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( Tae Wook Kong ),( Eun Ju Lee ),( Yonghee Lee ),( Suk Joon Chang ),( Joo Hyuk Son ),( Hee Sug Ryu ) 대한산부인과학회 2014 Obstetrics & Gynecology Science Vol.57 No.6
Cervical cancer is one of the most common malignancy diagnosed during pregnancy. The experience of the use of neoadjuvant chemotherapy (NACT) with paclitaxel plus cisplatin during pregnancy is limited. Three pregnant women with International Federation of Gynecology and Obstetrics (FIGO) stage IB cervical cancer received NACT with paclitaxel plus cisplatin until fetal lung maturity, and then underwent cesarean delivery and radical hysterectomy. Two of our patients had intermediate pathologic risk factors, and received adjuvant chemotherapy with the same regimen used in NACT. All patients did not have any evidence of disease recurrence for follow-up of 3, 4, and 8 years, respectively. NACT with paclitaxel plus cisplatin followed by radical hysterectomy and adjuvant chemotherapy could be considered as one of feasible alternatives to primary radical surgery or concurrent chemoradiation therapy with the termination of pregnancy in pregnant women with FIGO stage IB cervical cancer who have two or more intermediate pathologic-risk factors.
( Tae Wook Kong ),( Ji Heum Paek ),( Suk Joon Chang ),( Ki Hong Chang ),( Hee Sug Ryu ) 대한산부인과학회 2012 대한산부인과학회 학술대회 Vol.98 No.-
The objective of this study was to evaluate the prognostic significance of systematic pelvic and para-aortic lymphadenectomy on survival in patients with advanced ovarian cancer. We retrospectively analyzed the data of 189 consecutive patients with FIGO stage IIIC ovarian cancer between 2000 and 2011, who underwent primary cytoreductive surgery followed by platinum- and taxane-based chemotherapy. All patients were classified into two groups - patients who underwent systematic pelvic and para-aortic lymphadenectomy and those who did not. Progression-free (PFS) and overall survival (OS) times were analyzed using Kaplan-Meier method and Cox proportional hazards model. Patients who underwent systematic lymphadenectomy had significantly improved PFS (22 versus 9 months, p<0.01) and OS (66 versus 40 months, p<0.01). In patients with no gross residual disease (NGR) or residual disease 0.1-1 cm (GR-1), the median OS time of those who had lymphadenectomy was significantly longer than those who did not (86 versus 46 months, p=0.02). However, in patients with residual disease >1 cm (GR-B), there was no significant difference in OS according to lymphadenectomy (39 versus 40 months, p=0.50). Among patients with NGR, the median OS time of those who underwent systematic lymphadenectomy was significantly longer than those who did not undergo lymphadenectomy (not yet reached [>96] and 56 months, p<0.01). No significant difference of OS between patients with and without lymphadenectomy was observed in the subgroup of patient with GR-1 (50 versus 38 months, p=0.44). The performance of lymphadenectomy was a statistically significant and independent predictor of improved OS in addition to the status of residual disease and the performance of a radical cytoreductive procedures (Odds ratio, 0.34; [95% IC, 0.23-0.52]; p<0.01). Systematic lymphadenectomy may have a therapeutic value and be significantly associated with improved survival in stage IIIC ovarian cancer patients with grossly no residual disease.
( Tae Wook Kong ),( Ji Heum Paek ),( Suk Joon Chang ),( Hee Sug Ryu ) 대한산부인과학회 2012 대한산부인과학회 학술대회 Vol.99 No.-
Laparoscopic radical hysterectomy (LRH) has become the preferred surgical option over abdominal radical hysterectomy (ARH) in recent years. Many of the recently graduated gynecologic oncologists, therefore, have had little or no experience with ARH during their training period. The purpose of this study was to evaluate the learning curve of LRH for well-trained gynecologic oncologists. We retrospectively reviewed 72 patients with FIGO stage IB cervical cancer who underwent LRH (Piver type III) between April 2006 and March 2013. The patients were divided into two groups (surgeon A group, 42 patients; surgeon B group, 30 patients) according to the surgeon`s experience in ARH. Operating times were analyzed using the cumulative sum technique. There were no significant differences in clinico-pathologic characteristics and perioperative morbidities between the two groups. The operating time decreased with operative experience in both groups (surgeon A Pearson correlation coefficient = -0.508, p=0.001; surgeon B Pearson correlation coefficient = -0.397, p=0.030). Approximately 12 cases in the surgeon A group and 19 cases in the surgeon B group were required to achieve surgical proficiency for LRH. Multivariate analysis showed that tumor size (≥4 cm) was significantly associated with increased operating time (p=0.010, OR = 7.146, 95% CI = 1.573-32.469). After completing the residency and fellowship training course in laparoscopy but without open counterpart experience, we demonstrate that surgeons can reach an acceptable level of surgical proficiency in LRH after approximately 20 cases.
( Tae Wook Kong ),( Suk Joon Chang ),( Ji Sun Lee ),( Ji Heum Paek ),( Hee Sug Ryu ) 대한산부인과학회 2012 대한산부인과학회 학술대회 Vol.99 No.-
There have been many comparative reports on LRH versus ARH for early-stage cervical cancer. However, most of these studies included patients with International Federation of Gynecology and Obstetrics (FIGO) stage IA2 and small (tumor size ≤2 or 3 cm) IB1 disease. The purpose of this study was to compare the safety, morbidity, and recurrence rate of LRH and ARH for bulky (tumor size ≥3 cm) FIGO stage IB and IIA cervical cancer. We conducted a retrospective analysis of 88 patients with bulky (tumor size ≥3 cm) FIGO stage IB and IIA cervical cancer. All patients had no evidence of parametrial invasion and lymph node metastasis in preoperative gynecologic examination, pelvic MRI and PET-CT and underwent LRH or ARH between February 2006 and March 2013. Among 88 patients, 40 patients received LRH and 48 underwent ARH. Mean estimated blood loss was 588.0 mL for ARH group compared to 449.1 mL for LRH group (p<0.001). Mean operating time was similar in both groups (246.0 min. in ARH versus 254.5 min. in LRH group, p=0.589). Return of bowel motility was observed earlier after LRH (1.8 versus 2.2 days, p=0.042). The mean hospital stay was significantly shorter for LRH group (14.8 versus 18.0 days, p=0.044). There were no differences in histopathologic characteristics between the two groups. The mean tumor size was 44.4 mm in LRH and 45.3 mm in ARH group. Disease-free survival rates were 97.9% in ARH and 97.5% in LRH group, respectively (p=0.818). LRH might be a feasible therapeutic procedure for management of bulky FIGO stage IB and IIA cervical cancer. Further randomized studies which could support this approach are necessary to evaluate long-term clinical outcome.
공태욱 ( Tae-wook Kong ),( Suk-joon Chang ),( Jiheum Paek ),( Hyogyeong Park ),( Seong Woo Kang ),( Hee-sug Ryu ) 대한산부인과학회 2016 대한산부인과학회 학술대회 Vol.102 No.-
Objective: To evaluate the learning curve of laparoscopic radical hysterectomy (LRH) for gynecologic oncologists who underwent residency- and fellowship-training on laparoscopic surgery without previous experience in performing abdominal radical hysterectomy (ARH). Methods: We retrospectively reviewed 84 patients with FIGO (International Federation of Gynecology and Obstetrics) stage IB cervical cancer who underwent LRH (Piver type III) between April 2006 and March 2014. The patients were divided into two groups (surgeon A group, 42 patients; surgeon B group, 42 patients) according to the surgeon with or without ARH experience. Clinico-pathologic data were analyzed between the 2 groups. Operating times were analyzed using the cumulative sum technique. Results: The operating time in surgeon A started at 5 to 10 standard deviations of mean operating time and afterward steeply decreased with operative experience (Pearson correlation coefacient=-0.508, P=0.001). Surgeon B, however, showed a gentle slope of learning curve within 2 standard deviations of mean operating time (Pearson correlation coefacient=-0.225, P=0.152). Approximately 18 cases for both surgeons were required to achieve surgical proaciency for LRH. Multivariate analysis showed that tumor size (>4 cm) was signiacantly associated with increased operating time (P=0.027; odds ratio, 4.667; 95% conadence interval, 1.187 to 18.352). Conclusion: After completing the residency- and fellowship-training course on gynecologic laparoscopy, gynecologic oncologists, even without ARH experience, might reach an acceptable level of surgical proaciency in LRH after approximately 20 cases and showed a gentle slope of learning curve, taking less effort to initially perform LRH.