisciplinary approach to surgery is necessary to ensure rapid recovery. Enhanced recovery after surgery (ERAS) protocols have recently been applied to lumbar fusion surgery. Conclusions: Adequate and appropriate conservative treatment should be implemented before spine surgery. Medical risk factors (diabetes, smoking, osteoporosis, kidney disease, medications, etc.) should be identified and corrected preoperatively. In addition, early patient recovery with perioperative ERAS should be considered, as ERAS protocols may have a positive effect in older patients with a higher frequency of postoperative complications.

Oncologic safety of breast-conserving surgery in breast cancer patients under the age of 35

강인천,김주형,박세호,허호,박형석,김승일,조영업 대한종양외과학회 2017 Korean Journal of Clinical Oncology Vol.13 No.1

Purpose: Breast-conserving surgery (BCS) shows no difference in survival rates compared with total mastectomy. So, BCS is considered standard breast surgery with modified radical mastectomy. But in patients who received BCS, there is a risk of local recurrence in their long term follow up periods. Especially, BCS of young age is controversial regarding oncologic safety because of local recurrence. In this study, we struggle to confirm the oncologic safety of BCS compared with total mastectomy under the age of 35 in South Korea. Methods: All patients who underwent surgery for breast cancer were 5,366 at Severance Hospital, Yonsei University Health System, from January 1981 to April 2008. Of them, patients younger than 35 years old were 547. We excluded patients who received chemotherapy before surgery and included only stage 1 and 2 patients who identified through the pathology after surgery. Finally, we got 367 patients; total mastectomy was performed in 245 and BCS, in 122. We compared clinicopathological characteristics and oncologic outcomes between two groups using SPSS program. Results: In patients received BCS, a local recurrence rate was 7.7% at 5 years and up to 20.3% at 10 years. In patients received total mastectomy, a local recurrence rate was 1.9% over 10 years (P<0.001). However, there was no difference in 5-year and 10-year overall survival rates between two groups (P=0.689). Adjuvant chemotherapy decreased local recurrence rate in BCS patients (P=0.019). Conclusion: So, we concluded that BCS under the age of 35 has oncologic safety with undergoing chemotherapy.

Oncologic safety of breast-conserving surgery in breast cancer patients under the age of 35

Incheon Kang,Joo Heung Kim,Seho Park,Ho Hur,Hyung Seok Park,Seung Il Kim,Young Up Cho 대한종양외과학회 2017 Korean Journal of Clinical Oncology Vol.13 No.1

Purpose: Breast-conserving surgery (BCS) shows no difference in survival rates compared with total mastectomy. So, BCS is considered standard breast surgery with modified radical mastectomy. But in patients who received BCS, there is a risk of local recurrence in their long term follow up periods. Especially, BCS of young age is controversial regarding oncologic safety because of local recurrence. In this study, we struggle to confirm the oncologic safety of BCS compared with total mastectomy under the age of 35 in South Korea. Methods: All patients who underwent surgery for breast cancer were 5,366 at Severance Hospital, Yonsei University Health System, from January 1981 to April 2008. Of them, patients younger than 35 years old were 547. We excluded patients who received chemotherapy before surgery and included only stage 1 and 2 patients who identified through the pathology after surgery. Finally, we got 367 patients; total mastectomy was performed in 245 and BCS, in 122. We compared clinicopathological characteristics and oncologic outcomes between two groups using SPSS program. Results: In patients received BCS, a local recurrence rate was 7.7% at 5 years and up to 20.3% at 10 years. In patients received total mastectomy, a local recurrence rate was 1.9% over 10 years (P<0.001). However, there was no difference in 5-year and 10-year overall survival rates between two groups (P=0.689). Adjuvant chemotherapy decreased local recurrence rate in BCS patients (P=0.019). Conclusion: So, we concluded that BCS under the age of 35 has oncologic safety with undergoing chemotherapy.

유방암 환자에서 유방보존술 후 무세포 진피조직을 이용한 재건과 일차적 봉합 사이의 비교

양현규,홍성훈,이종은,한선욱,김성용 한국유방암학회 2022 Journal of Breast Disease Vol.10 No.1

Purpose: As breast-conserving surgery has become a standard treatment for patients with breast cancer, several approaches have been devised to achieve desirable cosmetic results, including a method using a patient’s own tissues or organs or a mesh to resolve defects. However, its application has been limited due to the associated complications. Accordingly, breast reconstruction using an acellular dermal matrix (ADM) has been introduced to improve patients’ cosmetic satisfaction. However, the comparison of reconstruction and primary sutures using this method has not been well-studied. Therefore, this study surveyed patients who underwent breast cancer surgery based on cosmetic indicators to study the efficacy of ADM after breast-conserving surgery. Methods: This retrospective study included 68 patients diagnosed with breast cancer who underwent breast-conserving surgery at a single institution by a single surgeon from April 2019 to December 2020. Results: This study included 68 patients who underwent breast-conserving surgery. Among them, 22 patients underwent breast-conserving surgery using ADM, while 46 patients received only primary sutures without ADM. Among the items of the Breast Cancer Treatment Outcome Scale-12 (BCTOS-12), patient satisfaction was significantly higher in the group using ADM, than that in the control group in terms of breast shape (1.86±0.89 vs. 2.39±0.80, p=0.017). Regarding breast tenderness, the result also confirmed the group treated using ADM experienced less tenderness than the control group not treated with ADM (1.68±0.78 vs. 2.22±1.03, p=0.035). The two groups exhibited no significant differences in breast texture, arm heaviness, nipple appearance, shoulder discomfort, arm discomfort, scar tissue, arm swelling, breast swelling, fit of the bra, and breast sensitivity. Conclusion: Breast reconstruction using ADM in patients with breast cancer was effective from a cosmetic perspective. Prospective multicenter studies should be conducted to provide clear guidelines.

Applicability of Oncoplastic Breast Conserving Surgery in Asian Breast Cancer Patients

Lim, Geok-Hoon,Pineda, Lea Angela Asian Pacific Journal of Cancer Prevention 2016 Asian Pacific journal of cancer prevention Vol.17 No.7

Background: There are limited studies on oncoplastic breast conserving surgery in Asian women. We aimed to determine the applicability and safety of oncoplastic surgery, highlighting the specific circumstances when it will be most useful and compare our preferred technique with the worldwide practice of oncoplastic approaches. Materials and Methods: Breast cancer patients who underwent oncoplastic breast conserving surgery at a single institution from 1st May 2014-31st March 2015 were included. Data on patient demographics, tumor characteristics and the type of oncoplastic surgery performed were collected. Results: Nineteen breast cancer patients were identified. 42.1% of patients had grade I ptosis. The indications for surgery included a large tumor to breast size ratio (52.6%), multifocal/multicentric lesions (36.8%) and asymmetric breasts (10.6%), averting a mastectomy in 89.4%. Round block was the commonest technique in 63% of patients, in contrast to the inverted T pattern most frequently used in renowned institutions in the West. Mean and median tumor size and weight of specimen were 29.4/25mm (11 - 75mm) and 77g/64g (10 - 246g) respectively. Re-excision rate was 10.5%. Complete mastectomy was performed for one patient. One patient developed wound dehiscence which was treated conservatively. Cosmetic outcome was rated as excellent/good by 94.7% of patients. The patients remained clinically well after a median 16 months follow up. Conclusions: Oncoplastic breast conserving surgery is useful in a specific subgroup of Asian patients with a relatively small breast volume and minimal ptosis. Round block was the commonest technique in our series, in contrast to the worldwide utility of oncoplastic techniques. It is oncologically safe and has good cosmetic outcomes.

Interoperative Radiotherapy of Seventy-two Cases of Early Breast Cancer Patients During Breast-conserving Surgery

Zhou, Shi-Fu,Shi, Wei-Feng,Meng, Dong,Sun, Chun-Lei,Jin, Jian-Rong,Zhao, Yu-Tian Asian Pacific Journal of Cancer Prevention 2012 Asian Pacific journal of cancer prevention Vol.13 No.4

Objective: To evaluate interoperative radiotherapy after breast conservative surgery in early breast cancer patients in terms of postoperative complications, cosmetic outcome and recurrence events. Methods: From June 2007 to Dec 2011, 143 early breast cancer patients received breast conservative surgery. Seventy-two (study group) received interoperative radiotherapy, compared with 71 patients (control group) given routine radiotherapy. Postoperative complications were evaluated 1 month after surgery; cosmetic outcome was evaluated 1 year postoperatively; recurrence and death events were followed up. Results: The average wound healing time was 13~22 d in the study group and 9~14 d in the control group. In the study group, 2 patients developed lyponecrosis, 16 patients showed wound edema while no such side effects were found in the control group. No infection or hematomas were found in either group. In the study group (59 cases), overall cosmetic outcome in 53 patients was graded as excellent or good, and in 6 as fair or poor. Meanwhile in the control group (56 cases), 42 patients were graded as excellent or good, and 14 as fair or poor (P=0.032). After a follow-up from 3 to 54 months (median: 32 months), two patients (2.78%) in study group developed local relapses, one of them (1.39%) died, 2 patients (2.78%) developed bone metastases. In control group, one patient (1.41%) developed local relapse, 2 patients (2.82%) developed bone metastases, and no one died. Conclusion: Intraoperative radiotherapy is safe and reliable with good cosmetic outcome.

Atypical Hyperplasia at the Margin of Frozen Sections from Breast-Conserving Surgery

Yongmin Na,유영재,HyoSoonLim,이지신,조진성,윤정한,박민호 한국유방암학회 2021 Journal of Breast Disease Vol.9 No.2

Purpose: Intraoperative frozen section analysis to assess margin status during breast-conserving surgery is often performed to reduce the rate of re-excision. Whether additional resection is required if atypical cells are found at the margin during breast-conserving surgery is controversial. The aim of this study was to evaluate the accuracy of intraoperative frozen section analysis and investigate the feasibility of additional resection in cases of atypical hyperplasia on frozen sections from breast-conserving surgery. Methods: A retrospective analysis was performed on 1,411 patients with invasive breast cancer who underwent breast-conserving surgery between July 2004 and June 2012. The microscopic margins of the intraoperative frozen sections and permanent sections were examined. Overall events (locoregional recurrence and distant metastasis) were analyzed between the negative margin group and the other margin group (including atypical hyperplasia, carcinoma in situ [CIS], and invasive carcinoma). Results: Of the 1,411 patients, 1,201 had negative margins and 210 had other margin types in the first frozen section. 68 patients had atypical hyperplasia on frozen section analysis. This atypical hyperplasia included atypical cells, atypical ductal hyperplasia, and atypical lobular hyperplasia. Of these 68 patients, the final findings on the permanent section were negative (n=32, 47.1%), atypical cells (n=16, 23.5%), and CIS (n=20, 29.4%). The rate of overall events and distant metastases were higher in the other margin group (9.5% vs. 5.4%, p=0.021) and (5.7% vs. 3.0%, p=0.045). Of the 1,411 patients, 44 (3.1%) had false-positive findings, and 15 (1.1%) had false-negative findings in the frozen sections, with an accuracy of 95.8%. Conclusion: The accuracy of intraoperative frozen section analysis was 95.8%, with 91.7% sensitivity and 96.4% specificity. Atypical hyperplasia on frozen section analysis requires additional resection at the time of breast-conserving surgery because of the possibility of CIS, but excessive resection may be performed in other cases. Therefore, sufficient consultation with patients is required.

Comparison of Psychological Influence on Breast Cancer Patients Between Breast-conserving Surgery and Modified Radical Mastectomy

Sun, Meng-Qing,Meng, Ai-Feng,Huang, Xin-En,Wang, Mei-Xiang Asian Pacific Journal of Cancer Prevention 2013 Asian Pacific journal of cancer prevention Vol.14 No.1

Objective: To compare the influence of breast-conserving surgery (BCS) and modified radical mastectomy (MRM) on the psychological state of breast cancer patients. Methods: Patients receiving MRM or BCS, and fulfilling the study criteria, were recruited. Patients were required to complete a self-reporting inventory (SCL-90) on admission and 6 months after surgery and a self-rating depression scale (SDS) when discharged from hospital and 6 months after surgery. Results: A total of 70 patients received MRM and 50 BCS. Compared with the national standard, patients suffered to some extent psychological problems on admission, at discharge from hospital and at 6 months after surgery. Patients received BCS had a higher score of SDS compared with those with MRM when discharged from hospital. However, 6 months after surgery, SDS score increased in MRM and decreased in the BCS group, so the difference was significant. Conclusion: The short-term psychological state of patients receiving BCS is worse than that with MRM but superior to MRM 6 months postoperatively. BCS imposed less influence on long term psychological state of breast cancer patients compared with MRM.