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김기현,이시학,최철웅,김수진,류대곤,최창인,김대환,전태용,김동헌,황순휘 대한내시경복강경외과학회 2017 Journal of Minimally Invasive Surgery Vol.20 No.4
Purpose: As the life expectancy increases, the population of elderly patients increases. We evaluated the complications and survival rate of patients over 80 years old, who underwent laparoscopic gastrectomy. Methods: A retrospective analysis was conducted for a total of 1,912 patients, who underwent surgery with stomach cancer from 2008 to 2016. We analyzed postoperative complications and the survival rate between the middle old (70~79, n=255) group and the very old (≥80, n=37) group. Results: Among 1,912 patients, 255 people in the middle old group and 37 people within the very old group underwent laparoscopic gastrectomy. We confirmed that there was no significant difference except for the age (p<0.001) between the two groups. Overall complications were not statistically significantly different between the Middle old (70~79) group and the very old (≥80) group, 11.8% and 16.2%, respectively. There were also no statistically significant differences in severe complications beyond Clavien-Dindo classification Grade III. Risk factors for overall complications were higher in males than in females (p=0.002). Overall survival was statistically significantly lower with very old group (p<0.001). Conclusion: Laparoscopic gastrectomy in gastric cancer patients over 80 years of age is feasible and safe in terms of complications. However, considering the life expectancy, it seems necessary to pay attention to the patients who apply surgery.
복강경 위절제술을 시행한 노인 위암환자에서의 P-POSSUM을 이용한 위험예측 모델 적용
고효정,김기현,이시학,최철웅,김수진,최창인,김대환,전태용,김동헌,황순휘 대한내시경복강경외과학회 2016 Journal of Minimally Invasive Surgery Vol.19 No.3
Purpose: The physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) is a validated scoring system for auditing surgical outcomes. However, evaluation of this system has primarily been applied to open surgical techniques. The present study demonstrates the validity of P-POSSUM in predicting morbidity and mortality in the treatment of elderly patients with gastric cancer who underwent curative laparoscopic gastrectomy. Methods: All patients aged 70 years or over, who underwent curative laparoscopic gastrectomy between January 2014 and January 2015, were collected from our hospital database. A case-note review was used to collate data in terms of clinical and operative factors as described in P-POSSUM. Observed/Estimated ratio of morbidity and 30-day mortality were calculated. Results: Laparoscopic gastrectomy was performed in 101 patients. The mean age was 74.9 years (70~83 years). A significant postoperative morbidity was observed in 20 (19.8%) of 101 patients. There was no 30-day mortality. Using exponential analysis, P-POSSUM predicted morbidity in 22 patients. Thus, O/E ratios for morbidity and mortality were 0.9 and 0, respectively. Conclusion: P-POSSUM scoring slightly overestimated predictions of morbidity and mortality. An assessment of its application to laparoscopic gastrectomy of elderly patients with gastric cancer merits further evaluation. Also, laparoscopic gastrectomy was a feasible and safe treatment for elderly patients in terms of P-POSSUM.
Dong Woo Hyun,김기현,이시학,황순휘,김대환,전태용,김동헌,Do Youn Park,최창인 대한내시경복강경외과학회 2018 Journal of Minimally Invasive Surgery Vol.21 No.1
Purpose: To analyze postoperative complications for gastric cancer patients undergoing laparoscopic gastrectomy in single institution over long period of time.Methods: The data of 1332 consecutive patients undergoing laparoscopic gastrectomy for gastric cancer at a single institution from January 2007 to December 2015 were reviewed. The patients were classified into the early or late surgery group; the initial 100 cases were classified as the initial group. We compared between the two groups and analyzed risk factors for postoperative complications.Results: A total of 265 postoperative complications occurred in 223 patients (16.7%). Major complications occurred in 38 patients (2.9%) including 1 death (0.1%). Operative time and hospital stay were significantly shorter in the late group. Blood loss was greater in the initial group. Sex, comorbidity, tumor location, D2 LND, operative method, non B-I anastomosis, co-resection, long operative time, and blood loss were significant risk factors for overall postoperative complication. In the multivariate analysis, male sex, comorbidity, D2 lymph node dissection, total or proximal gastrectomy, non B-I anastomosis, co-resection, operative time and blood loss were associated with postoperative overall complications.Conclusion: Sex, co-morbidity, D2 LND, operative method, co-resection, operative time and blood loss revealed as the risk factor of overall postoperative complication. And there was no significant differences of risk factor related to postoperative complication between initial and maturation surgical period. This suggests that beginners also can safely perform laparoscopic gastrectomy through the appropriate patient selection.