Lymphovascular space invasion is highly associated with lymph node metastasis and recurrence in endometrial cancer

( Ho Suap Hahn ),( In Ho Lee ),( Tae Jin Kim ),( Ki Heon Lee ),( Jae Uk Shim ),( Jae Wook Kim ),( Kyung Taek Lim ) 대한산부인과학회 2012 대한산부인과학회 학술대회 Vol.98 No.-

The purpose of this study was to evaluate whether lymphovascular space invasion (LVSI) is a prognostic factor for lymph node metastasis and relapse of disease in endometrial cancer. We retrospectively analyzed the medical records of 438 patients with endometrial adenocarcinoma treated by surgical staging, including pelvic and paraaortic lymph node dissection, between January 1996 and July 2011. One hundred sixty three patients (37.2%) were LVSI-positive and 275 (62.8%) were negative. LVSI-positive patients were statistically significantly older and showed more advanced stage, poorer differentiation, and a higher frequency of non-endometrioid histology type, myometrial invasion, and positive peritoneal cytology than LVSI-negative patients. Surgeries by laparotomy rather than laparoscopy and more adjuvant therapies were conducted in LVSI-positive patients. The median numbers of pelvic and paraaortic lymph nodes removed were not different, but LVSI-positive patients showed more lymph node metastases. The LVSI-positive group also showed a higher recurrence of disease and lower survival rates than the LVSI-negative group. Negative predictive values of LVSI for lymph node metastasis and recurrence of disease were 96.4 and 97.1%, respectively. In multivariate analysis, LVSI did not influence overall or disease-free survival after adjusting for several confounding factors. The presence of LVSI is highly associated with lymph node metastasis and relapse of disease in endometrial cancer, but dose not influence survival as an independent factor. Therefore, LVSI may be a valuable prognostic factor when used in conjunction with other risk factors.

골반 및 대동맥 주위 림프절 절제술을 포함한 자궁내막암 병기설정 수술에서 수술적 접근 방법 비교

한호섭 ( Ho Suap Hahn ),윤석근 ( Seok Geun Yoon ),김우철 ( Woo Chul Kim ),최홍준 ( Hong Jun Choi ),이인호 ( In Ho Lee ),권용순 ( Yong Soon Kwon ),김태진 ( Tae Jin Kim ),임경택 ( Kyung Taek Lim ),이기헌 ( Ki Heon Lee ),심재욱 ( Jae 대한산부인과학회 2009 Obstetrics & Gynecology Science Vol.52 No.9

목적: 자궁내막암의 병기설정 수술 시 복강경식 병기설정술 (이하 복강경식)과 복식 병기설정술 (이하 복식)을 비교하였다. 연구 방법: 1996년 1월부터 2007년 12월까지 골반 및 대동맥 주위 림프절 절제술을 포함한 자궁내막암의 병기설정 수술을 시행한 272명 (복강경식: 90명, 복식: 182명)을 대상으로 양군 간의 수술 및 임상 결과를 비교해보았다. 결과: 양군 간에 평균나이, 체질량 지수, 암의 조직학적 유형에 차이가 없었으나 암의 분화도와 수술적 병기는 복식이 더 높았다. 절제된 골반 림프절과 대동맥 주위 림프절수는 복강경식에서 각각 33.1±13.2, 16.1±11.6, 복식에서 각각 32.5±14.5, 19.0±12.7으로 유의한 차이는 없었다. 복강경식이 복식에 비하여 수술시간과 수술 후 입원기간이 짧았으며, 수술 전후 혈색소 변화도 더 적었다. 수술 후 합병증의 유의한 차이는 없었으나 양성 림프절 전이나 수술 후 항암 보조요법 시행은 복식이 더 많았다. 교란요인 교정 후 수술 방법은 생존율에 영향을 미치지 않았다. 결론: 골반 및 대동맥 주위 림프절 절제술을 포함한 자궁내막암의 병기설정 수술 시, 절제된 림프절수는 비슷하나 복강경식이 복식에 비하여 수술시간, 입원기간, 출혈량에서 우수하므로 우선적 수술 방법으로 고려해볼 수 있겠다. Objective: To compare laparoscopic surgery with laparotomy in comprehensive surgical staging of endometrial cancer. Methods: We retrospectively analyzed the medical records of 272 patients with endometrial adenocarcinoma treated by staging operation including pelvic and paraaortic lymphadenectomy between January, 1996 and December, 2007. Results: There was no significant difference between the two groups in terms of age, body mass index, or histologic type, but in the laparotomy group, grade and surgical stage were significantly higher. All the patients, 182 in the laparotomy and 90 in the laparoscopy group, had lymphadenectomy, and the mean number of pelvic and paraaortic lymph nodes (LNs) obtained were 33.1±13.2 and 16.1±11.6 in the laparoscopy group, and 32.5±14.5 and 19.0±12.7 in the laparotomy group, respectively; these differences were not statistically significant. In the laparoscopy group, the operating time and postoperative hospital length of stay were shorter than in the laparotomy group, as were the pre- and post-operative hemoglobin changes. There were no significant differences between the two groups in terms of intra- or post-operative complications, but positive lymph nodal metastasis and conducting of postoperative adjuvant therapy were highter in the laparotomy group. The operative technique did not influence overall or disease-free survival after adjusting for several confounding factors. Conclusion: Laparoscopic-assisted surgical staging for endometrial cancer required a shorter operating time, shorter postoperative hospital stay, and lower blood loss compared to traditional laparotomy staging, and can be a good therapeutic option for staging operation including lymphadenectomy of endometrial cancer.

The adequacy of conization in the management of adenocarcinoma in situ of the uterine cervix(초)

한호섭 ( Ho Suap Hahn ),( Mi La Kim ),( Seok Geun Yoon ),( Woo Chul Kim ),( Hong Jun Choi ),( Sung Ran Hong ),( Hy Sook Kim ),( Yong Soon Kwon ),( In Ho Lee ),( Kyung Taek Lim ),( Ki Heon Lee ),( Jae Uk 대한산부인과학회 2009 대한산부인과학회 학술대회 Vol.95 No.-

양성 자궁병변에 대한 세 가지 다른 자궁적출술 접근 방법

한호섭 ( Ho Suap Hahn ),최규홍 ( Kyu Hong Choi ),김주명 ( Joo Myung Kim ),이현주 ( Hyun Joo Lee ),최노미 ( No Mi Choi ),유원식 ( Won Sik Yoo ),김경연 ( Kyung Yeon Kim ),김남숙 ( Nam Sook Kim ),조수희 ( Soo Hee Jo ),홍준식 ( Jun Sh 대한산부인과학회 2007 Obstetrics & Gynecology Science Vol.50 No.5

목적: 자궁의 양성병변으로 자궁적출술시에 세 가지 다른 수술방법인 복식 자궁적출술, 복강경식 자궁적출술, 질식 자궁적출술의 시행비율과 임상적 결과를 비교하고자 하였다. 연구 방법: 2004년 3월부터 2006년 4월까지 세 가지 수술에 익숙한 한명의 집도의에 의하여 시행된 236예의 자궁적출술을 대상으로 하였다. 일차적인 결과로 각 수술의 시행비율을 알아보았고 이차적인 결과로서 수술전후의 결과를 알아보았다. 결과: 세 연구군 간에 평균나이, 체중, 신장, 체질량 지수, 분만력에 차이는 없었다. 연구대상에 합당한 222건의 자궁적출술은 복식이 13.5%, 복강경식 34.2%, 질식이 52.3%의 비율로 시행되었다. 복식, 복강경식, 질식 자궁적출술의 수술전후의 결과는 다음과 같다 : 수술시간 (83.2±27.1 min, 94.2±25.2 min, 50.8±15.5 min), 수술전후 혈색소 변화 (2.3±1.5 g/dL, 2.0±0.9 g/dL, 1.3±1.1 g/dL), 방광 도뇨관 유치일 (2.0±0.2 days, 1.0±0.0 days, 1.0±0.4 days), 수술 후 입원기간 (5.7±1.2 days, 4.7±0.9 days, 4.3±1.0 days), 자궁 무게 (733±665 g, 340±213 g, 300±156 g). 자궁의 무게는 복식이 복강경식이나 질식에 비하여 의미 있게 무거웠다 (p<0.05). 복강경식은 복식에 비하여 수술 후 입원기간과 도뇨관 유치기간에서 유리하였다 (p<0.05). 질식은 복식에 비하여 수술시간, 낮은 혈색소변화, 도뇨관 유치기간, 수술 후 입원기간에서 유리하였다 (p<0.05). 복식, 복강경식, 질식 자궁적출술의 합병증에서는 유의한 차이를 보이지 않았다 (13.3%, 10.5%, 9.5%, p=0.825). 결론: 질식이나 복강경식 자궁적출술은 86.5%에서 가능하였다. 질식과 복강경식 수술 방법을 적절히 사용하면 합병증의 증가 없이 복식 자궁적출술을 줄일 수 있다. Objective: To evaluate the rates and clinical outcomes between abdominal hysterectomy (AH), laparoscopic hysterectomy (LH) and vaginal hysterectomy (VH). Methods: Medical records of 236 patients who underwent hysterectomy (by one surgeon) for benign uterine pathology between march 2004 and april 2006 were reviewed. Primary outcome measure was the rate of each method of hysterectomy. Secondary outcome measures included perioperative and postoperative outcomes between groups. Results: The mean age, weight, height, body mass index, and parity in three groups showed no difference. In two hundred and twenty two cases of hysterectomies, the rate of AH was 13.5%, LH 34.2%, and VH 52.3%. Perioperative outcomes of AH, LH and VH were as follows : operative time (83.2±27.1 min, 94.2±25.2 min, and 50.8±15.5 min, respectively), change in hemoglobin (2.3±1.5 g/dL, 2.0±0.9 g/dL, and 1.3±1.1 g/dL, respectively), duration of urinary catheterization (2.0±0.2 days, 1.0±0.0 days, and 1.0±0.4 days, respectively), postoperative hospitalization (5.7±1.2 days, 4.7±0.9 days, and 4.3±1.0 days, respectively), uterine weight (733±665 g, 340±213 g, and 300±156 g, respectively). Uterine weight in the AH group was significantly heavier than in the LH and VH. The benefits of LH versus AH were shorter duration of urinary catheterization and postoperative hospitalization (p<0.05). The benefits of VH versus AH were shorter operative time, a smaller drop in hemoglobin, shorter duration of urinary catheterization and postoperative hospitalization (p<0.05). The benefits of VH versus LH were shorter operative time, a smaller drop in hemoglobin, and postoperative hospitalization (p<0.05). There were no differences in complications of AH, LH and VH (13.3%, 10.5%, and 9.5%, respectively p=0.825). Conclusions: Eighty six point five percent of hysterectomy can be done vaginal or laparoscopic approach. When there is a concerted effort to increase laparoscopic or vaginal hysterectomy, abdominal hysterectomy can decrease without increasing complication rate.

자궁내막 생검에서 비정형 자궁내막증식증 진단 시 향후 임상적 접근 방법

한호섭 ( Ho Suap Hahn ),윤석근 ( Seok Geun Yoon ),김우철 ( Woo Chul Kim ),최홍준 ( Hong Jun Choi ),이인호 ( In Ho Lee ),권용순 ( Yong Soon Kwon ),김태진 ( Tae Jin Kim ),임경택 ( Kyung Taek Lim ),이기헌 ( Ki Heon Lee ),심재욱 ( Jae 대한산부인과학회 2009 Obstetrics & Gynecology Science Vol.52 No.12

목적: 자궁내막 생검 시 비정형 자궁내막증식증 진단받은 환자군에서 향후 적절한 임상적 접근 방법을 모색하였다. 연구 방법: 2000년 1월부터 2007년 12월까지 자궁내막 생검에서 비정형 자궁내막증식증 진단받고 자궁적출술을 시행받은 108명의 환자들을 대상으로 병리조직학적 소견을 재검토하여 임상병리적 고찰을 시행하였다. 결과: 비정형 자궁내막증식증은 87건에서 자궁내막 소파술로, 17건에서는 Z-sampler를 이용한 자궁내막 생검으로 진단되었고, 나머지 4건에서는 자궁내시경을 이용한 용종제거술 시행 후 진단되었다. 이들 환자에서 자궁적출술 시행 결과, 33.3%에서 단순성 또는 복잡성 자궁내막증식증을 보였고, 52.8%에서 비정형 단순성 또는 비정형 복잡성 자궁내막증식증을 보였다. 3.7%에서는 정상 내막 소견을 보였으나, 나머지 10.2% (11/108)에서는 자궁내막암이 비정형 복잡성 자궁내막증식증과 동반되어 있었다. 자궁내막암이 동반된 11건 모두에서 암조직은 자궁내막에 국한되어 있었고 자궁근층 침범은 없었다. 결론: 자궁내막 조직생검에서 비정형 자궁내막증식증 진단 시 자궁내막암과 동반되어 있을 위험도가 증가한다는 것을 간과해서는 안 되며, 환자의 임상적 접근 방법에 있어서도 자궁내막암의 가능성과, 수술 전 자궁내막 조직생검과 자궁적출술 후 조직학적 소견의 차이가 크다는 것을 염두에 두어야 한다. Objective: To evaluate the proper approach in women diagnosed with atypical endometrial hyperplasia (AEH) by endometrial biopsy. Methods: We retrospectively analyzed the medical records of 108 patients who underwent hysterectomies for AEH diagnosed by endometrial biopsy from 2000 to 2007. The results of the endometrial biopsies were graded on an ordinal scale and were compared with pathologic features obtained at the hysterectomy. Results: AEH was initially diagnosed by dilatation and curettage (87 cases) or endometrial biopsy with a Z-sampler (17 cases). The remaining four cases were diagnosed by hysteroscopic polypectomy. In patients preoperatively diagnosed with AEH by biopsy, hysterectomy specimens revealed a rate of simple or complex endometrial hyperplasia without atypia of 33.3% with AEH and normal endometrium found in 52.8 and 3.7% of specimens, respectively. The incidence of endometrial carcinoma was considerably high (11/108, 10.2%). All cases were confined to the endometrium and two of those were located at the adenomyosis without myometrial invasion. All patients with endometrial carcinoma displayed coexisting atypical complex hyperplasia following hysterectomy. Conclusion: Biopsy specimens showing AEH, particularly atypical complex hyperplasia, are associated with an increased risk of coexisting endometrial carcinoma. When considering management strategies for women with a biopsy diagnosis of AEH, clinicians should take into account the considerable rate of concurrent endometrial cancer and the discrepancy with pathologic diagnosis.

Laparoscopic assisted vaginal hysterectomy vs. abdominal hysterectomy in endometrial cancer

한호섭 ( Ho Suap Hahn ),Seok Geun Yoon,Jae Shik Hong,Yong Soon Kwon,In Ho Lee,Kyung Taek Lim,Ki Heon Lee,Jae Uk Shim,Jung Eun Mok,Tae Jin Kim 대한산부인과학회 2008 대한산부인과학회 학술대회 Vol.94 No.-

난소의 과립막세포종양의 임상병리학적 연구

이인호 ( In Ho Lee ),권용순 ( Yong Soon Kwon ),한호섭 ( Ho Suap Hahn ),윤석근 ( Seok Geun Yoon ),홍재식 ( Jae Shik Hong ),김태진 ( Tae Jin Kim ),이기헌 ( Ki Heon Lee ),심재욱 ( Jae Uk Shim ),목정은 ( Jung Eun Mok ),임경택 ( Kyung 대한산부인과학회 2009 Obstetrics & Gynecology Science Vol.52 No.4

목적: 난소에 발생하는 과립막세포종양의 임상병리학적 특징을 알아보고자 하였다. 연구 방법: 1995년 1월부터 2003년 12월까지 본원에서 난소의 과립막세포종양으로 치료받은 27명의 환자를 대상으로 의무기록을 토대로 후향적으로 분석하였다. 결과: 환자의 나이는 평균 48.3세 (24~70)였으며, 평균 추적관찰 기간은 56.7개월이었다 (12~102). 가장 흔한 증상은 질출혈이었고, 평균 종양의 크기는 9.9 cm이었다 (3~21). 수술 후 병기는 Objective: The aim of this study was to evaluate the clinicopathologic characteristics of granulosa cell tumor of the ovary (OGCT). Methods: We retrospectively reviewed the medical records of 27 patients with OGCT at our hospitals from January 1995 to Dece

The efficacy of cone biopsy on patients with carcinoma In Situ and microinvasive squamous cell carcinoma of uterine cervix

홍재식 ( Jae Shik Hong ),Ho Suap Hahn,Seok Geun Yoon,Yong Soon Kwon,In Ho Lee,Tae Jin Kim,Ki Heon Lee,Jae Uk Shim,Jung Eun Mok,Kyung Taek Lim 대한산부인과학회 2008 대한산부인과학회 학술대회 Vol.94 No.-

Laparoscopic assisted surgical staging in the management of endometrial cancer

윤석근 (Seok Geun Yoon ),Ho Suap Hahn,Jae Shik Hong,Yong Soon Kwon,In Ho Lee,Tae Jin Kim,Ki Heon Lee,Jae Uk Shim 대한산부인과학회 2008 대한산부인과학회 학술대회 Vol.94 No.-

Fertility preservation in patients with early epithelial ovarian cancer

Yong-Soon Kwon,Ho-Suap Hahn,김태진,이기헌,임경택,이인호,심재욱,Jung-Eun Mok 대한부인종양학회 2009 Journal of Gynecologic Oncology Vol.20 No.1

Objective: To assess the role of fertility preservation in the treatment of patients with early epithelial ovarian cancer (EOC). Methods: We retrospectively analyzed the medical records of 21 patients with early EOC from January 1995 to December 2006. All eligible patients with a strong desire to preserve fertility were younger than 35 years and underwent fertility-sparing surgery with or without adjuvant chemotherapy. Results: Twenty-one eligible patients with a median age of 26.7 years (range, 20 to 33 years) were identified, and the mean follow-up period was 43 months (range, 5 to 86 months). Only one patient with stage IC recurred 34 months after the first operation. A total of five patients were able to become pregnant at least once after the first fertility preserving treatment, with or without adjuvant chemotherapy. All five patients succeeded in full-term vaginal delivery with healthy infants. No patients died of their disease. Conclusion: Fertility preserving treatment in patients with early EOC can be considered as a proper treatment strategy in patients with early EOC, who have the strong desire for fertility preservation.