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.

The first successful report of liver transplantation from category III donation after circulatory death in South Korea: a case report

강인천,Lee Jae-myeong,이재근 대한이식학회 2022 Korean Journal of Transplantation Vol.36 No.4

Deceased donor liver transplantation (DDLT) using donations after brain death (DBDs) has been widely performed in Korea. However, to date, there is no report regarding donation after circulatory death (DCD) category III. A 56-year-old male patient diagnosed with hepatitis B virus-associated liver cirrhosis underwent DDLT using DCD category III. The recipient’s recovery was uneventful, and he was discharged on postoperative day 37. Currently, the patient is alive, with no complications 20 months after transplantation. This case suggests that DCD with LT is both feasible and safe. Further studies are required to validate this finding.

Comparison of characteristics in patients with both thyroid and breast cancer: Based on order of incidence

김주형,강인천,남상근,박형석,박세호,정종주,남기현,정웅윤,김승일,조영업,박병우 대한종양외과학회 2017 Korean Journal of Clinical Oncology Vol.13 No.1

Purpose: Clinicopathologic characteristics of patients with both thyroid and breast cancer during their lifetime were analyzed to investigate the association between the two malignancies according to the order of incidence. Methods: A total of 405 patients who underwent surgery for breast and thyroid cancer at Severance Hospital between 1995 and 2014 were retrospectively selected and classified into 3 groups according to the order of incidence of the two cancers: simultaneous cancer (S), thyroid cancer followed by breast cancer (TB), and breast cancer followed by thyroid cancer (BT). Univariate analysis was conducted to compare parameters. Results: S, TB, and BT groups were 166 (41.0%), 96 (23.7%), and 143 (35.3%) patients, respectively. In TB and BT groups, tumor size and surgical site for secondary cancer were smaller; therefore, adjuvant treatments were less frequently required for secondary cancer. ER positive rate was 77.1% in S, 75% in TB, and 63.7% in BT groups (P=0.027). The ratio of ER negative was higher in the group with BRAF mutation. Survival rate for index tumor was higher in order from TB, and BT, followed by S groups without statistical difference. Conclusion: It is difficult to find a significant difference according to the order of occurrence except by screening test, and more studies are needed in the future. Establishing an appropriate screening program is important in order to detect secondary breast or thyroid cancer after surgery for thyroid or breast cancer.

Risk factors of incisional hernia after single-incision cholecystectomy and safety of barbed suture material for wound closure

김예슬,최성훈,정성엽,이성환,강인천,장재영 대한내시경복강경외과학회 2021 Journal of Minimally Invasive Surgery Vol.24 No.3

Purpose: Single-incision cholecystectomy is a surgical method that offers comparable results to conventional laparoscopic cholecystectomy. However, a high risk of postoperative incisional hernia is an issue in single-incision cholecystectomy. This study evaluated the risk factors and incidences of incisional hernia after single-incision cholecystectomy and the advantage issue of using barbed suture material during wound closures. Methods: A total of 1,111 patients underwent laparoscopic or robotic single-incision cholecystectomy between March 2014 and February 2020 at our institution at CHA Bundang Medical Center. During this period, there were 693 patients who underwent wound closure with monofilament suture material (Monosyn 2-0; B. Braun) and the other 418 patients used barbed suture material (Stratafix 2-0; Ethicon). Results: The two patient groups were comparable in age, body mass index, and diagnosis. The total incidence of incisional hernia after single-incision cholecystectomy was 0.5% (five cases). All patients who developed incisional hernia were in the monofilament suture material group (0.7% vs. 0%, p = 0.021). The influence of predictive and possible risk factors on incisional hernia rate was analyzed. Among these factors, only old age was an independent predictive risk factor of incisional hernia. Conclusion: Our study showed a low incidence of incisional hernia, all of which occurred in the monofilament suture material group. If technically appropriate, single-incision cholecystectomy does not appear to present a high incidence of hernia. Barbed suture material can be safely applied in wound closure showing comparable incisional hernia incidence to monofilament suture material.

유지용량 EPO투여로 정액 혈액투석 환자의 효율적인 빈혈관리

유수정,최정미,조경희,강인천,최유리,이명인,소영은,이소라,강명선,윤승희 한국의료QA학회 2009 가을학술대회 Vol.2009 No.2

Adverse Impact of Intraoperative Conversion on the Postoperative Course Following Laparoscopic Pancreaticoduodenectomy

Law Cho Kwan Connie,홍승수,강인천,노승윤,황호경,이우정,강창무 연세대학교의과대학 2021 Yonsei medical journal Vol.62 No.9

Purpose: The aim of the current study was to evaluate the adverse clinical impact of intraoperative conversion during laparoscopicpancreaticoduodenectomy (LPD). Materials and Methods: The medical records of patients who underwent pancreaticoduodenectomy (PD) were retrospectivelyreviewed. Perioperative clinical variables were compared between patients who underwent converted PD (cPD) and initiallyplanned open PD (OPD) to investigate the clinical impact and predictive factors of intraoperative conversion during LPD. Results: A total of 171 patients were included. Among them, 31 patients (19.3%) were found to have intraoperative conversion duringLPD. Failure of progression due to severe adhesion (12 patients, 7%) and major vessel invasion (7 patients, 4%) were the twomost frequent reasons for conversion. On multivariate analysis, age [Exp(β)=1.044, p=0.044] and pancreatic texture [Expa(β)=2.431,p=0.039) were found to be independent factors for predicting intraoperative conversion during LPD. In comparative analysis withthe OPD group, the cPD group had a longer operation time (516.8 min vs. 449.9 min, p=0.001), higher rate of postoperative hemorrhage(12.1% vs. 0.85%, p=0.008), higher reoperation rate (9.1% vs. 0%, p=0.01), and higher cost (21886.4 USD vs. 17168.9 USD,p=0.018). Conclusion: Intraoperative conversion during LPD can have an adverse clinical impact on the postoperative course followingLPD. Appropriate patients selection and improvement of surgical techniques will be crucial for unnecessary intraoperative conversionand safe LPD.