미분화 췌장암

전광식(Kwang-Sik Chun),송인상(In-Sang Song) 대한외과학회 2008 Annals of Surgical Treatment and Research(ASRT) Vol.74 No.6

Local invasion or distant metastasis is frequently seen in patients with anaplastic carcinoma at the time of presentation, and this is unlike the usual cases of pancreatic carcinoma. So most cases of anaplastic carcinoma are confirmed by autopsy. We report here on our experiences of two cases of the anaplastic pancreatic carcinoma that were confirmed by the postoperative pathology. From January 2006 to December 2006, two patients at Chung-Nam National University Hospital were postoperatively diagnosed as having anaplastic carcinoma of the pancreas. The clinicopathologic data of these patients was reviewed. Case 1) A seventy-years-old male was admitted to our hospital due to his left abdominal pain. On physical examination, there was ill-defined palpable mass on the left upper abdomen. The CA 19-9 level was 4.8 (U/㎖). On the abdominal CT scans, a 14.8 cm sized cystic mass with a mild enhancing internal solid portion was detected. He underwent distal pancreatectomy, total gastrectomy and segmental resection of the transverse colon due to direct invasion. The mass was pathologically confirmed as anaplastic pancreatic carcinoma. Postoperatively 3 months later, multiple liver and lymph node metastases were detected on the follow-up CT scan. Case 2) A sixty-five years-old female was referred to our department for a splenic hilar mass that involved the distal pancreas. The CA19-9 level was 3.18 (U/㎖). On the preoperative CT scan, an 8.0 cm sized irregular mass with heterogenous contrast enhancement was detected on the tail of the pancreas. She underwent distal pancreatectomy with splenectomy and segmental resection of the transverse colon due to direct invasion. On the pathology report, the pancreatic mass was revealed to be anaplastic carcinoma of the pancreas. One month later, a recurred pancreatic mass and multiple liver and peritoneal metastases were detected on the follow-up CT scan. Anaplastic pancreatic carcinomas show distinctive aggressive behavior and a dismal prognosis.

직장 결장암의 간전이 환자에서 VEGF-A, C, D 발현의 비교연구

전광식(Kwang-Sik Chun),이경하(Kyung-Ha Lee),송인상(In-Sang Song),김지연(Ji-Yeon Kim),김제룡(Je-Ryong Kim),안문상(Moon-Sang Ahn),이상일(Sang-Il Lee),박종현(Jong-Hyun Park),최송이(Song-E Choi),강대영(Dae-Young Kang),송규상(Kyu-Sang Son 대한외과학회 2009 Annals of Surgical Treatment and Research(ASRT) Vol.76 No.5

Purpose: We aimed to investigate the correlations between expressions of angiogenic cytokines VEGF-A, C, D of primary colorectal cancer and liver metastasis. Methods: We examined paraffin-embedded primary colorectal cancer tissue from 45 patients who had liver resection due to colorectal liver metastasis (metastasis group) and 37 patients who had surgical resection due to colorectal cancer only (control group). In the control group, local recurrence and distant metastasis had not occurred. Immunohistochemical staining for VEGF-A, C and D was performed. We analysed the correlations between expression of VEGF-A, C and D in primary colorectal cancer tissues and clinicopathologic parameters. Results: VEGF-A expressions of primary colorectal carcinoma were not different between the two groups. VEGF-C was more frequently expressed in the metastasis group (P=0.008) but VEGF-D was more expressed in the control group (P=0.003). Patients with VEGF-C negative and VEGF-D positive expression were predominant in the control group (P=0.020). Tumor location, T stage, lymph node metastasis and tumor differentiation were not related with the expressions of VEGF-A, C, D but only preoperative CEA was positively correlated with VEGF-A and C expression. Conclusion: Expressions of VEGF-C in primary tumor were more frequent in metastatic colorectal cancer and expressions of VEGF-D were more frequent in nonmetastatic colorectal cancer. More large-scale prospective studies for VEGF-C and D expression in colorectal cancer are necessary.

내시경적 치료에 실패한 총담관석 환자에서의 복강경 총담관 탐색술

신형섭(Hyoung Seob Shin),전광식(Kwang Sik Chun),송인상(In Sang Song) 한국간담췌외과학회 2009 한국간담췌외과학회지 Vol.13 No.3

Purpose : Laparoscopic common bile duct exploration (LCBDE) has more advantages than conventional common bile duct surgery, but the use of this route for stone removal and biliary drainage remains controversial. The goal of this study was to investigate the usefulness of LCBDE in patients who had been failed in the endoscopic stone extraction. Methods : From November 2005 to August 2008, 52 patients aunderwent LCBDE due to failure of endoscopic stone extraction in Chungnam National University Hospital. Clinical data were collected and analyzed retrospectively. Results : Duodenal diverticulum (23 cases, 44.2%) was the most common cause in failure of endoscopic stone extraction and large common bile duct stone 12 cases (23.1%), previous upper gastrointestinal operation 10 cases (19.2%) were followed. Twenty four patients did not have preoperative biliary drainage, such as PTBD, ENBD, PTGBD. Forty-five patients (86.5%) of the 52 participating patients underwent LCBDE successfully, but 7 cases resulted in open surgery for the following reasons: 3 cases of severe intraabdominal adhesions, 3 cases of stone impaction in ampulla portion, and 1 case of a remnant stone. Extemal biliary drainage was performed in 41 cases with T-tube (31 cases, 68.9%), PTBD(7 cases, 15.6%), ENBD (3 cases, 6.7%). The stone clearance of LCBDE was 95.6%. Remnant stone were detected in 2 cases (4.4%) and removed with choledochoscope via extemal biliary drain. Postoperative complications happened in 5 cases (9.5%). Procedure related complications happened in 2 cases (3.8%). Conclusion : LCBDE is useful technique in patients with failed endoscopic stone extraction, and biliary drainage may be necessary for detection and removal of latent remnant CBD stones.

급성 괴사성 담낭염의 임상적 예측 인자에 대한 연구

지종태(Jong Tae Jee),전광식(Kwang Sik Chun),송인상(In Sang Song) 한국간담췌외과학회 2007 한국간담췌외과학회지 Vol.11 No.4

전 복강경 술식에 의한 우간절제술

윤유석(Yoo-Seok Yoon),한호성(Ho-Seong Han),신상현(Sang-Hyun Shin),전광식(Kwang-Sik Chun),장진영(Jin-Young Jang),서경석(Kyung-Suk Suh),김선회(Sun-Whe Kim),이건욱(Kuhn Uk Lee),박용현(Yong-Hyun Park) 대한외과학회 2007 Annals of Surgical Treatment and Research(ASRT) Vol.72 No.4

Until now, reports on laparoscopic liver resections have mainly involved the antero-lateral segments (Couinaud segments Ⅱ∼Ⅵ), but those on laparoscopic major liver resection including a right hepatectomy are rare. Herein, we report on two total laparoscopic right hepatectomy cases. One patient was a 69-year-old female, with a hepatocellular carcinoma, and the other a 59-year-old female, with right intrahepatic duct stones. A total laparoscopic right hepatectomy was performed using four or five trocars. After cholecystectomy, the right liver was dissected from the IVC and surrounding ligaments until the right hepatic vein was visualized. After full mobilization of the right liver, the right portal vein, hepatic artery and bile duct were dissected and individually divided. The hepatic parenchyma was dissected along the ischemic line, using a Harmonic scalpel, into the superficial parenchyma and CUSA into the deep parenchyma. The large branches of the hepatic veins were controlled with endoclips. The right hepatic vein was transected with endo-GIA. The epigastric trocar site was extensionally incised for removal of the specimen. The operative times were 385 and 480 minutes the first and second case, respectively. Intraoperative transfusion was needed in the second patient due to biliary cirrhosis and distorted anatomy associated with an IHD stone. The two patients were discharged on postoperative days 15 and 6, respectively, without postoperative complications. These cases confirm that a total laparoscopic right hepatectomy is a feasible and safe operation. However, the technical problems, such as long operation time and bleeding during liver parenchymal resection, should be resolved in order that this procedure can be accomplished more safely.

혈흉을 동반한 췌흉강루

설영훈(Young-Hoon Sul),신형섭(Hyoung-Seob Shin),이경하(Kyung-Ha Lee),전광식(Kwang-Sik Chun),송인상(In-Sang Song) 대한외과학회 2009 Annals of Surgical Treatment and Research(ASRT) Vol.76 No.3

Pancreaticopleural fistula is an uncommon complication of chronic pancreatitis. We report a case of pancreaticopleural fistula that was presented with right-sided hemothorax. A 49-year-old male with a history of chronic alcoholism was presented with a month of dyspnea. A chest radiography showed a right-sided massive pleural effusion with old-blood-colored fluids and amylase levels of 1,020 IU/L. On the chest computerized tomography (CT), there was pleural effusion and a well-defined tract from the posterior mediastinum to the pseudocyst in the tail of the pancreas. Even with conservative treatment with closed thoracostomy, octreotide and gabexate mesilate, he developed hemothorax. Abdominal CT revealed an increase of the hemorrhagic pancreatic pseudocyst. Distal pancreatectomy with splenectomy and external drainage of the pancreaticopleural fistula on the posterior mediasternum were performed. The patient had an uneventful course and was discharged on the 27th postoperative day. Management of pancreaticopleural fistula is multimodal included medication, endoscopic stenting and surgery. Surgery in pancreaticopleural fistula might be beneficial in selective cases.

위장관 기질종양의 10년 수술 성적

이경하(Kyung-Ha Lee),송인상(In-Sang Song),설지영(Ji-Young Sul),김지연(Ji-Yeon Kim),전광식(Kwang-Sik Chun),이상일(Sang-Il Lee),강대영(Dae-Young Kang),최송이(Song-I Choi),노승무(Seung-Moo Noh) 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.78 No.6

Purpose: Gastrointestinal stromal tumors (GISTs) possess highly variable clinical behaviors and the study thereof is insufficient. There are no standard guidelines for diagnosis and treatment of GISTs, so it is difficult to predict recurrences and conduct appropriate treatments. Throughout the last 10 years of experiences with GIST patients, we have identified the variables predicting recurrences and classified the risk groups by NIH classification, Fletcher risk stratification and UICC TNM stage. Methods: From January 1998 to December 2007, 88 patients with pathologic confirm and surgical resection were diagnosed with GISTs. GISTs were diagnosed when the tumor had characteristic histologic features and confirmed positive by KIT, CD34, or PDGFRA. Results: The size, mitotic index, existence of symptoms, and origins of tumor correlate statistically with recurrence (0.002, <0.001, 0.027, 0.011). The NIH classification, Fletcher risk stratification and UICC TNM stage are correlated with recurrence (0.001, <0.001, <0.001) and 5 year disease free survival, statistically (0.009, <0.001, <0.001). Fifteen patients experienced recurrences. 14 patients were treated with imatinib, and 6 of them showed a response to the treatment. All 4 patients who had R1 resection did not survived due to the progression of the disease. Conclusion: The patients with large, high mitotic index, symptomatic, or extra-gastric tumor require strict surveillance. Also, patients with low risk must be under surveillance due to the possibility of recurrence. It is important to perform R0, en bloc resection. Although the imatinib is the treatment of choice with recurred or metastatic GISTs, the disease is likely to develop resistance, further studies on newly targeted therapy is in need.

전 복강경 술식에 의한 간 절제술에 대한 경험

김창균(Chang Gyun Kim),윤유석(Yoo-Seok Yoon),한호성(Ho-Seong Han),신상현(Sang-Hyun Shin),전광식(Kwang-Sik Chun),장진영(Jin-Young Jang),서경석(Kyung-Suk Suh),김선회(Sun-Whe Kim),이건욱(Kuhn Uk Lee),박용현(Yong-Hyun Park) 대한외과학회 2007 Annals of Surgical Treatment and Research(ASRT) Vol.73 No.6

Purpose: The aim of this study is to assess the feasibility and clinical outcomes of laparoscopic liver resection by reviewing our experience of laparoscopic liver resection performed in a single institution. Methods: We retrospectively analyzed the clinical outcome of 64 patients that had undergone laparoscopic liver resection for various liver diseases between May 2003 and June 2006. Results: The patients were composed of 36 men and 28 women, with a mean age of 56.9 years. Indications for laparoscopic liver resection included 37 cases of a tumor (20 hepatocellular carcinomas, 8 metastatic cancers and 9 benign tumors) and 25 cases of IHD stones. The surgical procedures were 19 tumorectomy cases, 24 left lateral sectionectomy cases, 15 left hepatectomy cases, 4 right posterior sectionectomy cases and 2 right hepatectomy cases. The mean surgical time was 280.3 minutes. Intraoperative transfusion was required for 18 patients (28.1%). There was one postoperative death (1.6%) due to biliary sepsis after a left lateral sectionectomy for an IHD stone. Postoperative complications developed in 9 cases (14.0%) (2 intraabdominal abscesses, 1 hematoma, 1 bile leakage, 1 ascites, 1 gastric variceal bleeding, 1 ulcer bleeding and 1 anastomosis leakage), all of which were improved by conservative management. The mean postoperative hospital stay was 11.0 days. Conclusion: Our experience shows that laparoscopic liver resection is a feasible operation and is comparable to surgery with the open method. However, a prospective comparative study with long term follow-up is needed to confirm the equivalence of the procedures.

직장-결장 수술 후 발생가능한 고아밀라제혈증의 임상적 고찰

전광식,윤완희 대한대장항문학회 2002 Annals of Coloproctolgy Vol.18 No.5