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다발성 대장암 간전이 환자의 간절제를 위한 새로운 시도
주종우,김형철,임철완,신응진,조규석,유기원,송옥평,홍대식,박성진,조준희,이혜경,김희경,권계원,고은석 순천향의학연구소;Soonchunhyang Medical Research Institute 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2
Multiple bilobar liver matastases (MBLM) are the main cause of low resectability in the colon cancer liver metastases. The authors experienced one case of initially non-resectable colon cancer liver metastases. He was curatively and safely treated with a two-stage hepatectomy using the new method of future remnant liver volume growing. A 54-year-old man was referred to our department with the sigmoid colon cancer combined with MBLM, which were checked in two small metastatic lesions in the left lobe and five large sized lesions in the right lobe in the computed tomogram (CT). A laparoscopic assisted anterior resection was primarily performed. We performed the 1^(st) stage hepatectomy 3 weeks after the colon resection. Intra-operative Ultrasonogram (US) found 9 small superficial metastatic lesions in the left lobe. All that lesions were completely removed by non-anatomical wedge resection. An occlusion ballon catheter was placed in the right portal vein through a small branch of the inferior mesenteric vein at that time. The future remnant liver volume was sufficiently increased 3 weeks after the 1^(st) hepatectomy. A right hepatectomy was safely performed 22 days after the 1^(st) hepatectomy. The patient received a regional chemotherapy (interleukin2 based immuno-chemotherapy through hepatic artery) for 4 months, then received 9 cycles of systemic chemotherapy (biweekly Oxaliplation, leucovorin, plus 5-fluorouracil) without any recurrence evidence.
상부 조기 위암 환자의 복강경하 상부 위절제술 3례 경험
조규석,김형철,박경규,이문수,송옥평,임철완,신웅진,주종우,유기원 순천향의학연구소;Soonchunhyang Medical Research Institute 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2
Background : The reported incidence of early gastric cancer located in the upper portion of the stomach has been increasing with the recent advances in its diagnosis and screening. Recently, we have successfully performed laparoscopic assisted proximal gastrectomy and gastric tube reconstruction without pyloroplasty on three patients with early gastric carcinoma localized to the upper third of the stomach. We describe our modification of this procedure in this report. Method : After creating an surgical pneumoperitoneum, the stomach was mobilized using laparoscopic coagulating shears. Upper half of the greater curvature and three-quarters of the lesser curvature were then dissected along with regoinal D2 lymphadenectomy. This was followed by a 5 cm, longitudinal mini-laparotomy in the upper abdomen, and the construction of the exteriorized stomach with a gastric tube measuring 20 cm long and 4 cm wide. Reconstruction with an esophagogastrostomy was performed using a circular stapler. Result : No post-operative morbidity or mortality was observed in this small series of patients. The average operative time was 250 minutes (range 220-300 minutes), and the average blood loss was 150 ml (range 90-180 ml). The mean number of lymph nodes harvested during these laparoscopic proximal gastrectomies was 24 nodes (range 22-25 lymph nodes). The average postoperative hospital stays was 7.5 days (range 7-8 days). Conclusion : Our technique of laparoscopic assisted proximal gastrectomy and gastric tube reconstruction without phloroplasty offers a minimally invasive technique with the potential of impoving the post-operative quality of life patients with an early-stage proximal gastric cancer.
Acceptable Guidelines of Liver Transplantation for Advanced Hepatocellular Carcinoma
( Chong Woo Chu ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1
Introduction: The Milan criteria are widely accepted for indicating liver transplantation (LT) in patients with hepatocellular carcinoma(HCC). However, there remains a 7-20% possibility of HCC recurrence, even among patients who fulfill the Milan criteria.It has been shown that tumor biology including differentiation, serum alpha fetoprotein (AFP) and protein induced by vitaminK absence-II (PIVKAII) predict posttransplant recurrence and survival better than morphology criteria. And also, downstagingby locoregional therapies of HCC before LT serves as a selection tool. Furthermore, successful downstaging can affect recurrenceof HCC by modulation of these biology. We analysis the result of downstaging and correlation with tumor recurrence.Methods: We retrospectively reviewed 119 patients with HCC who underwent LT at Pusan National University Yangsan Hospitalbetween May 2010 and December 2015. The risk factors for HCC recurrence were analyzed and the overall survival and disease-free survival rates were calculated based on each risk factor.Results: we defined the A-P 200 criteria as simultaneously exhibiting alphafetoprotein levels of ≤ 200 ng/mL and PIVKA-II levelsof ≤ 200 mAU/mL. Multivariate analyses revealed that the independent risk factors for HCC recurrence were Above A-P 200criteria (HR = 3.776, p = 0.013) and microvascular invasion (HR = 3.781 p = 0.012). The 3-year disease-free survival rates amongpatients who fulfilled or exceeded the A-P 200 criteria in within Milan criteria were 92.8% and 60.0%, respectively (P = 0.009).And the 3-year disease-free survival rates among patients who fulfilled or exceeded the A-P 200 criteria in above Milan criteriawere 89.5% and 35.8%, respectively (P = 0.011). And we intentionally controlled the patient with advanced HCC by neoadjuvanttherapy and 23 cases were included into the control group. The control group comparing with 33cases of the uncontrolled groupshowed significantly lower recurrence rate. (the 3-year disease-free survival rates 95.5% versus 56.1%, p = 0.007). We also retrospectiveanalyzed preoperative radiologic findings and can predict histologic grade and microvascular invasion and reveal thecorrelation between biologic change and neoadjuvant therapy such as TACE.Conclusion: The A-P 200 criteria can be used to predict recurrence after liver transplantation among patients with HCC. Andsuccessful downstaging can affect recurrence of advanced HCC by modulation of tumor biology (AFP, PIVKAII).
재발성 직장암의 간전이 환자에서 시행된 전간 혈류 차단과 정맥 혈류 우회술 그리고 장기 보존액 주입 하의 ante situm 간절제술
주종우(Chong Woo Chu),김형철(Hyung Chul Kim),신응진(Eung Jin Shin),임철환(Cheol Wan Lim),조규석(Gyu Seok Cho),정준철(Jun Cheol Chung),정귀애(Gui Ae Jeong),송옥평(Ok Pyung Song),진수지(Soo Ji Jin),김희경(Hee Kyung Kim),박성진(Seong Ji 한국간담췌외과학회 2008 한국간담췌외과학회지 Vol.12 No.2
We present here a case of recurrent rectal cancer liver metastasis that was managed with ante situm liver resection under total vascular exclusion (TVE) and venovenous bypass with hypothermic perfusion. A 58-year-old man who suffered with rectal cancer liver metastasis was transferred to our hospital in January 2006. A left lateral sectionectomy had been previously performed. Recurrent lesion developed in segments I, IV and VIII one year after the first hepatectomy. The tumor was 5 cm in diameter and it involved the confluence of the hepatic veins and the retrohepatic vena cava. An incomplete tumor-free margin and massive bleeding were expected with performing a conventional liver resection, together with vena cava reconstruction. Therefore, we planned an ante situm liver resection under TVE and venovenous bypass with hypothermic perfusion. After adhesiolysis, hilar dissection was carried out. The inflow to the medial segment was interrupted, and then the liver and inferior vena cava (IVC) were mobilized fully. During controlling the bleeding of a short hepatic vein, we found adhesion of the hepatocaval portion. Therefore, TVE and venovenous bypass were performed along with suprahepatic IVC transection. The long conduit of V5 was preserved during hepatic parenchymal dissection, and the paracaval portion of the caudate lobe was readily detached from the IVC. The suprahepatic IVC was reconstructed after V5 reconstruction with using the saphenous vein. Portal vein anastomosis was then conducted. After reperfusion, an end-to-side anastomosis was performed between the saphenous vein graft and the IVC. Finally, a Roux-en- Y hepaticojejunostomy was carried out. The patient remains well without recurrence 12 months after the last operation.