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RISS 인기검색어
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- 저자 : 한대훈(Dai Hoon Han) (검색결과 3 건)
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한대훈(Dai Hoon Han),최기홍(Gi Hong Choi),김동현(Dong Hyun Kim),최새별(Sae Byeol Choi),강창무(Chang Moo Kang),김경식(Kyung Sik Kim),최진섭(Jin Sub Choi),박영년(Young Nyun Park),박준용(Jun Yong Park),김도영(Do Yong Kim),한광협(Kwang-H 한국간담췌외과학회 2008 한국간담췌외과학회지 Vol.12 No.4
Purpose:Although surgical resection is the most effective treatment for hepatocellular 4 carcinoma (HCC), high recurrence after resection is a major challenging problem. We attempted to determine the optimal strategies for improving the long-term surgical outcome through the review of our 10 years’ experience with surgically treating HCC. Methods: We retrospectively reviewed 497 patients who received curative resection at the Yonsei University Health System from January 1996 to August 2006. Results: The 5 year disease-free rate and the overall survival rate after curative resection were 45.0% and 63.9%, respectively. Of the 497 patients, 491 (98.8%) were Child-Pugh A and 107 (56.3%) were diagnosed with liver cirrhosis. The postoperative complication and mortality rates were 28.6% and 1.8%, respectively. Of the 243 recurrent patients, 184 (75.7%) were diagnosed with intrahepatic recurrence alone. Of these intrahepatic recurrent patients, 169 (91.9%) received active treatment, including transplantation (n=7), re-resection (n=12), local ablation therapy (n=18) and transarterial chemoembolization (n=132). Multivariate analysis revealed that perioperative transfusion, a satellite nodule, the pathologic TNM stage, the Edmondsons-Steiner grade, the serum alkaline phosphatase (ALP) and aspartate aminotransferase levels and cirrhosis were associated with disease free survival, and perioperative transfusion, a satellite nodule, macroscopic vascular invasion, the Edmondsons-Steiner grade, the ALP and serum albumin levels and the platelet count were related with overall survival after resection. Conclusions: The long-term surgical outcome of HCC can be further improved by proper patient selection, delicately performed surgery and administering postoperative adjuvant therapy for patients with a high risk of recurrence. Early diagnosis and aggressive treatment are needed to treat the recurrence.
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간세포암의 근치적 절제 후 간내 재발암의 위험 인자 분석
김강미(Gang Mi Kim),최기홍(Gi Hong Choi),한대훈(Dai Hoon Han),김동현(Dong Hyun Kim),강창무(Chang Moo Kang),최진섭(Jin Sub Choi),박준용(Jun Yong Park),김도영(Do Yong Kim),한광협(Kwang-Hyub Han),전재윤(Chae Yoon Chon),박영년(Young Nyun 한국간담췌외과학회 2008 한국간담췌외과학회지 Vol.12 No.4
Purpose: Intrahepatic recurrent HCC has been classified according to location, the time to recurrence and the pattern of presentation. The purpose of this study is to classify intrahepatic recurrent HCCs into subgroups that have relatively similar recurrent patterns and to identify the risk factors for each recurrent type. Methods: A total of 353 patients were retrospectively studied. Intrahepatic recurrent HCC was classified into nodular recurrence (<4 nodules; type I), multinodular-diffuse recurrence (≥4 nodules; type II) and infiltrative recurrence (type III). The cut-off time between early and late recurrence was chosen to be 12 months following hepatectomy. Results: Among the 134 patients with only intrahepatic recurrence, 94 were type I, 27 were type II and 13 were type III. The median survival time following the recurrence of types I, II and III were 55, 16 and 8 months, respectively. As determined by multivariate analysis, perioperative transfusion and indocyanine green retention at 15 minutes (ICG R 15 >10%) were the independent risk factors for type I; an ICG R 15>10%, microvessel invasion and intrahepatic metastasis were the independent risk factors for type II; an ICG R 15>10% and microscopic portal vein invasion were the independent risk factors for type III. Multivariate analysis revealed that the prognosis of patients with IHR was associated with the recurrent types, the time to recurrence and the serum albumin level at the initial presentation. Following multivariate analysis, an ICG R 15>10% and intrahepatic metastasis were the independent risk factors for early type I recurrence; perioperative transfusion and a higher grade of hepatitis activity were the independent risk factors for late type I recurrence. Conclusions: The recurrent types and the time to recurrence may help us to predict the cellular origin of intrahepatic recurrent HCC and the prognosis of the patients who suffer with intrahepatic recurrent HCC.
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최기홍(Gi Hong Choi),김창희(Kim Chang Hee),한대훈(Dai Hoon Han),김동현(Dong Hyun Kim),최새별(Sae Byeol Choi),강창무(Chang Moo Kang),김경식(Kyung Sik Kim),최진섭(Jin Sub Choi),박영년(Young Nyun Park),박준용(Jun Yong Park),김도영(Do Yo 한국간담췌외과학회 2008 한국간담췌외과학회지 Vol.12 No.4
Purpose: Recent studies have reported improved perioperative and long-term outcomes for the initial postoperative results for patients with a huge HCC. The purpose of this study was to investigate the surgical outcomes of patients with a huge HCC and we wanted to identify any subgroup that would likely benefit from hepatic resection. Methods: From January 1996 to August 2006, 55 patients were diagnosed with a huge HCC (≥ 10cm in diameter). All the tumors were classified as either the expanding nodular type or the non- expanding nodular type. Results: The mean age of the patients was 50.6 years and 39 patients were male. The most common cause of liver disease was hepatitis B virus. The mean size of tumor was 11.9 cm. Microscopic liver cirrhosis was present in 17 patients. Twenty-three patients had tumors of the expanding nodular type. Curative resection was performed in 50 patients. The 5-year diseasefree and overall survival rates after resection were 35.8% and 41.0%, respectively. Univariate analysis revealed that surgical margins of ≤ 1.0, a non-curative resection, the non-expanding nodular type and microscopic vascular invasion were adverse prognostic factors for survival. Multivariate analysis indicated that the gross tumor classification (expanding nodular vs. nonexpanding nodular) was the only independent prognostic factor. Conclusions: Huge HCC is not a homogenous group and the gross tumor pattern may represent the biologic behavior of huge HCC. Because the outcome of surgical treatment is far better than that of non-surgical treatment, resection should be actively considered for patients with a huge HCC. An expanding nodular type tumor is the best candidate for surgical resection.
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