직결장암 난소 전이 환자의 특징 및 임상 양상

시윤(Youn Si),이재임(Jae-Im Lee),김수홍(Soo-Hong Kim),김지훈(Ji-Hoon Kim),김형진(Hyung Jin Kim),이윤석(Yoon Suk Lee),조현민(Hyun Min Cho),김준기(Jun Gi Kim),오승택(Seung Tack Oh),이인규(In Kyu Lee) 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.79 No.4

Purpose: Treatment of ovarian metastasis from colorectal cancer has been controversial. We investigated the clinicopathologic features and treatment outcomes of patients with ovarian metastasis from colorectal carcinoma. Methods: From January 1996 to May 2009, 567 women were treated for colorectal cancer. Of those, 23 patients were diagnosed as having ovarian metastasis. We reviewed 19 pathologically proven cases, retrospectively. Results: The incidence of ovarian metastasis was 4.0%. The number of cases involving synchronous ovarian metastases was 9 (47.4%), and 10 cases (52.6%) involved metachronous ovarian metastases. Thirteen patients had metastases located in the pelvis and 6 also had peritoneal dissemination in addition to the ovarian metastasis. Twenty (63.1%) were treated with grossly complete resection. After a median follow-up duration of 45 months (range of 6∼96 months), the median survival after the diagnosis of ovarian metastasis was 40 months. The median overall survival was significantly longer in the grossly complete resection group (48.5 vs. 16 months; P=0.001). For median survival after the diagnosis of ovarian-metastasis, patients with grossly complete resection showed a significantly more favorable survival rate than the group with remnant tumors (46.5 vs 9 months; P=0.009). The survival of patients with metastases located in the pelvis was better than the group with peritoneal dissemination. Conclusion: Grossly complete resection would be of help to improve the prognosis in selective patients with metastasis from colorectal cancer, especially when metastasis is located in the pelvis.

액와부 수술에서 손상받기 쉬운 장흉신경 근위부 변이

시윤(Youn Si),김신선(Sin Sun Kim),이제승(Je Seung Lee),전해명(Hae Myung Jeon),이재학(Jai Hak Lee),박우찬(Woo-Chan Park) 대한외과학회 2007 Annals of Surgical Treatment and Research(ASRT) Vol.72 No.6

Herein, our experience of a rare variation of the long thoracic nerve during an axillary dissection in a female patient with a breast ductal carcinoma in situ (DCIS) is reported. Her long thoracic nerve was duplicated and united at its proximal and distal parts, respectively. She was a 45-year old female, with microcalcification on her left breast, which had been diagnosed as a DCIS by a stereotactic core needle biopsy. Due to the diffuse distribution of lesions, a mastectomy was performed, with immediate reconstruction using a transverse rectus abdominis muscle (TRAM) free flap. After the mastectomy, an axillary dissection was performed for anastomoses of the free flap to the thoracodorsal vessels, at which point the duplicated variation of the proximal part of the long thoracic nerve was found. This variation is very rare, and would be vulnerable to injury during an axillary dissection. Therefore, surgeons should take care to avoid injury to such a nerve during axillary surgery.

유두상 갑상선암에서 임상상의 COX-2의 발현 고찰

김형래,시윤,이연수<SUP>1<.SUP>,김정수,전해명,박우찬,Hyung Rae Kim,M.D.,Youn Si,M.D.,Youn Soo Lee,M.D.<SUP>1<.SUP>,Jung Soo Kim,M.D.,Hae Myung Jeon,M.D. and Woo Chan Park,M.D. 대한갑상선-내분비외과학회 2007 The Koreran journal of Endocrine Surgery Vol.7 No.2

Purpose: It is well known that cyclooxygenase-2 (COX-2) is associated with carcinogenesis in many human cancers. In thyroid cancers, COX-2 expression in aging patients is known as a powerful prognostic factor of differentiated thyroid cancer. Therefore, in this study, we investigated the expression of COX-2 in cases of papillary thyroid cancer (PTC), as well as its association with other prognostic factors of thyroid cancer. Methods: A total of 213 cases of papillary thyroid cancer were enrolled in this study and their clinicopathological characteristics were investigated retrospectively by a review of medicalrecords. Immunohistochemical staining for COX-2 was performed in the malignant tissue of the cases and the resultsof were then evaluated to determine if they were associated with other prognostic factors. Results: The mean age of patients was 46 years (Range: 17∼77 years old) and the tumor sizesranged from 0.1 to 5 cm (mean 1.2±0.9 cm). The pathological findings were as follows; thyroid capsule invasion in 101 patients (47%), lymph node metastasis in 76 patients (36%), multiplicity in 47 patients (22%), and bilaterality in 36 patients (17%). Positive results of immunohistochemical staining for COX-2 were noted in 131 patients (62%), however, the statistical analyses showed no significant association between COX-2 expression and other prognostic factors of papillary thyroid cancer. Conclusion: No association of COX-2 expression and prognostic factors of papillary thyroid cancer were found in this study. However, a larger prospectivestudy with survival analyses would provide a better understanding of thesignificance of COX-2 expression in cases of papillary thyroid cancer. (Korean J Endocrine Surg 2007;7:75-79)

결장직장 점액성 선암의 예후에 대한 분석

최승봉(Seung Bong Choi),이인규(In Kyu Lee),원대연(Dae Youn Won),이윤석(Yoon Suk Lee),시윤(Yoon Si),이상철(Sang Chul Lee),강원경(Won Kyung Kang),박종경(Jong Kyung Park),안창혁(Chang Hyeok Ahn),김준기(Jun-Gi Kim),오승택(Seong Taek Oh) 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.79 No.6

Purpose: Although many papers have reported poor prognosis of colorectal mucinous adenocarcinoma, the underlying cause for its unfavorable outcome is yet to be elucidated. In the peritoneal fluid studies, we observed that peritoneal recurrences and cytology positive cases were many times mucinous cancers. On the basis of these observations, mucinous and non-mucinous adenocarcinomas were compared and prognostic factors were studied. Methods: Five hundred and forty-six patients who underwent surgery for colorectal adenocarcinomas from January 2004 to December 2008 were included. Results: Among the 546 patients, mucinous adenocarcinomas were 30 (5.5%) and non-mucinous adenocarcinomas were 516 (94.5%). Mean age was 55.0 years, which was younger than 63.2 years in non-mucinous colon cancers. They tend to develop in the right colon. Mucinous adenocarcinomas were more advanced in depth of invasion and distant metastasis, but no significant difference in lymph node (LN) metastasis. Peritoneal CEA, CA19-9, and positive cytology were more apparent. Liver and peritoneal metastasis did not show significant increases. Five year survival rates were 82.9% and 91.7% and cancer free survival rates were 42.7% and 68.5% each, respectively, for mucinous and non-mucinous cancers. According to stage, only stage Ⅲ and Ⅳ patients showed differences in cancer free survival and overall survival (P=0.001, 0.040). Conclusion: Mucinous adenocarcinomas showed worse prognoses and significant differences in recurrences, but had similar prognoses in early cancers. Although no significant differences were in LN metastasis, dissimilarities were in infiltration depth. Infiltrations led to the increase in free cancer cells and peritoneal fluid tumor markers: ultimately cancer recurrences developed.

간문맥 및 상장간막 정맥의 혈전증을 동반한 장회전이상

이정선(Jung Sun Lee),이인규(In Kyu Lee),심정호(Jungho Shim),시윤(Youn Si),이윤석(Yoon Suk Lee),오승택(Seung Tack Oh) 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.79 No.6

Intestinal malrotation with volvulus is generally presented as a bilious vomiting and acute intestinal obstruction in the newborn period. It could compromise vascular supply of the small bowel secondary to torsion of superior mesenteric artery (SMA) and without urgent surgical management, it could lead to detrimental outcomes such as transmural bowel infarction and sepsis. However, in chronic cases, it is rarely obstructs the vascular supply and propagates to an acute bowel infarction. Rarely, chronic malrotation with midgut volvulus may not reduce the mesenteric blood supply because of collateral vessels, and the chronically stagnated blood flow of the superior mesenteric vein (SMV) favors thrombus formation within the lumen. The recommended treatment is Ladd’s procedure and anticoagulation therapy. The authors present an unusual case of intestinal malrotation with chronic volvulus resulting in superior mesenteric vein and portal vein thrombosis in a 28-year-old patient.