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Kang, Sang Yull,Park, Ho Sung,Kim, Chan-Young The Korean Surgical Society 2016 Annals of Surgical Treatment and Research(ASRT) Vol.90 No.5
<P><B>Purpose</B></P><P>Depth of wall invasion is an important prognostic factor in patients with gastric cancer, whereas the prognostic significance of intraoperative macroscopic serosal invasion (mSE) findings remain unclear when they show a discrepancy in pathologic findings. This study, therefore, assessed the prognostic significance of mSE.</P><P><B>Methods</B></P><P>Data from cohort of 2,835 patients with resectable gastric cancer who underwent surgery between 1990 and 2010 were retrospectively reviewed.</P><P><B>Results</B></P><P>The overall accuracy of mSE and pathologic results was 83.4%. The accuracy of mSE was 75.5% in pT2. On the other hand, the accuracy of pT3 dropped to 24.5%. According to mSE findings (+/–), the 5-year disease-specific survival (DSS) rate differed significantly in patients with pT2 (+; 74.2% <I>vs.</I> –; 92.0%), pT3 (+; 76.7% <I>vs.</I> –; 91.8%) and pT4a (+; 51.3% <I>vs.</I> –; 72.8%) (P < 0.001 each), but not in patients with T1 tumor. Multivariate analysis showed that mSE findings (hazard ratio [HR], 2.275; 95% confidence interval [CI], 1.148–4.509), tumor depth (HR, 6.894; 95% CI, 2.325–20.437), nodal status (HR, 5.206; 95% CI, 2.298–11.791), distant metastasis (HR, 2.881; 95% CI, 1.388–6.209), radical resection (HR, 2.002; 95% CI, 1.017–3.940), and lymphatic invasion (HR, 2.713; 95% CI, 1.424–5.167) were independent predictors of 5-year DSS rate.</P><P><B>Conclusion</B></P><P>We observed considerable discrepancies between macroscopic and pathologic diagnosis of serosal invasion. However, macroscopic diagnosis of serosal invasion was independently prognostic of 5-year DSS. It suggests that because the pathologic results could not be perfect and the local inflammatory change with mSE(+) could affect survival, a combination of mSE(+/–) and pathologic depth may be predictive of prognosis in patients with gastric cancer.</P>
Kang, Sang-Yull,Lee, Se-Youl,Kim, Chan-Young,Yang, Doo-Hyun The Korean Gastric Cancer Association 2010 Journal of gastric cancer Vol.10 No.4
Purpose: Most stomach surgeons have been educated sufficiently in conventional open distal gastrectomy (ODG) but insufficiently in laparoscopy-assisted distal gastrectomy (LADG). We compared learning curves and clinical outcomes between ODG and LADG by a single surgeon who had sufficient education of ODG and insufficient education of LADG. Materials and Methods: ODG (90 patients, January through September, 2004) and LADG groups (90 patients, June 2006 to June 2007) were compared. The learning curve was assessed with the mean number of retrieved lymph nodes, operation time, and postoperative morbidity/mortality. Results: Mean operation time was 168.3 minutes for ODG and 183.6 minutes for LADG. The mean number of retrieved lymph nodes was 37.9. Up to about the 20th to 25th cases, the slope decrease in the learning curve for LADG was more apparent than for ODG, although they both reached plateaus after the 50th cases. The mean number of retrieved lymph nodes reached the overall mean after the 30th and 40th cases for ODG and LADG, respectively. For ODG, complications were evenly distributed throughout the subgroups, whereas for LADG, complications occurred in 10 (33.3%) of the first 30 cases. Conclusions: Compared with conventional ODG, LADG is feasible, in particular for a surgeon who has had much experience with conventional ODG, although LADG required more operative time, slightly more time to get adequately retrieved lymph nodes and more complications. However, there were more minor problems in the first 30 LADG than ODG cases. The unfavorable results for LADG can be overcome easily through an adequate training program for LADG.
Sang Yull Kang,Se Youl Lee,김찬영,양두현 대한위암학회 2010 Journal of gastric cancer Vol.10 No.4
Purpose: Most stomach surgeons have been educated sufficiently in conventional open distal gastrectomy (ODG) but insufficiently in laparoscopy-assisted distal gastrectomy (LADG). We compared learning curves and clinical outcomes between ODG and LADG by a single surgeon who had sufficient education of ODG and insufficient education of LADG. Materials and Methods: ODG (90 patients, January through September, 2004) and LADG groups (90 patients, June 2006 to June 2007) were compared. The learning curve was assessed with the mean number of retrieved lymph nodes, operation time, and postoperative morbidity/mortality. Results: Mean operation time was 168.3 minutes for ODG and 183.6 minutes for LADG. The mean number of retrieved lymph nodes was 37.9. Up to about the 20th to 25th cases, the slope decrease in the learning curve for LADG was more apparent than for ODG, although they both reached plateaus after the 50th cases. The mean number of retrieved lymph nodes reached the overall mean after the 30th and 40th cases for ODG and LADG, respectively. For ODG, complications were evenly distributed throughout the subgroups, whereas for LADG, complications occurred in 10 (33.3%) of the first 30 cases. Conclusions: Compared with conventional ODG, LADG is feasible, in particular for a surgeon who has had much experience with con-ventional ODG, although LADG required more operative time, slightly more time to get adequately retrieved lymph nodes and more com-plications. However, there were more minor problems in the first 30 LADG than ODG cases. The unfavorable results for LADG can be overcome easily through an adequate training program for LADG.
Sang Yull Kang,Seon Kwang Kim,Hyun Jo Youn,Sung Hoo Jung 대한갑상선-내분비외과학회 2016 The Koreran journal of Endocrine Surgery Vol.16 No.1
A non-recurrent laryngeal nerve is a rare anatomical variant that entails considerable riskfor iatrogenic injury during thyroid surgery. We encountered a patient with a non-recurrentlaryngeal nerve that went unnoticed on preoperative imaging but was discoveredincidentally during robotic thyroidectomy. A 44 year old woman presented at ourdepartment with papillary thyroid microcarcinoma, diagnosed by ultrasonography-guidedfine needle aspiration cytology. During robotic right thyroidectomy and central lymphnode dissection, we could not detect any structure resembling the recurrent laryngeal nervearound the inferior thyroid artery. Thus, we suspected the existence of a non-recurrentlaryngeal nerve, and successfully identified a nerve entering the larynx directly from thevagus nerve without recurring. A three-dimensional high magnification view via a roboticendoscope can aid thyroid surgeons to safely identify and preserve a non-recurrentlaryngeal nerve.
Sang Yull Kang,Ho Sung Park,Chan-Young Kim 대한외과학회 2016 Annals of Surgical Treatment and Research(ASRT) Vol.90 No.5
Purpose: Depth of wall invasion is an important prognostic factor in patients with gastric cancer, whereas the prognostic significance of intraoperative macroscopic serosal invasion (mSE) findings remain unclear when they show a discrepancy in pathologic findings. This study, therefore, assessed the prognostic significance of mSE. Methods: Data from cohort of 2,835 patients with resectable gastric cancer who underwent surgery between 1990 and 2010 were retrospectively reviewed. Results: The overall accuracy of mSE and pathologic results was 83.4%. The accuracy of mSE was 75.5% in pT2. On the other hand, the accuracy of pT3 dropped to 24.5%. According to mSE findings (+/–), the 5-year disease-specific survival (DSS) rate differed significantly in patients with pT2 (+; 74.2% vs. –; 92.0%), pT3 (+; 76.7% vs. –; 91.8%) and pT4a (+; 51.3% vs. –; 72.8%) (P < 0.001 each), but not in patients with T1 tumor. Multivariate analysis showed that mSE findings (hazard ratio [HR], 2.275; 95% confidence interval [CI], 1.148–4.509), tumor depth (HR, 6.894; 95% CI, 2.325–20.437), nodal status (HR, 5.206; 95% CI, 2.298–11.791), distant metastasis (HR, 2.881; 95% CI, 1.388–6.209), radical resection (HR, 2.002; 95% CI, 1.017–3.940), and lymphatic invasion (HR, 2.713; 95% CI, 1.424–5.167) were independent predictors of 5-year DSS rate. Conclusion: We observed considerable discrepancies between macroscopic and pathologic diagnosis of serosal invasion. However, macroscopic diagnosis of serosal invasion was independently prognostic of 5-year DSS. It suggests that because the pathologic results could not be perfect and the local inflammatory change with mSE(+) could affect survival, a combination of mSE(+/–) and pathologic depth may be predictive of prognosis in patients with gastric cancer.
갑상선 유두암에서 전이 림프절 비율의 예후 인자적 가치
강상율(Sang Yull Kang),김선광(Seon Kwang Kim),윤현조(Hyun Jo Youn),정성후(Sung Hoo Jung) 대한갑상선-내분비외과학회 2015 The Koreran journal of Endocrine Surgery Vol.15 No.3
Purpose: Metastatic lymph node ratio (MLNR) is known as an important prognostic factor in many solid carcinomas; however, the role of MLNR in papillary thyroid carcinoma (PTC) is unclear. The purpose of this study was to determine whether MLNR has prognostic significance for recurrence in patients with pathological N1a PTC. Methods: A retrospective analysis was conducted of 1,198 patients with PTC who underwent total thyroidectomy with central neck dissection between 2006 and 2011. Only patients with central lymph node metastasis were included in this study. Patients with lateral neck lymph node metastasis or extrathyroidal involvement were excluded. Finally, this study included 282 patients with N1a patients. MLNR was defined as the number of metastatic lymph nodes divided by the number of removed lymph nodes. Results: Median age was 47.3 years (17∼73 years). There were 209 female patients and 41 male patients, respectively. Median follow-up period was 53 months (36∼114 months). Median value of MLNR was 0.36 (0.04∼1.000). Of 250 patients, 20 patients (8.0%) developed recurrent disease. MLNR independently predicted PTC recurrence (odds ratio [OR], 6.385; 95% confidence interval [CI], 2.523-16.158; P < 0.001). In receiver operating characteristic curve analysis, 0.47 was significantly meaningful for recurrence when three or more lymph nodes were collected. Conclusion: MLNR is an independent predictor of PTC recurrence in patients with pathological N1a PTC. Therefore, N1a patients with MLNR > 0.47 should be monitored closely for recurrence.