Changes of Quality of Life after Gastric Cancer Surgery

Kong, Horyon,Kwon, Oh Kyung,Yu, Wansik The Korean Gastric Cancer Association 2012 Journal of gastric cancer Vol.12 No.3

Purpose: The aim of this study was to evaluate chronological change of quality of life after surgery in patients with gastric cancer during one year postoperatively. Materials and Methods: Quality of life data were obtained from 272 gastric cancer patients who underwent curative gastrectomy between September 2008 and February 2011 at the Kyungpook National University Hospital. The Korean versions of the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core (QLQ) 30 with gastric cancer-specific module, the EORTC QLQ-STO22 were used to assess quality of life. All patients had no evidence of recurrence or metastasis during the first postoperative year. Patients were asked to complete the questionnaire, by themselves preoperatively, 3-, 6-, 9-, and 12-months postoperatively. Results: Physical functioning score and role functioning score significantly decreased at first 3 months after surgery and the significant differences were noticed until 12 months after surgery. Emotional functioning score started with the lowest score before surgery and significant improvement was shown 6 months after surgery. Most symptom scores and STO-22 scores were highest at 3 months after surgery and gradually decreased, thereafter. Eating restriction, anxiety, taste, body image scores was highest at 3 months after surgery without significant decrease afterwards. Conclusions: Most scales worsened after surgery and gradually recovered afterwards with some differences in rate of recovery. However the scales did not fully recover by 1 year period. Further follow-up after 1 year would be helpful in determining which scales are permanently damaged and which are just taking longer time to recover.

Morpholigical and Functional Changes of Remnant Pan-creas after Pancreatoduodenectomy

( Hyung Jun Kwon ),( Horyon Kong ),( Sang Geol Kim ),( Yun Jin Hwang ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

Aims: The aim of this study was to evaluate about morphological and functional changes of the remained pancreas and to determine risk factors for these changes after pancreatoduodenectomy (PD). Methods: From January 2013 to August 2014, 48 patients were enrolled into this study. Data was collected retrospectively at 1 week after operation, then at 3, 6, 9, and 12 months. Clinicopathological findings were collected retrospectively. Results: The pancreatic volume decreased by average 49.3 ± 18.5% compared to immediate postoperative volume after PD. Of 16 patients with a dilated pancreatic duct preoperatively, 12 (75%) patients demonstrated a decline in ductal size. Of 32 patients with a normal-ranged pancreatic duct preoperatively, 11 patients (34.4%) developed ductal dilatation after surgery. Diabetes mellitus was newly present in 13 (27.1%) patients. Postoperative volume change of the remnant pancreas was not associated pancreatic endocrine insufficiency (p = 0.137). The volume reduction of the remnant pancreas in malignant disease was larger than that of benign disease although there was no statistical difference (p = 0.058). Atrophy was associated with origin of disease (p = 0.003). Atrophy was prominent in ampullary and bile duct tumor. A significant atrophy was frequently observed in patients who were occurred pancreatitis (P = 0.042). Conclusions: The loss of pancreatic parenchyma did not correlated with postoperative diabetes. The morphological change was mainly happened in short term postoperative period. Early operative complications such as pancreatitis and pancreatic fistula seem to be associated with atrophic change of the pancreatic remnant. Therefore, perioperative consideration for reducing pancreatic inflammation should include strategies to minimize atrophic change of the pancreatic tissue.

A Comparative Study of Outcomes between Single-Port and Conventional Multi-Port Laparoscopic Cholecystectomy

( Hyung Jun Kwon ),( Horyon Kong ),( Sang Geol Kim ),( Yun Jin Hwang ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

Aims: The aim of this study was to investigate the technical feasibility, safety, and benefit of single-port laparoscopic cholecystectomy (SPLC) by retrospective comparision with conventional multi-port laparoscopic cholecystectomy (MPLC). Methods: Between August 2015 and April 2016, hundred patients underwent laparoscopic cholecystectomy by one surgeon. SPLC was introduced and performed in 43 patients for benign gallbladder disease (SPLC), fifty seven patients underwent MPLC (MPLC group). We retrospectively reviewed the clinical features and outcomes between the two groups. Results: All of 43 patients had successfully completion of SPLC (100%) without conversion. The age was similar between the two groups (p = 0.433). There was no significant difference between the two groups regarding patient body mass index (p = 0.336), history of previous abdominal surgery (p = 0.088), history of preoperative endoscopic retrograde cholangiopancreatography (ERCP) (p = 0.812), history of percutaneous drainage (p = 1.000), and ASA score (p = 0.132). There were no statistical differences between the two groups in term of operative time (p = 0.339), postoperative complication (p = 1.000), the length of postoperative hospital stay (p =0.580), and pain score (p = 0.350). Conclusions: In this study, SPLC has been successfully performed for benign gallbladder disease and the safety and feasibility was also confirmed. Although this study is retrospective and not large enough to provide definitive conclusion that SPLC may be equal to MPLC in term of safety and feasibility, SPLC may become an effective alternative option to MPLC for the treatment of benign gallbladder.

Laparoscopy-Assisted Pylorus Preserving Pancreatoduodenectomy for Periampullary Disease: Early Experience of Second Mover

( Hyung Jun Kwon ),( Horyon Kong ),( Sang Geol Kim ),( Yun Jin Hwang ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

Aims: Laparoscopic approaches are routinely used for a variety of procedures in abdominal surgery. In pancreas surgery, laparoscopic distal pancreatectomy (LDP) was accepted as standard procedure. However, application of laparoscopic pancreatoduodenectomy (LPD) was a challenging abdominal operation requiring complex dissection and difficult reconstruction, and as a results has been adopted slowly until recently. However, LPD for periampullary disease has been at tempted worldwide, and become increasingly popular. In the present report, we describe our experience with LPPPD, including early postoperative results. Methods: Between May 2016 and February 2017, eleven patients with periampullary disease underwent LPD. After surgery, data for demographics, operation time, RBC transfusion, histology, postoperative complication, and length of hospital stay after surgery were collected. Results: Ten patients received laparoscopic pylorus preserving pancreatoduodenectomy (LPPPD) and one patient was converted to open method because of injury of portal vein. The mean age was 63.0 ± 12.0 years and gender ratio was 1:1. Mean ASA score and BMI were 1.8 ± 0.4 and 23.1 ± 3.4 respectively. The mean operation time (from skin incision to skin closure) was 542.1 ± 73.2 min and 3 patient required RBC transfusion. Postoperative pancreatic fistula (POPF) occurred in only 1 case and it was Grade B defined by ISGPF. Also, delayed gastric emptying (DGE) occurred in 2 patients and it was Grade B defined by ISGPF. But, no postpancreatectomy hemorrhage (PPH) and other complication occurred. The mean length of hospital stay was 12.8 ± 3.0 days and no postoperative mortality occurred in 10 patients. Conclusions: LPD can be safely performed in selected patients with periampullary disease.

Single-Port Robotic Cholecystectomy: Early Experience from 8 Cases

( Hyung Jun Kwon ),( Horyon Kong ),( Sang Geol Kim ),( Yun Jin Hwang ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

Aims: Single-port laparoscopic cholecystectomy (SPLC) is a technical concept to reduced pain and improve cosmetic results when compared to multi-port cholecystectomy. However, SPLC is associated with technical limitation due to the enhanced complexity of the approach and limited number of specialized instruments or platforms. On the other hand, using a robotic platform may overcome these problems and enable more precise surgical actions by increasing freedom of movement and by restoring intuitive instrument control. In this presentation, we report the early clinical experience of our first 8 sing-port robotic cholecystectomy (SPRC) cases. Methods: Between November 2016 and February 2017, eight patients underwent SPRC with the da Vinci Xi robot and single-site instrumentation. We retrospectively reviewed clinical data on those patients. Results: All of 8 patients had completion of SPRC. Seven patients were female and one was male. Average patient age was 43.3±11.8 years and BMI was 22.4±1.4 kg/m2. Three patients (37.5%) were diagnosed with chronic calculous cholecystitis. Three patients (37.5%) underwent operation for polypoid lesions of the gallbladder. One patient (12.5%) was diagnosed with acute calculous cholecystitis. The mean operation time (skin-to-skin) was 83.9±30.7 min, docking time was 13.25±8.1 min, and console time was 42.1±26.4 min. The intraoperative blood loss was negligible. The mean Visual Analog Pain Scale score 6hr after the surgery was 2.9±0.4. The mean length of hospital stay average postoperative hospital stay was 2.3±1.0 day. There were no intraoperative complication and one patient developed seroma on port site. Conclusions: Robotic single-port cholecystectomy appears feasible and safe in our early experience.

Impact of clinically significant portal hypertension on surgical outcomes for hepatocellular carcinoma in patients with compensated liver cirrhosis

Chul Woo Jang,Hyung Jun Kwon,Horyon Kong,Heontak Ha,Young Seok Han,Jae Min Chun,Sang Geol Kim,Yun Jin Hwang 한국간담췌외과학회 2016 Annals of hepato-biliary-pancreatic surgery Vol.20 No.4

Backgrounds/Aims: The roles of portal hypertension (PHT) on the postoperative course after hepatectomy are still debated. The aim of this study was to evaluate surgical outcomes of hepatectomy in patients with PHT. Methods: Data from 152 cirrhotic patients who underwent hepatectomy for hepatocellular carcinoma (HCC) were collected retrospectively. Patients were divided into two groups according to the preoperative presence of PHT as follows: 44 patients with PHT and 108 without PHT. Propensity score matching (PSM) analysis was used to overcome selection biases. Results: There were no significant differences in morbidity (56.8% vs. 51.9%, p=0.578) and 90-days mortality (4.5% vs. 4.6%, p=0.982) between the two groups. Post-hepatectomy liver failure (PHLF) was not significantly different between the two groups (43.2% vs. 35.2%, p=0.356). Patients without PHT had a better 5-year disease-free survival than those with PHT, although the difference did not reach statistical significance (30.9% vs. 17.2%, p=0.081). Five-year overall survivals were not significantly different between the two groups (46.6% vs. 54.9%, p=0.724). Repeat analyses after PSM showed similar rates of morbidity (p=0.819), mortality (p=0.305), PHLF (p=0.648), disease-free survival (p=0.241), and overall survival (p=0.619). The presence of PHT was not associated with either short-term or long-term poor surgical outcomes. Conclusions: Child-Pugh A and B patients with PHT have surgical outcomes similar to those without PHT. Hepatectomy can be safely performed and can also be considered as a potentially curative treatment in HCC patients with PHT.