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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.
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.