비알코올성 지방간질환 치료에 있어서 베리아트릭 수술의 효능

변철수 ( Cheul Su Byun ),한상욱 ( Sang Uk Han ) 대한간학회 2013 Postgraduate Courses (PG) Vol.2013 No.-

Nonalcoholic fatty liver disease (NAFLD) comprises a spectrum of disorders ranging from simple steatosis, nonalcoholic steatohepatitis (NASH) to fibrosis, which may even lead to cirrhosis, hepatocellular carcinoma, and end-stage liver disease. The current best treatment of NAFLD is weight reduction through lifestyle modifications, drug therapy and bariatric surgery. However, it is often difficult to achieve sustained weight loss in morbidly obese patients with diet and exercise alone. Bariatric surgery is an effective treatment option for individuals who are severely obese and provides for long-term weight loss and resolution of obesity-associated diseases in most patients. The most commonly performed bariatric surgeries are Roux-en-Y gastric bypass (RYGB), adjustable gastric banding (AGB) and sleeve gastrectomy (SG). Thus, in this article, we describe the current options for bariatric surgery and the outcomes of bariatric surgery on NAFLD patients.

간외담도암에서 54세 이하 환자와 75세 이상 고령 환자의 비교분석

변철수(Chul Su Byeun),이재명(Jae Myeong Lee),김봉완(Bong Wan Kim),김욱환(Wook Whan Kim),왕희정(Hee Jung Wang),김명욱(Myung Wook Kim) 한국간담췌외과학회 2008 한국간담췌외과학회지 Vol.12 No.4

Purpose: The objective of this study was to compare the clinicopathologic characteristics of the patients with extrahepatic bile duct cancer between the patients who are younger than 54 years and those who are older than 75 years. Methods: Between 1994 and 2008, 63 patients underwent resectional surgery or palliative treatment for extrahepatic bile duct cancer. The medical records of these patients, including the clinicopathologic characteristics and the other relevant data, were retrospectively reviewed. Results: There were some differences between the patient groups for the tumor location, distant metastasis and preoperative co-morbidity. The frequency of tumor locations were 58% proximal, 13% middle, 22% distal and 5% diffuse in the young patients and these were 33%, 18%, 48% and 0%, respectively, in the older patient group (p=0.049). The frequency of distant metastasis was 13% in the young patient group and none in the older patient group (p=0.026). The elderly patient group showed more preoperative co-morbidities (68% vs 29%, respectively) (p=0.009), but there was no statistical difference between the two groups for postoperative complications (p=0.301). There was no correlation between the preoperative co-morbidity and the operative complications for both groups. There were no differences in the other clinicopathologic characteristics and the survival rate for both groups. Conclusion: Young and elderly patients with extrahepatic bile duct cancer had different clinicopathologic characteristics. Especially, in the young patients, there were more proximally located-tumors and distant metastases. Although there were more preoperative co-morbidities in the elderly patient group over the age of 75, this did not affect the operative complication rate when the co-morbidities were well controlled preoperatively.

Conventional Cytology Is Not Benefi cial for Predicting Peritoneal Recurrence after Curative Surgery for Gastric Cancer: Results of a Prospective Clinical Study

강기관,변철수,김영배,한상욱,조용관,허훈 대한위암학회 2014 Journal of gastric cancer Vol.14 No.1

Purpose: The role of peritoneal washing cytology in determining further treatment strategies after surgery for gastric cancer remains unclear. One reason for this is the fact that optimal procedures to increase the accuracy of predicting peritoneal metastasis have not been established. The aim of this study was to evaluate the efficacy of cytology using samples harvested from two different abdominal cavity sites during gastric cancer surgery. Materials and Methods: We prospectively recruited 108 patients who were clinically diagnosed with locally advanced gastric cancer (higher than cT1 stage disease). Peritoneal washing fluids were collected from the pouch of Douglas and the subphrenic area. Patients were prospectively followed up for 2 years to determine the recurrence and survival rates. Results: Thirty-three patients dropped out of the study for various reasons, so 75 patients were included in the final analysis. Seven patients (9.3%) showed positive cytology findings, of whom, three showed peritoneal recurrence. Tumor size was the only factor associated with positive cytology findings (P=0.037). The accuracy and specificity of cytology for predicting peritoneal recurrence were 90.1% and 94.2%, respectively, whereas the sensitivity was 50.0%. The survival rate did not differ between patients with positive cytology findings and those with negative cytology findings (P=0.081). Conclusions: Peritoneal washing cytology using samples harvested from two different sites in the abdominal cavity was not able to predictperitoneal recurrence or survival in gastric cancer patients. Further studies will be required to determine whether peritoneal washingcytology during gastric cancer surgery is a meaningful procedure.

근위부 조기위암에서 복강경보조 위전절제술식(LATG)과 개복하 위전절제술식(OTG)의 비교

박종민,변철수,이호원,김홍,정인호,전성호,김명욱,조용관,한상욱 대한외과학회 2006 대한외과학회 학술대회 초록집 Vol.2006 No.11

Laparoscopic Resection of Gastric Submucosal Tumors: Outcomes of 141 Consecutive Cases in a Single Center

유기상,허훈,변철수,Yi Xian,한상욱,조용관 대한내시경복강경외과학회 2012 Journal of Minimally Invasive Surgery Vol.15 No.4

Purpose: The treatment of choice for gastric submucosal tumors (SMT) is surgical resection. Recent advanced techniques has facilitated more extensive application of laparoscopic surgery to most types of resectable gastric SMTs. The aim of this study was to verify the efficacy of laparoscopic resection for treatment of gastric SMT through analysis of outcomes obtained at a single center. Methods: A total of 141 patients who underwent laparoscopic resection for treatment of gastric SMT were enrolled between April 2003 and June 2011. Analysis of the demographics, tumor characteristics, and surgical or oncological outcomes of these patients was performed. Results: Gastrointestinal stromal tumors (GIST) were the most common pathologic findings (90 cases), and the upper third of the stomach was the most common location (70 cases). Wedge resections were performed in 128 patients and major gastrectomies were performed in 13 patients. The mean surgical time was 102 minutes, which was reduced to a stable 70 minutes after the 30th case. The surgical time for tumors located on the posterior or lesser portion of the upper third of the stomach was longer than that for other lesions. Twelve postoperative complications, including two cases of intra-abdominal bleeding, one case of marginal ulcer bleeding, and one case of leakage occurred. However, there was no occurrence of complications after the 70th case. During the follow-up period, two patients suffered recurrent GIST. Conclusion: Laparoscopic surgery for treatment of gastric SMT is safe and feasible, particularly as the surgeon develops greater skill with increased experience. Laparoscopic resection is useful for treatment of any type of gastric SMT.

A Novel Roux-en-Y Reconstruction Involving the Use of Two Circular Staplers after Distal Subtotal Gastrectomy for Gastric Cancer

허훈,안창욱,변철수,신호정,김영배,손상용,한상욱 대한위암학회 2017 Journal of gastric cancer Vol.17 No.3

Purpose: Although Roux-en-Y (R-Y) reconstruction after distal gastrectomy has several advantages, such as prevention of bile reflux into the remnant stomach, it is rarely used because of the technical difficulty. This prospective randomized clinical trial aimed to show the efficacy of a novel method of R-Y reconstruction involving the use of 2 circular staplers by comparing this novel method to Billroth-I (B-I) reconstruction. Materials and Methods: A total of 118 patients were randomly allocated into the R-Y (59 patients) and B-I reconstruction (59 patients) groups. R-Y anastomosis was performed using two circular staplers and no hand sewing. The primary end-point of this clinical trial was the reflux of bile into the remnant stomach evaluated using endoscopic and histological findings at 6 months after surgery. Results: No significant differences in clinicopathological findings were observed between the 2 groups. Although anastomosis time was significantly longer for the patients of the R-Y group (P<0.001), no difference was detected between the 2 groups in terms of the total surgery duration (P=0.112). Endoscopic findings showed a significant reduction of bile reflux in the remnant stomach in the R-Y group (P<0.001), and the histological findings showed that reflux gastritis was more significant in the B-I group than in the R-Y group (P=0.026). Conclusions: The results of this randomized controlled clinical trial showed that compared with B-I reconstruction, R-Y reconstruction using circular staplers is a safe and feasible procedure. This clinical trial study was registered at www.ClinicalTrials.gov (registration No. NCT01142271).

제대탈출이 동반된 Goltz 증후군

이호원(Ho Won Lee),변철수(Chul Soo Byun),홍정(Jeong Hong) 대한외과학회 2011 Annals of Surgical Treatment and Research(ASRT) Vol.80 No.3

Primary Gastric Histiocytic Sarcoma Reminiscent of Inflammatory Pseudotumor: A Case Report with Review of the Literature

이다근,김영배,정숙희,이상령,변철수,한상욱,한재호 대한병리학회 2014 Journal of Pathology and Translational Medicine Vol.48 No.3

Outcomes of Critical Pathway in Laparoscopic and Open Surgical Treatments for Gastric Cancer Patients: Patients Selection for Fast-Track Program through Retrospective Analysis

최지우,허훈,Yi Xuan,변철수,한상욱,조용관 대한위암학회 2013 Journal of gastric cancer Vol.13 No.2

Purpose: The aim of this study is to investigate the clinical factors affecting on the cure rate by invasive and open surgery for gastric cancer and to establish a subgroup of patients who can be applied by the early recovery after surgery program through this retrospective analysis. Materials and Methods: In this retrospective study, we analyzed 425 patients who underwent gastric cancer surgery between January 2011 and December 2011 and were managed with conventional clinical therapies. This clinical algorithm was made when the patient was in minimally invasive surgery group and discharged from hospital one day faster than them in open surgery group. Results: The completion rate of the clinical pathway was 62.4%. Despite the different applications of clinical pathway, completion rate in minimally invasive surgery group was significantly higher than that of open group (P<0.001). In multivariate analysis, the surgical procedure of minimally invasive surgery (odds ratio=4.281) was the most predictable factor to complete clinical pathway. Additionally,younger patients (odds ratio=1.933) who underwent distal gastrectomy (odds ratio=1.999) without combined resection (odds ratio=3.069) were predicted to accomplish the clinical pathway without any modifications. Conclusions: We concluded that high efficacy of the clinical pathway for gastric cancer surgery was expected to selected patients through retrospective analysis (expected completion rate=85.4%). In addition, these patients would become enrolled criteria for early recovery program in gastric cancer surgery.

Effects of Continuing Adjuvant S-1 for 1 Year on the Prognosis of Gastric Cancer Patients: Results from a Prospective Single Center Study

은하수,허훈,손상용,한상욱,조용관,변철수 대한위암학회 2015 Journal of gastric cancer Vol.15 No.2

Purpose: Although several clinical trials have proven the efficacy of adjuvant S-1 treatment in gastric cancers, it is still unclear which patients receive the most benefit. In this study, we prospectively recruited patients with locally advanced gastric cancer who had undergone curative resection followed by adjuvant S-1 administration to investigate which factors affect the outcomes. Materials and Methods: Between July 2010 and October 2011, we enrolled 49 patients who underwent curative resection for stage II or III gastric cancer and who subsequently received adjuvant S-1 treatment for 1 year. Results: Twenty-nine patients (59.2%) continued S-1 treatment for 1 year, and 12 patients (24.5%) experienced recurrent disease during the follow-up period. Patients with continuation of S-1 for 1 year had significantly increased rates of disease-free survival (P<0.001) and overall survival (P=0.001) relative to the patients who discontinued S-1 during year 1. Multivariate analysis indicated poor outcomes for patients with stage III disease and those who discontinued S-1 treatment. Excluding patients who discontinued S-1 due to cancer progression (n=7), adjuvant treatment with S-1 still demonstrated a significant difference in the disease-free survival rate between the patients who continued treatment and those who discontinued it (P=0.020). Conclusions: S-1 is tolerated as adjuvant treatment in gastric cancer patients. However, discontinuing S-1 treatment may be an unfavorable factor in the prevention of recurrence. S-1 adjuvant treatment should be continued for 1 year if possible through the proper management of toxicities.