Balloon dilatation of the pylorus for delayed gastric emptying after esophagectomy

Kim, Jae-Hyun,Lee, Hyun-Sung,Kim, Moon Soo,Lee, Jong Mog,Kim, Seok Ki,Zo, Jae Ill Elsevier 2008 European journal of cardio-thoracic surgery Vol.33 No.6

<P><B>Abstract</B></P><P><B>Objective:</B> Delayed gastric emptying after esophageal operations occurs in up to 50% of patients. A good quality of life, in long-term survivors after esophagectomy, may depend on both dietary adaptation and the improvement of intrathoracic gastric motility itself. The objective of this study was to investigate the effect of pyloric balloon dilatation on the sustained delay of gastric emptying after esophagectomy. <B>Methods:</B> Two hundred and fifty-seven patients underwent esophagectomy with a gastric conduit from January 2003 to December 2006. A gastric drainage procedure was routinely performed during the esophagectomy. The intrathoracic gastric emptying of solid food was evaluated by radioisotope imaging. A 50% gastric emptying time over 180min was defined as delayed. We assessed the changes of the intrathoracic gastric emptying time, and the symptoms after balloon dilatation of the pylorus, associated with delayed gastric emptying. <B>Results:</B> Balloon dilatation of the pylorus was performed in 21 patients (8%) who had sustained symptoms of delayed gastric emptying after esophagectomy for esophageal cancer despite the use of prokinetics. The symptoms associated with delayed gastric emptying were improved after balloon dilatation of the pylorus in all patients. Pyloric balloon dilatation was performed twice in two patients. In seven of 19 patients (37%), who had a follow-up gastric emptying study, the delayed gastric emptying rate for 180min was improved from 30% to 88%. Six patients had slightly improved results, and six patients had no increase in the rate of gastric emptying compared with the previous gastric emptying study. <B>Conclusions:</B> After balloon dilatation of the pylorus, two thirds of patients with delayed gastric emptying show increased rates of gastric emptying as measured by radioisotope imaging. Mechanical balloon dilatation of the pylorus is a useful method to treat sustained delay of intrathoracic gastric emptying after esophagectomy.</P>

EBUS-centred versus EUS-centred mediastinal staging in lung cancer: a randomised controlled trial

Kang, Hyo Jae,Hwangbo, Bin,Lee, Geon-Kook,Nam, Byung-Ho,Lee, Hyun-Sung,Kim, Moon Soo,Lee, Jong Mog,Zo, Jae Ill,Lee, Hee Seok,Han, Ji-Youn BMJ Publishing Group Ltd 2014 Thorax Vol.69 No.3

<P><B>Background</B></P><P>The impact of procedure sequence and primary procedure has not been studied in the combined application of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in lung cancer staging.</P><P><B>Methods</B></P><P>In a randomised controlled trial, 160 patients with histologically confirmed or strongly suspected potentially operable non-small cell lung cancer were enrolled (Group A, n=80, EBUS-centred; Group B, n=80, EUS-centred). EBUS-TBNA and EUS-FNA with an ultrasound bronchoscope were used as the first procedures in Groups A and B, respectively, and secondary procedures (EUS-FNA in Group A, EBUS-TBNA in Group B) were added.</P><P><B>Results</B></P><P>Diagnostic values were evaluated in 148 patients (74 in each group). In Groups A and B the diagnostic accuracy (93.2% (95% CI 87.5% to 99.0%) vs 97.3% (95% CI 93.6% to 101.0%), p=0.245) and sensitivity (85.3% (95% CI 68.9% to 95.0%) vs 92.0% (95% CI 74.0% to 99.0%), p=0.431) in detecting mediastinal metastasis were not statistically different. In Group A, adding EUS-FNA to EBUS-TBNA did not significantly increase the accuracy (from 91.9% to 93.2%, p=0.754) or sensitivity (from 82.4% to 85.3%, p=0.742). In group B, adding EBUS-TBNA to EUS-FNA increased the accuracy (from 86.5% to 97.3%, p=0.016) and sensitivity (from 60.0% to 92.0%, p=0.008). There were no intergroup differences in procedure time, cardiorespiratory parameters during procedures, complications or patient satisfaction.</P><P><B>Conclusions</B></P><P>Using a combination of EBUS-TBNA and EUS-FNA in mediastinal staging, we found that diagnostic values and patient satisfaction were not different between the EBUS-centred and EUS-centred groups. However, the necessity for EBUS-TBNA following EUS suggests that EBUS-TBNA is a better primary procedure in endoscopic mediastinal staging of potentially operable lung cancer.</P><P><B>Trial Registration number</B></P><P>ClinicalTrials.gov number NCT01385111.</P>

Resection of extrahepatic metastasis with curative intent after hepatectomy for hepatocellular carcindoma

Hyung Joong Jung,Sang Jae Park,Sung Sik Han,Hyun Sung Lee,Seong Hoon Kim,Soon Ae Lee,Moon Soo Kim,Kwang Woong Lee,Jong Mog Lee,Woo Jin LEE,Joong Won Park,Eun Kyoung Hong,Jae Ill Zo 대한간학회 2008 Clinical and Molecular Hepatology(대한간학회지) Vol.14 No.3(S)

S-19 Influence of esophagectomy on the gastroesophageal reflux in patients with esophageal cancer

( Dongwuk Kim ),( Yang Won Min ),( Jae Geun Park ),( Hyuk Lee ),( Byung-hoon Min ),( Jun Haeng Lee ),( Poong-lyul Rhee ),( Jae J. Kim ),( Jae Ill Zo ) 대한내과학회 2016 대한내과학회 추계학술대회 Vol.2016 No.1

Background/Aims: The present study aimed to assess the influence of esophagectomy with gastric transposition on the gastroesophageal reflux (GER) and gastric acidity in patients with esophageal cancer.?Methods: Fifty-three esophageal cancer patients who underwent 24-hour impedance-pH monitoring after esophagectomy were retrospectively analyzed. We used a solid state esophageal pH probe in which esophageal pH sensor was placed 1.5 cm distal to the upper esophageal sphincter and gastric pH sensor is located 15 cm distal to esophageal pH channel. 24-hour impedance-pH monitoring data and other clinical data including anastomosis site stricture and pneumonia were collected. We defined pathologic reflux with reference to known normative data. Stricture was defined when intervention such as bougienage or balloon dilatation was required to relief dysphagia.?Results: Esophageal and gastric mean pH was 5.47±1.51 and 3.33±1.64, respectively. Percent time of acidic pH (<4) was 6.66±12.49% in the esophagus and 70.53±32.19% in the stomach. Esophageal pathologic acid reflux was noticed in 32.1%, 20.8%, and 35.8% during total, upright, and recumbent time, respectively. Esophageal pathologic bolus reflux was noticed in 83.0%, 77.4%, and 64.2% during total, upright, and recumbent time, respectively. Gastric acidity increased with time after esophagectomy. Esophageal acid exposure time correlated with intragastric pH. However, esophageal pathologic acid reflux was not associated with anastomosis site stricture and pneumonia.?Conclusions: GER frequently occurs after esophagectomy. Strict life-style modification and acid suppression seems necessary to manage GER in patients underwent esophagectomy.

Prediction of Occult Lymph Node Metastasis by Metabolic Parameters in Patients with Clinically N0 Esophageal Squamous Cell Carcinoma

Moon, Seung Hwan,Kim, Ho Seong,Hyun, Seung Hyup,Choi, Yong Soo,Zo, Jae Ill,Shim, Young Mog,Lee, Kyung-Han,Kim, Byung-Tae,Choi, Joon Young Society of Nuclear Medicine 2014 The Journal of nuclear medicine Vol.55 No.5

<P>The aim of this study was to investigate the value of <SUP>18</SUP>F-FDG parameters of the primary tumor in predicting occult lymph node metastasis in patients with clinically N0 esophageal squamous cell carcinoma. <B>Methods:</B> The study comprised 143 consecutive patients (mean age ± SD, 63.9 ± 8.6 y; range, 31.8–81.2 y) from May 2003 to January 2010 who had clinically N0 esophageal squamous cell carcinoma based on preoperative imaging studies including chest CT, <SUP>18</SUP>F-FDG PET/CT, and endoscopic ultrasound. We measured maximum standardized uptake value (SUV<SUB>max</SUB>), mean SUV (SUV<SUB>mean</SUB>), total lesion glycolysis (TLG), and metabolic tumor volume (MTV) of the primary tumor and analyzed the relationship between clinicopathologic variables including PET parameters and occult lymph node metastasis using a logistic regression model. <B>Results:</B> Univariate analysis indicated that clinical T classification, SUV<SUB>max</SUB>, SUV<SUB>mean</SUB>, MTV, TLG, and longitudinal diameter of tumor were significant risk factors associated with occult lymph node metastasis. Optimal thresholds were cT2–4, SUV<SUB>max</SUB> ≥ 4.8, SUV<SUB>mean</SUB> ≥ 3.2, MTV ≥ 5.5 cm<SUP>3</SUP>, TLG ≥ 220, and diameter ≥ 3.8 cm. After multivariate analysis, the logistic regression model revealed that clinical T classification (hazard ratio [HR], 4.6; 95% confidence interval [CI], 1.7–12.4; <I>P</I> = 0.003) and SUV<SUB>max</SUB> (HR, 3.5; 95% CI, 1.3–9.2; <I>P</I> = 0.012) were independent risk factors. The combination of SUV<SUB>max</SUB> and clinical T classification (HR, 13.2; 95% CI, 5.4–31.9; <I>P</I> < 0.001) was a significantly better powerful risk factor for occult lymph node metastasis than SUV<SUB>max</SUB> or clinical T classification alone. Sensitivity, specificity, positive predictive value, and negative predictive value of the combination of clinical T classification and SUV<SUB>max</SUB> were 73.0%, 81.5%, 60.0%, and 89.7%, respectively. <B>Conclusion:</B> SUV<SUB>max</SUB>, combined with clinical T classification, may be useful for predicting occult lymph node metastasis in patients with clinically N0 squamous cell carcinoma of the esophagus.</P>

Dose-volumetric Parameters for Predicting Severe Radiation Pneumonitis after Three-dimensional Conformal Radiation Therapy for Lung Cancer

Kim, Tae Hyun,Cho, Kwan Ho,Pyo, Hong Ryull,Lee, Jin Soo,Zo, Jae Ill,Lee, Dae Ho,Lee, Jong Mog,Kim, Hyae Young,Hwangbo, Bin,Park, Sung Yong,Kim, Joo Young,Shin, Kyung Hwan,Kim, Dae Yong Radiological Society of North America 2005 Radiology Vol.235 No.1

<P>PURPOSE: To retrospectively evaluate dose-volumetric parameters for association with risk of severe (grade >/=3) radiation pneumonitis (RP) in patients after three-dimensional (3D) conformal radiation therapy for lung cancer. MATERIALS AND METHODS: The study was approved by the institutional review board, which did not require informed consent. Data from 76 patients (66 men, 10 women; median age, 60 years; range, 35-79 years) with histologically proved lung cancer treated curatively with 3D conformal radiation therapy between August 2001 and October 2002 were retrospectively analyzed. Twenty patients underwent surgery before radiation therapy; 57 patients received chemotherapy. Median total radiation dose of 60 Gy (range, 54-66 Gy) was delivered in 30 (range, 27-33) fractions over 6 weeks. RP was scored by using Radiation Therapy Oncology Group criteria. Clinical parameters were analyzed. Dose-volumetric parameters analyzed were percentage of lung volume that received a dose of 20 Gy or more (V20), 30 Gy or more (V30), 40 Gy or more (V40), or 50 Gy or more (V50); mean lung dose (MLD); normal tissue complication probability (NTCP); and total dose. Fisher exact test was performed to compare clinical parameters between patients who developed severe RP and those who did not. Univariate and multivariate logistic regression analyses were performed to evaluate data for association between dose-volumetric parameters and severe RP. Pearson chi(2) test was used to assess data for correlations among dose-volumetric parameters. P < or = .05 was considered to indicate statistically significant difference. RESULTS: Of 76 patients, 30 (39%) did not develop RP; 23 (30%) developed RP of grade 1; 11 (14%), grade 2; 11 (14%), grade 3; and 1 (1%), grade 4. None had grade 5 RP. Age (< 60 vs > or =60), sex, Karnofsky performance status (< 70 vs > or =70), forced expiratory volume in 1 second, presence of weight loss, preexisting lung disease, history of thoracic surgery, and history of chemotherapy did not significantly differ between patients who developed severe RP and those who did not. In univariate analyses, MLD, V20, V30, V40, V50, and NTCP were associated with severe RP (P < .05). In multivariate analysis, MLD was the only variable associated with severe RP. CONCLUSION: MLD is a useful indicator of risk for development of severe RP after 3D conformal radiation therapy in patients with lung cancer.</P>

FDG-PET in Mediastinal Nodal Staging of Non-small Cell Lung Cancer: Correlation of False Results with Histopathologic Finding

Hee Jong Baek,Jin-Haeng Chung,Jong-Ho Park,Jae Ill Zo,Gi Jeong Cheon,Chang-Woon Choi,Sang-Moo Lim,Soo Yong Choi,Jong Myeon Hong,Jang Soo Hong 대한암학회 2003 Cancer Research and Treatment Vol.35 No.3

Treatment Patterns and Outcomes of Anastomotic Leakage after Esophagectomy for Esophageal Cancer

Seo Hyo Won,Jeon Yeong Jeong,조종호,김홍관,Choi Yong Soo,Zo Jae Ill,Shim Young Mog 대한심장혈관흉부외과학회 2024 Journal of Chest Surgery (J Chest Surg) Vol.57 No.2

Background: Anastomotic leakage (AL) following esophagectomy represents a serious complication that often results in prolonged hospitalization and necessitates repeated interventions, including nothing-by-mouth (NPO) restriction, endoscopic vacuum therapy (EVT), or surgical repair. In this study, we evaluated the patterns and outcomes of AL treatment. Methods: We retrospectively reviewed the medical records of patients who underwent esophagectomy for esophageal cancer at a single center between 2003 and 2020. Of 3,096 examined cases, 181 patients (5.8%) with AL were included in the study: 114 patients (63%) with cervical anastomosis (CA) and 67 (37%) with intrathoracic anastomosis (TA). Results: The incidence of AL was 11.9% in the CA and 3.2% in the TA group (p<0.001). Among patients with CA who developed AL, 87 (76.3%) were managed with NPO, 15 (13.2%) with EVT, and 12 (10.5%) with surgical repair. Over 90% of patients with cervical AL resumed an oral diet by the time of discharge, regardless of treatment method. Among patients with TA and AL, 36 (53.7%) received NPO, 25 (37.7%) underwent EVT, and 6 (9%) required surgery. Of these, 34 patients who were managed with NPO and 19 with EVT could resume an oral diet. However, only 2 patients who underwent surgery resumed an oral diet, and 2 patients required additional EVT. Conclusion: Although patients with CA displayed a higher incidence of AL, their rate of successful oral intake exceeded that of those with TA, regardless of treatment method. Among patients exhibiting AL with TA, EVT was more commonly employed than in CA cases, and it appears effective.

Verapamil 심정지액의 심근보호 효과에 관한 실험적 연구

박표원 ( Pyo Won Park ),성상현 ( Sang Hyun Sung ),조재일 ( Jae Ill Zo ),안재호 ( Jae Ho Ahan ),채수완 ( Soo Wan Chai ),이중기 ( Joong Ki Lee ) 국군의무사령부 1986 대한군진의학학술지 Vol.17 No.1

Employment Status and Work-Related Difficulties in Lung Cancer Survivors Compared With the General Population

Kim, Young Ae,Yun, Young Ho,Chang, Yoon Jung,Lee, Jongmog,Kim, Moon Soo,Lee, Hyun-Sung,Zo, Jae Ill,Kim, Jhingook,Choi, Yong Soo,Shim, Young Mog,Yoon, Seok-Jun by Lippincott Williams Wilkins. 2014 Annals of surgery Vol.259 No.3

OBJECTIVE:: To investigate the employment status of lung cancer survivors and the work-related problems they face. BACKGROUND:: Although the number of lung cancer survivors is increasing, little is known about their employment and work-related issues. METHODS:: We enrolled 830 lung cancer survivors 12 months after lung cancer curative surgery (median time after diagnosis, 4.11 years) and 1000 volunteers from the general population. All participants completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, Core 30-item and a questionnaire that included items relating to their jobs. We used logistic regression analysis to identify independent predictors of unemployment. RESULTS:: The employment rate of lung cancer survivors decreased from 68.6% at the time of diagnosis to 38.8% after treatment, which was significantly lower than the employment rate of the general population (63.5%; adjusted odds ratio = 2.31, 95% confidence interval: 1.66–3.22). The posttreatment unemployment rate was higher for women than for men. Among survivors, employment was inversely associated with older age, household income, number of comorbidities, and poor social functioning. Fatigue (78.6%) was the most common work-related problem reported by survivors. CONCLUSIONS:: Lung cancer survivors experienced more difficulties in employment than did the general population. Age, monthly household income, number of comorbidities, and social functioning appear to be important factors influencing employment status. These findings suggest that lung cancer survivors need support to cope with the financial impact of cancer.