폐쇄공 탈장 환자에 대한 경험 및 국내 보고 고찰

허승철(Seung Chul Heo),강성범(Sung-Bum Kang),정중기(Jung Kee Chung),황기태(Ki-Tae Hwang),유승범(Seungbum Ryoo),이택구(Taek-Gu Lee),박규주(Kyu-Joo Park) 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.78 No.1

Purpose: We performed this study to share experiences in the management of obturator hernia, which is a very rare disease among elderly women, because rarity of this disease will not approve an expert institute or surgeon and because the aging society, Korea, can increase the incidence. Methods: Patient characteristics, clinical manifestations and treatment results were retrospectively collected from the 12 obturator hernia patients since 2000 in the three hospitals of the authors. Twenty-one obturator hernia cases reported in the Korean literatures were reviewed. In addition, we analyzed clinical features and treatment results of the total 33 patients, collectively. Results: Most of the patients were elderly women except one young, poorly nourished, male patient with pulmonary tuberculosis. Their mean age was 79.6 years. Sixty-four percent (21/33) of the patients had preoperative morbidity. Symptoms from the compression of the obturator nerve, which is an important clue to the diagnosis, were observed in 67% (22/33). Interestingly, spontaneous or suspicious-spontaneous reductions were reported in 7 (21%) patients. Abdominal CT scan was the major tool for diagnosis. Abdominal approach alone could successfully manage most cases, though 84% (27/32) needed anastomosis of the bowel. Operative mortality was 2 of the 32 cases but morbidity was 44% of the 32 patients and the mean hospital period after operation was 21 days. Conclusion: Management of patients with obturator hernia connotes high morbidity and mortality. Sharing the experience of management, prompt diagnosis and surgical management and proper peri-operative care as well as appropriate managing the families is essential for improved results.

직장 신경내분비종양의 국소절제술 후 추적관찰 결과

권유민(Yoomin Kwon),유승범(Seung-Bum Ryoo),송인호(Inho Song),권윤혜(Yoon-Hye Kwon),이동운(Dong Woon Lee),문상희(Sang Hui Moon),박지원(Ji Won Park),정승용(Seung-Yong Jeong),박규주(Kyu Joo Park) 대한종양외과학회 2016 Korean Journal of Clinical Oncology Vol.12 No.2

Purpose: Neuroendocrine tumor is a rare tumor in the rectum, but incidence has been increasing. Local excision is an option for treatment of small tumors, and transanal excision or endoscopic resection can be undergone. But indications for local excision have not been established yet. This study was to compare the long-term oncologic outcomes between transanal excision and endoscopic resection for rectal neuroendocrine tumor. Methods: Patients diagnosed and treated with rectal neuroendocrine tumor from 2000 to 2015 were collected prospectively, and medical records were analyzed retrospectively. Results: Forty patients were included, mean age was 50.20±13.35 years (male:female=23:17). Transanal excision and endoscopic resection were performed in 28 (70%) and 12 (30%) patients, respectively. Mean tumor size was 0.63±0.37 cm, and tumor location was 5.45±1.89 cm from anal verge. Tumor location was more distal rectum in transanal excision (5.04±1.73 cm vs. 6.42±1.98 cm, P=0.049). Pathologic T stage was T1 in all patients. Most of the patients (90%) showed tumor grade 1. After median 24 months (range, 0–86 months) follow-up, one patient (2.5%) experienced local recurrence. The patient underwent further transanal excision. There was no mortality after local excision. Conclusion: Local excision is a safe and effective treatment for small-sized neuroendocrine tumors in rectum.

체질량 지수가 대장암 환자의 생존율에 미치는 영향

박상욱(Sang Wook Park),이동운(Dong-Woon Lee),박지원(Ji Won Park),유승범(Seung-Bum Ryoo),신루미(Rumi Shin),정승용(Seung-Yong Jeong),박규주(Kyu Joo Park) 대한종양외과학회 2016 Korean Journal of Clinical Oncology Vol.12 No.2

Purpose: The studies on the impact of obesity on survival for colorectal cancer (CRC) in Korea are still insufficient. The aim of this study is to evaluate body mass index (BMI) as a prognostic factor of CRC. Methods: From January 2006 to December 2008, a total of 1873 patients with CRC who underwent surgery at Seoul National University Hospital were included in this study. Study participants were divided into five BMI groups: underweight (<18.5 kg/m2), normal weight (18.5– 22.9 kg/m2), overweight (23–24.9 kg/m2), obese (25–29.9 kg/m2) and morbidly obese (≥30 kg/m2). Clinicopathological variables and survival data were reviewed retrospectively. Overall survival was analyzed using log-rank test and Cox regression analysis. Results: Overall survivals of underweight, normal weight, overweight, obese, and morbidly obese groups were significantly different (5-year overall survivals rates: 54.4%, 73.2%, 78.6%, 77.2%, and 53.8%, respectively; P<0.001). In multivariable analysis for overall survival, BMI was an independently significant risk factor. Normal weight, overweight, and obese groups had lower hazard ratios for overall survival than underweight group (hazard ratio [HR], 0.626; 95% confidence interval [CI], 0.462–0848, P=0.002; HR, 0.530, 95% CI, 0.377–0.744, P<0.001; HR, 0.511, 95% CI, 0.470–1.675, P<0.001, respectively). The hazard ratio of morbid obese group was not significantly different from that of underweight group (HR=0.887, 95% CI=0.470–1.675, P=0.712). Conclusion: BMI can be a prognostic factor for CRC in Korea. Underweight and morbidly obese were associated with poor overall survival. Large multicenter studies in the Korean population is needed for a definite conclusion.

재발한 대장암에서 재발 후 생존율에 영향을 미치는 위험인자 분석

김유미(Yu Mi Kim),박병관(Byung Kwan Park),박지원(Ji Won Park),한언철(Eon Chul Han),유승범(Seung-Bum Ryoo),정승용(Seung-Yong Jeong),박규주(Kyu Joo Park) 대한종양외과학회 2014 Korean Journal of Clinical Oncology Vol.10 No.2

Purpose: Recently, survival after recurrence (SAR) has been one of the major concerns after recurrence of colorectal carcinoma. To identify the risk factors about SAR is important as much as to identify the risk factors about recurrence. It provides us useful information for treatment strategy to know which patient will be expected with long term survival after recurrence. This study was aimed to identify the risk factors about overall SAR in recurred colorectal carcinoma. Methods: Between January 2002 and December 2005, two hundred twenty one patients, who had recurrence of colorectal carcinoma after initial curative resection at Seoul National University Hospital, were included. Clinicopathologic characteristics and survival outcomes were retrospectively reviewed. Survival analysis was performed to identify the risk factors for SAR. Results: Median recurrence time after initial curative resection was 22.5 months (range, 0?93.0 month). Median follow-up time after recurrence was 34.8 months (range, 0?130.0 month). In univariate analysis, low body mass index, preoperative elevated carcinoembryonic antigen (CEA) level, high grade histology, metastatic disease and perineural invasion were significant associated with poor SAR. In multivariate analysis, preoperative elevated CEA (hazard ratio [HR], 1.517; 95% confidence interval [CI], 1.088?2.114; P=0.014), high grade histology (HR, 2.307; 95% CI, 1.343?3.961; P=0.002) and treatment after recurrence (HR, 2.755; 95% CI, 1.374?5.524; P=0.004) were significant associated with poor SAR. Conclusion: Preoperative elevated CEA, high grade histology and treatment after recurrence were independent risk factors for SAR.

충수돌기에서 기인한 고등급 복막가성점액종의 반복적인 용적축소수술의 임상적 고찰

박정현(Jung Hyun Park),송인호(Inho Song),이동운(Dong Woon Lee),권윤혜(Yoon-Hye Kwon),김정기(Jeong-Ki Kim),문상희(Sang Hui Moon),박지원(Ji Won Park),유승범(Seung-Bum Ryoo),정승용(Seung-Yong Jeong),박규주(Kyu Joo Park) 대한종양외과학회 2016 Korean Journal of Clinical Oncology Vol.12 No.2

Purpose: To evaluate the effect of repeated debulking surgery for high-grade pseudomyxoma peritonei (PMP) originating from the appendix. Methods: Between January 1998 and December 2014, fifty patients, who underwent debulking surgery for high-grade PMP originating from the appendix, were obtained from a prospectively collected database and retrospectively analyzed. Two groups according to the number of operations were divided and analyzed. Results: A total of 118 operations were performed. Thirty-one patients received more than two operations. The median interval between operations was 18.2 months (range, 2–170 months). Complications developed after 26 operations (22.0%), including ileus (n=10), intra-abdominal fluid collection (n=7), surgical site infection (n=5), and others. There were two mortalities within 30 days after operation. Between two groups of patients who received one operation only and patients who received more than two operations, transfusion, diversion operation, and postoperative complication rate showed statistically significant differences. Two groups of patients had no differences in overall survival rates. Conclusion: Our results indicate that the number of operations does not affect the survival rate of high-grade appendiceal PMP, in which repeated debulking surgery is vital to relieve symptoms of the tumor burden.