위암 환자에서 수술 전 혈청 CEA, CA 19-9, AFP측정의 예후 인자로서의 의의

나국영,장연수,이길연,이석환,윤충 대한외과학회 2005 대한외과학회 학술대회 초록집 Vol.2005 No.10

위암 환자에서 수술 전 혈청 CEA, CA19-9, AFP의 예후 인자로서의 의의

나국영(Kuk-Young Na),장연수(Yeon Soo Chang),김용호(Yong Ho Kim),주선형(Sun Hyung Joo),이석환(Suk-Hwan Lee) 대한외과학회 2008 Annals of Surgical Treatment and Research(ASRT) Vol.75 No.5

Purpose: No tumor-specific markers for gastric cancer are currently known, although various tumor markers have been utilized. CEA, CA19-9 and AFP are the most commonly used tumor markers for gastric cancer. The aim of this study is to evaluate the prognostic significance of the preoperative CEA, CA19-9 and AFP levels in patients with gastric cancer. Methods: A total of 366 patients who underwent curative surgery for gastric cancer were analyzed. The clinicopathologic characteristics and disease-free survival rate of the patients were compared between the positive and negative CEA, CA19-9 and AFP groups of patients, respectively. Also, the prognostic significance of each tumor marker was assessed by multivariate analysis. Results: The CEA, CA19-9 and AFP levels were elevated in 14.2%, 7.9% and 19.1% of the patients, respectively. Serosal invasion and advanced cancer were more frequently found in the groups of patients who were positive for CEA and CA19-9 (P<0.05). More lymph node metastasis and an advanced tumor stage were found in the group of patients who were positive for CA19-9 (P<0.05). On univariate analysis, the disease-free survival rate was significantly lower in the CA19-9 positive group (P<0.05). Serosal invasion and lymph node metastasis were the only significant prognostic factors on multivariate analysis. Conclusion: CEA, CA19-9 and AFP have proved unhelpful for the early detection of gastric cancer due to the low positive rate. CEA and AFP have no prognostic significance and only CA19-9 can be useful for estimating the severity of gastric cancer and as a limited prognostic factor for gastric cancer patients.

담낭암에서 Fascin 발현에 대한 연구

나국영(Kuk Young Na),김용호(Yong Ho Kim),김윤화(Youn Wha Kim),홍성화(Sung Wha Hong) 대한외과학회 2008 Annals of Surgical Treatment and Research(ASRT) Vol.75 No.2

Purpose: Gallbladder carcinoma is the most common malignancy of the biliary tract in Koreans. However the exact histopathological characteristics and its carcinogenesis are not well understood. Fascin is an actin bundling protein, and it induces membrane protrusions and increased cell motility in various transformed cells. The expression of fascin is known to be greatly increased in various human neoplasms, but its expression in gallbladder carcinoma is unknown. Methods: A total 110 cases of gallbladder carcinoma, six cases of carcinoma in situ and 10 cases of chronic cholecystitis were immunohistochemically studied to evaluate the expression of fascin in the light of its relationship with various prognostic factors. Results: Seventy eight gallbladder carcinomas (70.9%) showed positive staining for fascin, but none of the chronic cholecystitis and carcinoma in situ was positive. Fascin was strongly stained in the cytoplasm of the cancer cells. The adjacent normal mucosa was negative for fascin staining. There was a significant correlation between lymph node metastasis (P=0.039) and the presence of residual tumor (P=0.016) but there was no significant correlation between age, gender, tumor invasion, histologic difference, neural invasion, lymphatic invasion, stage and recurrence. The 5-year overall survival rate of the fascin positive and negative groups were 48.5% and 53.8%, respectively (P=0.236). On the multivariate analysis, a fascin expression was not significant. Conclusion: Our results suggest that a fascin expression is strongly associated with neoplastic progression in gallbladder carcinomas and fascin positive gallbladder carcinomas show more aggressive behavior.

만성 질환과 동반된 치핵의 수술적 치료

나국영 ( Kuk Young Na ),장연수 ( Yeon Soo Chang ),이길연 ( Ku Yeon Lee ),이석환 ( Suk Hwan Lee ),윤충 ( Choong Yoon ) 경희대학교 경희의료원 2005 慶熙醫學 Vol.21 No.2

Differential Diagnosis in Idiopathic Granulomatous Mastitis and Tuberculous Mastitis

서희리나,나국영,임현애,김태희,강두경,오기근,강석윤,안영실,전미선,김우재,박래웅,정용식,김구상,임현이 한국유방암학회 2012 Journal of breast cancer Vol.15 No.1

Purpose: Idiopathic granulomatous mastitis (IGM) is a rare chronic inflammatory disease of unknown etiology. The diagnosis of IGM requires that other granulomatous lesions in the breast be excluded. Tuberculous mastitis (TM) is also an uncommon disease that is often difficult to differentiate from IGM. The purpose of this study is to develop a new algorithm for the differential diagnosis and treatment of IGM and TM. Methods: Medical records of 68 patients (58 with IGM and 10 with TM) between July 1999 and February 2009 were retrospectively reviewed. Results: The mean age of the patients was 33.5 (IGM) and 40 (TM) years (p=0.018). The median follow-up was 84 months. Of the total 10 patients with TM, 5 patients had a history of pulmonary tuberculosis. The most common symptoms of the diseases were breast lump and pain. However, axillary lymphadenopathy was more seen in TM (50%) compared to IGM (20.6%) (p=0.048). TM showed more cancer-mimicking findings on radiologic study (p=0.028). In IGM, 48 patients (82.7%) underwent surgical wide excision and 21 patients (36.2%) were managed with corticosteroid therapy and antibiotics. All of the TM patients received antituberculosis medications and 9 patients (90%) underwent wide excision. The mean treatment duration was 2.8 months in IGM and 8.4 months in TM. Recurrence developed in 5 patients (8.6%) in IGM and 1 patient (10%) in TM. Conclusion: This study shows different characteristics between IGM and TM. The IGM patients were younger and had more mastalgia symptoms than the TM patients. Axillary lymphadenopathy was seen more often in TM patients. Half of the TM patients had pulmonary tuberculosis or tuberculosis lymphadenitis. Surgical wide excision might be both therapeutic and useful for providing an exact diagnosis.

Nation-Wide Korean Breast Cancer Data from 2008 Using the Breast Cancer Registration Program

정용식,나국영,김구상,안세현,이수정,박흥규,조영업 한국유방암학회 2011 Journal of breast cancer Vol.14 No.3

Purpose: Since 1996, the Korean Breast Cancer Society has collected nation-wide breast cancer data and analyzed the data using their online registration program biannually. The purpose of this study was to evaluate the characteristics of Korean breast cancer from 2008 and examine chronological based patterns. Methods: Data were collected from 38 medical schools (67 hospitals), 20 general hospitals, and 10 private clinics. The data on the total number, gender, and age distribution were collected through a questionnaire as well as other detailed data analyzed via the online registration program. Results: In 2008, there were 13,908 patients who were newly diagnosed with breast cancer. The crude incidence rate of female breast cancer was 57.3 among 100,000 and the median age was 49 years. The age distribution had not changed since the initial survey; however the proportion of postmenopausal patients had increased and median age was older than the past. In staging distribution, the proportion of early breast cancer (stage 0, I) was 47.2% with, breast-conserving surgery performed in 58% and mastectomy in 39.5%. Conclusion: Compared to past data, the incidence of breast cancer in Korea continues to rise. Furthermore, the proportion of those detected by screening and breast conservation surgery has increased remarkably. To understand the patterns of Korean breast cancer, the nation-wide data should continuously investigated.

무기하 액와 접근법을 이용한 로봇 갑상선 절제술: 단일 술자에 의한 최초 1년간의 경험

노재형,이정훈,나국영,이잔디,정웅윤<SUP>1<.SUP>,소의영,Jae Hyung Noh,Jeong Hun Lee,Kuk Young Na,Jandee Lee,Ph.D.,Woong Youn Chung Ph.D.<SUP>1 <.SUP>and Euy Young Soh,Ph.D. 대한갑상선-내분비외과학회 2010 The Koreran journal of Endocrine Surgery Vol.10 No.3

Purpose: Various endoscopic thyroidectomy procedures have been designed to minimize visible cervical scarring. However, endoscopic thyroidectomy is a technically challenging procedure that is performed by a limited surgeon. Robotic systems aida surgeon in performing minimally invasive head and neck surgery by offering superior visualization and dexterity. This study reports the initial experience of one surgeon with robotic thyroidectomy to assess the technical feasibility and safety of the approach. Methods: One hundred four thyroid cancer patients (97 females, 7 males; mean age of 39.8±8.1 years) underwent robotic thyroidectomy using gasless transaxillary approach between November 2008 and October 2009 in Ajou University Hospital. All the procedures were completed successfully using the da Vinci surgical system without open conversion. Patient characteristics, postoperative clinical results, complications, and pathologic details were assessed. Results: Total thyroidectomy was performed in 25 (24.0%) patients, subtotal thyroidectomy in 13 (12.5%) patients, and unilateral lobectomy in 66 (63.5%) patients. All patients underwent ipsilateral central compartment neck dissection, and two patients underwent selective lymph node (LN) dissection. The mean operation time was 134.5±47.2 min (range 61∼310 min), in which the actual time for the thyroidectomy with lymphadenectomy (console time) was 56.4 min. (range 31∼270). The mean number of LN resected was 3.9 (range 0∼28). There were no serious complications. The mean hospital stay was 2.9±0.9 days (range 2∼7). Conclusion: Robotic thyroidectomy is a feasible, safe, and cosmetically excellent procedure. The application of robotic technology for thyroid surgeries could be an alternative to endoscopic or conventional open thyroidectomy. (Korean J Endocrine Surg 2010;10:157-162)

‘유방수술에 있어서 외과용 메시 사용현황’ 에대한 국내 설문조사 결과

김구상,박만영,김우재,나국영,정용식,최영진,박용래,오세정,신혁재,한국유방암학회 한국유방암학회 2009 Journal of breast cancer Vol.12 No.3

The aim of this study is to investigate the use of absorbable mesh in breast surgery in Korea. We conducted a survey from members of Korea Breast Cancer Society by phone, E-mail, and notice on the website from 6th to 20th April 2009. A total of 54 breast surgeons had responded to the survey. Of these, 40 surgeons (74.1%) had used absorbable mesh during breast surgery, with Vicryl mesh being the choice of every surgeon and Interceed having been used by 36 (90%) of the surgeons. In responding to the indications for mesh use, 26 surgeons (65%) indicated that mesh use was effective when a deformity was expected regardless of T stage. Contraindications for mesh use principally included existing patients’ comorbidity such as a wound healing problem, diabetes mellitus and immunocompromised condition. Thirty one surgeons (77.5%) had experienced an infection in the mesh insertion site. However, on a case basis, only 39 of 843 cases (4.6%) had resulted in an infection. In the follow up after mesh use, 33 of the 37 responding surgeons (89.2%) used breast ultrasonography. Nineteen of the 38 respondents (50%) replied that the mesh was absorbed in 6 months and it did not confuse diagnostic imaging. The cited merits of mesh included maintenance of breast shape following surgery (n=38/49, 77.6%) and ease of surgical use (n=35/49, 71.4%). However, the high price of mesh was cited as a disadvantage by 33 of the 48 respondents (68.8%). In summary, survey results mentioned above show that surgical mesh use in breast surgery is increasing by times and the procedures greatly varies by surgeons. Thereby, we suggest that a guideline for mesh use should be made in the near future.