점막하 종양으로 오인된 위의 원발성 편평세포암종

정귀애(Gui-Ae Jeong),민영돈(Young-Don Min),임성철(Sung-Chul Lim) 대한외과학회 2007 Annals of Surgical Treatment and Research(ASRT) Vol.73 No.5

Squamous cell carcinoma (SCC) of the stomach is relatively rare. We report a patient with a primary SCC of the stomach that was initially misdiagnosed as a submucosal tumor. The patient was a 64-year-old male who had a large submucosal tumor in the gastric fundus. Gastric endoscopy, endoscopic ultrasonography and abdominal computed tomography indicated a malignant submucosal tumor with multiple lymph node metastases. The patient underwent a total gastrectomy and a regional lymph node dissection. Histologically, the tumor was identified as a primary SCC of the stomach.

침윤성 유방암에서 PTEN 단백 발현과 다른 예후인자들과의 관계

정귀애(Gui-Ae Jeong),이미자(Mi-Ja Lee),김병철(Byung-Cheol Kim),전호종(Ho-Jong Jeon),민영돈(Young-Don Min),김성환(Seong-Hwan Kim),김권천(Kweon-Cheon Kim) 대한외과학회 2004 Annals of Surgical Treatment and Research Vol.66 No.4

Neurofibroma of the appendix and multiple gastrointestinal stromal tumors of small bowel in neurofibromatosis type 1 patient

Gui-Ae Jeong(정귀애) 대한종양외과학회 2014 Korean Journal of Clinical Oncology Vol.10 No.2

Neurofibromatosis type 1 (NF-1) is an autosomal dominant hereditary disease with association of tumorous condition of body. Although the pathogenesis of tumorous condition with NF-1 is unclear, there were several reports for gastrointestinal tumors (GISTs) of gastrointestinal tract or nervous system tumors. However, there are few reports of appendiceal neurofibroma in NF-1 patients. We report here a case of NF-1 patient with multiple jejunal GISTs and appendiceal neurofibroma. A 61-year-old man was referred to department of surgery for abnormal findings of appendix on abdominal computed tomography scan. He underwent the laparoscopic appendectomy and laparoscopy-assisted segmental resection of proximal jejunum and he had numerous masses on duodenum and proximal jejunum in the operative findings. The pathologic findings revealed the neurofibroma of appendix and multiple GISTs of the jejunum.

재발성 위암에서 재수술의 유용성

정귀애(Gui-Ae Jeong),조규석(Gyu-Seok Cho),이문수(Moon-Su Lee),김용진(Yong-Jin Kim),강길호(Kil-Ho Kang),김형수(Hyung-Soo Kim),김형철(Hyung-Chul Kim) 대한외과학회 2009 Annals of Surgical Treatment and Research(ASRT) Vol.77 No.2

Purpose: Radical gastrectomy and lymph node dissection is the treatment of choice for gastric cancer but the efficacy of surgical treatment of recurrent gastric cancer has been debated. We evaluated the efficacy of surgical treatment for recurrent gastric cancer. Methods: We collected the data on 108 recurrent gastric cancer patients who underwent radical gastrectomy and lymph node dissection for gastric cancer and analyzed the clinicopathologic data, the patterns of recurrence of gastric cancer, and the strategies of treatment for recurrent gastric cancer. Results: The patterns of recurrence were 32 locoregional, 26 hematogenous, 24 peritoneal, and 26 mixed recurrences. The strategies of treatment for recurrent gastric cancer were the combination of surgical treatment and chemotherapy in 31 cases (28.7%), chemotherapy alone in 49 cases (45.4%), and conservative treatment in 28 cases (25.9%). The morbidity and mortality in reoperation group were 35.5% and 9.7%, respectively. The mean survival after recurrence was 25.4, 12.7, and 4.9 months in reoperation group, chemotherapy group and conservative treatment group, respectively. In multivariate analysis, the differentiation of primary tumor, patterns of recurrence, and the strategies of treatment for recurrent gastric cancer were related with survival after recurrence of gastric cancer. Conclusion: Our data suggested that the more aggressive and intensive treatment such as surgical treatment could improve the survival rate for recurrent gastric cancer. Therefore, if the patients’ conditions are tolerable and there is resectability, surgical treatment may be an applicable strategy for recurrent gastric cancer in terms of long-term survival.

뇌에 전이된 유두상 갑상선암

정귀애(Gui-Ae Jeong),김권천(Kweon-Cheon Kim),김동현(Dong-Hyun Kim),김영숙(Young-Sook Kim),배학연(Hak-Yeon Bae),오윤경(Yeun-Kyoung Oh),기근홍(Keun-Hong Ki) 대한외과학회 2003 Annals of Surgical Treatment and Research(ASRT) Vol.64 No.6

유방암 환자의 수술 전 액와림프절 전이 여부 평가를 위한 영상의학적 검사의 효용성

김경덕(Kyeong Deok Kim),인정진(Jeong Jin In),장윤희(Yun Hee Jang),김지선(Zisun Kim),국중철(Jung Cheol Kuk),최규성(Kyu Sung Choi),정재홍(Jaehong Jeong),허성모(Sung Mo Hur),정귀애(Gui Ae Jeong),정준철(Jun Chul Chung),조규석(Gyu Seok Ch 대한종양외과학회 2015 Korean Journal of Clinical Oncology Vol.11 No.2

Purpose: The purpose of this retrospective study was to identify the diagnostic performance of positron emission tomography/computed tomography (PET/CT) compared to conventional modalities, such as ultrasonography (US) and contrast-enhanced computed tomography (CT) in detecting axillary lymph node metastasis (ALNM) in patients with breast cancer. Methods: Two hundred thirty-three consecutive patients diagnosed with primary breast cancer who had not been treated with neoadjuvant chemotherapy and had been examined by US, CT, and PET/CT before surgery were included. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of each imaging modality and combinations of modality according to tumor size were obtained, and were compared with the histopathological results of sentinel lymph node biopsy or axillary lymph node dissection. Results: ALNM was confirmed in 32.6% (76/233) of patients. The sensitivity, specificity, PPV, NPV, and accuracy of US for detecting ALNM were 65.8%, 86.6%, 70.4%, 84.0%, and 79.8%, respectively. The sensitivity, specificity, PPV, NPV, and accuracy of CT were 72.4%, 72.6%, 56.1%, 84.4%, and 72.5%, respectively. The sensitivity, specificity, PPV, NPV, and accuracy of PET/CT were 69.7%, 86.0%, 70.7%, 85.4%, and 80.7%, respectively. The combination of US and PET/CT showed the most accurate results with specificity, PPV and accuracy values of 93.6%, 81.5%, and 82.0%, respectively. Conclusion: The diagnostic performance of PET/CT was comparable to that of US and CT. Combination of US and PET/CT could be a reliable strategy for determining preoperative ALNM in patients with operable breast cancer.

조기위암에서 불완전 내시경 절제 후의 수술 전략

박지혜 ( Ji Hyae Park ),김용진 ( Yong Jin Kim ),강길호 ( Gil Ho Kang ),정귀애 ( Gui Ae Jeong ),조규석 ( Gyu Seok Cho ),이문수 ( Moon Soo Lee ),허경열 ( Kyung Yul Hur ),김재준 ( Jae Joon Kim ),( Joo Young Cho ) 대한임상종양학회 2010 Korean Journal of Clinical Oncology Vol.6 No.1

배경 및 목적 : 한국에서의 조기위암 증가와 함께 개별화와 최소 침습적 면에서 내시경 절제술이 널리 시행되고 있다. 하지만, 내시경 절제의 증가와 함께 그 치료범위에 대해서는 논란의 여지가 있다. 본 연구는 내시경으로 불완전하게 절제된 조기 위암에 있어 수술 결과를 토대로 적절한 수술 범위를 제안하고자 본 연구를 고안하였다. 환자 및 방법 : 1999년 3월부터 2006년 2월까지 내시경 절제 후위 절제 수술을 받은 63명의 조기위암환자를 대상으로 하였다. 절제 방법, 일괄절제율, 수술시행 근거, 그리고 병리학적 결과(잔존암의 유무, 침습깊이, 분화도, 림프절전이)를 후향적으로 분석하였다. 결과 : 일괄절제는 50명(80%)의 환자에서 가능했으며, 이 중 내시경 점막절제술을 시행한 경우는 35명(56%), 내시경 점막하 박리술을 시행한 경우는 28명(44%)이었다. 수술시행 근거로, 절제변연의 잔존암이 28명(44%), 점막하 침습이나 나쁜 분화도가 19명(30%), 내시경 절제와 관련된 합병증이 9명(14%), 그리고 기타7명(11%)이었다. 내시경 절제 합병증으로 수술을 받은 예를 제외한 54명의 수술 후 병리결과를 분석하였을 때, 잔존암이 발견된 경우는 21명(44%), 림프절전이가 있는 경우는 3명(6%)이었다. 잔존암이 발견된 21명 중 내시경 절제 시 절제변연에 암이 없었던 경우가 5명(23%)이었다. 내시경 절제변연에서 수평침윤이 있었던 환자들만 유일하게 림프절전이가 없었다. 평균추적기간은 23개월이었으며, 추척 관찰 중 소실된 7명의 환자를 제외한 나머지는 현재까지 생존 중이다. 결론 : 대부분의 환자는 위암 1기로 진단되었지만, 점막하층 침윤이 있거나 조직분화도가 나쁜 경우가 상대적으로 많았고 또한 내시경적 절제변연에서 암이 없었음에도 불구하고 수술 후 잔존암이 있었던 경우가 일부 환자에서 발견되었다. 따라서 조기위암의 치료에 있어 내시경 점막 하 절제술의 치료범위를 넓히는 것에 대하여 매우 조심스럽게 생각해야 하겠다. 또한, 내시경 절제 후 점막 하 위암으로 진단된 환자의 수술계획에 있어, 저자들의 연구결과 림프절 전이는 수직 절단면 양성인 경우에만 관찰되어, 수직 절단면 양성인 경우는 D1이상, 측면 절단면 양성인 경우 D1이하의 림프절 절제가 가능하다고 판단하였다. Background: Treatment individualization and minimal invasiveness are main current issues in the management of early gastric cancer, along with increased incidence of the disease in Korea. Although several controversies remain, it is technically feasible to extend the indications for ESD. We intended to clarify the clinico-pathologic characteristics and the optimal management for incompletely resected gastric cancer with endoscopic treatment. Patients and Methods: Sixty-three patients with early gastric cancer were treated with surgery after endoscopic resection between 1999 and 2006. The resection method, rate of en-block resection, reasons for surgery, and pathologic results (presence of residual cancer, depth of invasion, differentiation and lymph node metastasis) were retrospectively analyzed. Results: En-block resection was attempted in 80% of the patients, with 56% EMR and 44% ESD. The reasons for surgery were positive resection margin (44%), submucosal invasion or poorly differentiated cancer (30%), EMR or ESD related complications (14%) and miscellaneous (11%). Of 54 patients (except for the patients with complications), we observed 20 patients (37%) with residual cancer, 28 (52%) with submucosal involvement and 3(6%) with lymph node metastasis. Among 22 patients with negative resection margins, 5 (23%) had residual cancer. For patients with positive lateral margin, there was no lymph node metastasis. The median survival time was 23 months and all patients are still alive in a disease-free state, with excluding 7 patients who were lost to follow-ups. Conclusions: Although majority of the patients were diagnosed as stage IA, extending the indications for endoscopic resection should be carefully considered, due to relatively high rate of submucosal involvement and the presence of residual cancer with negative resection margin. However, in selected cases with positive lateral margin or well differentiated submucosal cancer, D1 lymphadenectomy could be an alternative treatment strategy.

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.

갑상선유두암에서 갑상선전절제술과 중심경부림프절절제술 후 발생하는 저칼슘혈증 예측 인자 연구

이옥주(Ok Joo Lee),김형철(Hyung Chul Kim),임철완(Cheol Wan Lim),신응진(Eung Jin Shin),조규석(Gyou Suk Cho),정준철(Jun Chul Jung),정귀애(Gui Ae Jung),김지선(Zisun Kim),정재홍(Jae Hong Jeong),최규성(Kyusung Choi),한선욱(Sun Wook Han),허 대한갑상선-내분비외과학회 2015 The Koreran journal of Endocrine Surgery Vol.15 No.3

Purpose: Total thyroidectomy with central lymph node dissection (CLND) is a treatment modality of choice for thyroid cancer. Hypocalcemia is the most common complication after total thyroidectomy. The aim of the current study was to determine the association between surgery-related clinical factors and postoperative hypocalcemia. Methods: A prospective analysis was performed for 101 patients who underwent total thyroidectomy with CLND for papillary cancer from June 2013 to June 2014. Correlation between clinicopathologic factors and postoperative hypocalcemia was analyzed. Results: Based on the postoperative day-2 calcium, 56 patients (55%) developed hypo-calcemia and 45 patients (45%) were normal. No significant differences in histopathologic (tumor size, tumor focality, histologic type, number of retrieved lymph nodes, metastatic lymph node, thyroiditis, retrieved parathyroid gland) findings were observed between the hypocalcemia group and normal calcium group. Mean value of the postoperative day-0 parathyroid hormone (PTH) was significantly lower in the hypocalcemia group (hypoca1cemia group: 14.3±9.4 pg/mL; normal group: 25.0±16.4 pg/mL; P<0.001). In logistic regression analysis, postoperative PTH was a factor significantly affecting postoperative hypocalcemia (OR 0.93; CI: 0.90-0.97; P<0.001). In ROC analysis, the cut-off value of PTH was 19.965 (sensitivity 79%, specificity 58%), and area under the curve (AUC) was 0.709 (95% CI: 0.607-0.811). Conclusion: Postoperative PTH was a factor predicting hypocalcemia after total thyroidectomy with CLND. Use of postoperative PTH as a screening tool for prediction of postoperative hypocalcemia would be useful in management of patients with hypocal-cemia.

췌십이지장절제술 후 결과에 영향을 미치는 인자

정희석,정귀애,장정환,김권천,민영돈,김성환 조선대학교 2003 The Medical Journal of Chosun University Vol.28 No.1

`Background : Pancreatoduodenectomy is a widely used technique in the treatment of periampullary, duodenal and cephalic pancreatic disease. Although many improvements have been made in operative technique and posmiddleerative care, pancreatoduodenectomy remains a technically difficult procedure attended by relatively high morbidity and mortality rates. Materials and methods : The hospital records of 51 patients who underwent pancreatoduodenectomy at the Chosun University Hospital between 1994 and 2001 were reviewed. Clinical data and the following morbidity and mortality were recorded The risk factors were analyzed by a Chi-square test. Results : Fifth decade was the most prevalent ages (43.1%) The mean age was 59 years (ranging from 29 to 78) and the male to female ratio was 26 to 1. The periampullary cancer was the most reason to operation (86%) and injury due to trauma, adenocarcinoma of stomach, colon cancer, chronic pancreatitis in order Posmiddleerative complications were developed in seventeen patients and anastomotic leakage was the most common complication Death within a month after operation was 3 (5.8%) and the one of the cause of death was leakage in two patients, the other cause was intraadbominal bleeding in one patients. The cardiovascular disease, pulomnary problem, diabetes, level of bilirubin were checked preoperatively and showed no statistical difference in the posmiddleerative morbidity. The other factors such as amount of bleeding, operation time were not influencing posmiddleerative complications. The occurrence of leakage in eight cases of drainage tuve inserted into the pancreaticojejunostomy site was not different from no tuve insertion statistically Conclusion: old age of the patients, diabetes mellitus and massive intraoperative hemorrhage are the risk factors influencing the results after pancreatoduodenectomy. Morbidity and mortality after pancreatoduodenctomy can be devreased if a prudent selection of paients is made and the operation is performed by accomplushed surgeon.