피부와 피하조직으로 다발성 전이를 보인 위암 1예

계봉현,전해명,김진조,진형민,김욱,박조현,박승만,임근우,김승남,박우배 대한외과학회 2003 대한외과학회 학술대회 초록집 Vol.2003 No.11

Overview of Radiation Therapy for Treating Rectal Cancer

계봉현,조현민 대한대장항문학회 2014 Annals of Coloproctolgy Vol.30 No.4

A major outcome of importance for rectal cancer is local control. Parallel to improvements in surgical technique, adjuvant therapy regimens have been tested in clinical trials in an effort to reduce the local recurrence rate. Nowadays, the local recurrence rate has been reduced because of both good surgical techniques and the addition of radiotherapy. Based on recent reports in the literature, preoperative chemoradiotherapy is now considered the standard of care for patients with stages II and III rectal cancer. Also, short-course radiotherapy appears to provide effective local control and the same overall survival as more long-course chemoradiotherapy schedules and, therefore, may be an appropriate choice in some situations. Capecitabine is an acceptable alternative to infusion fluorouracil in those patients who are able to manage the responsibilities inherent in self-administered, oral chemotherapy. However, concurrent administration of oxaliplatin and radiotherapy is not recommended at this time. Radiation therapy has long been considered an important adjunct in the treatment of rectal cancer. Although no prospective data exist for several issues, we hope that in the near future, patients with rectal cancer can be treated by using the best combination of surgery, radiation therapy, and chemotherapy in near future.

Multimodal Assessments Are Needed for Restaging after Neoadjunvant Chemoradiation Therapy in Rectal Cancer Patients

계봉현,김형진,김건,김준기,조현민 대한암학회 2016 Cancer Research and Treatment Vol.48 No.2

Purpose Restaging after neoadjuvant treatment is done for planning the surgical approach and, increasingly, to determine whether additional therapy or resection can be avoided for selected patients. Materials and Methods Local restaging after neoadjuvant chemoradiation therapy (nCRT) was performed in 270 patients with locally advanced (cT3or4 or N+) rectal cancer. Abdomen and pelvic computed tomography (APCT) was used in all 270 patients, transrectal ultrasound (TRUS) in 121 patients, and rectal magnetic resonance imaging (MRI) in 65 patients. Findings according to imaging modalities were correlated with pathologic stage using Cohen’s kappa (!) to test agreement and intra-class correlation coefficient " to test reliability. Results Accuracy for prediction of yp T stage according to three imaging modalities was 45.2% (!=0.136, "=0.380) in APCT, 49.2% (!=0.259, "=0.514) in rectal MRI, and 57.9% (!=0.266, "=0.520) in TRUS. Accuracy for prediction of yp N stage was 66.0% (!=0.274, "=0.441) in APCT, 71.8% (!=0.401, "=0.549) in rectal MRI, and 66.1% (!=0.147, "=0.272) in TRUS. Of 270 patients, 37 (13.7%) were diagnosed as pathologic complete responder after nCRT. Rectal MRI for restaging did not predict complete response. On the other hand, TRUS did predict three complete responders (!=0.238, "=0.401). Conclusion APCT, rectal MRI, and TRUS are unreliable in restaging rectal cancer after nCRT. We think that multimodal assessment with rectal MRI and TRUS may be the best option for local restaging of locally advanced rectal cancer after nCRT.

반복적 췌장염을 일으킨 총담관류 1예

계봉현,윤상섭,박종경,최승혜,이성 대한외과학회 2004 대한외과학회 학술대회 초록집 Vol.2004 No.5

[Poster] Tumor Budding as a Risk Factor of Lymph Node Metastasis in Submucosal Invasive T1 Colorectal Cancer

계봉현,조현민,강세구,김형진,김준기 대한외과학회 2011 대한외과학회 학술대회 초록집 Vol.2011 No.11

A Laparoscopic Excision of a Retrorectal Cystic Teratoma: A Case Report

계봉현,김형진,이인규,김도형,원대연,강원경,오승택 대한대장항문학회 2009 Annals of Coloproctolgy Vol.25 No.6

Retrorectal or presacral tumors are rare, with incidences of approximately 0.01%. Generally, these tumors have no specific symptoms and are likely to be found incidentally on CT or MRI scans. Most of them are benign masses, but malignant masses are reported on occasion. The modality of treatment is a resection in cases of a benign mass, but chemotherapy or radiation therapy can be done in cases of malignancy. Like our case, a matured cystic teratoma in the retrorectal area is very rare. In addition, no laparoscopic resection of a retrorecal teratoma was reported until 2008. Thus, we report the case of a 31-yrold female patient who underwent a total laparoscopic excision for a matured cystic teratoma in the retrorectal space.

The long-term outcomes for patients with right-sided colon cancer

계봉현,김준기,조현민,김수홍,강원경,이재임,김형진,이재청,오승택 대한외과학회 2009 대한외과학회 학술대회 초록집 Vol.2009 No.11

염증성 장질환 환자에서의 영양 요법

계봉현 ( Bong-hyeon Kye ) 한국정맥경장영양학회 2016 한국정맥경장영양학회지 Vol.8 No.1

Underweight and specific nutrient deficiencies are frequent in adult patients with inflammatory bowel disease (IBD). In addition, a significant number of children with IBD, particularly Crohn’s disease (CD) have impaired linear growth. Nutritional support is important in patients with IBD and nutritional problems. Enteral nutrition (EN) can reduce CD activity and maintain remission in both adults and children. Given that the ultimate goal in the treatment of CD is mucosal healing, this advantage of EN over corticosteroid treatment is valuable in therapeutic decision-making. EN is indicated in active CD, in cases of steroid intolerance, in patient’s refusal of steroids, in combination with steroids in undernourished individuals, and in patients with inflammatory stenosis of the small intestine. EN should be the first choice compared to total parenteral nutrition. However, EN does not have a primary therapeutic role in ulcerative colitis. In conclusion, it appears that the role of nutrition as supportive care in patients with IBD should not be underestimated. The aim of this comprehensive review is to provide the reader with an update on the role of nutritional support in IBD patients.

Propensity Score Matching을 이용한 위암과 대장암 환자들의 수술 전후 영양상태 변화의 비교

윤승훈,계봉현,김형진,전경화,강원경,조현민,진형민 한국정맥경장영양학회 2017 한국정맥경장영양학회 학술대회집 Vol.2017 No.-

Background: Patients with cancers arising from gastrointestinal tract may have some major risks to affect their nutritional conditions; cancer itself, absorption of nutrients and secretion of enzymes, passage disturbance of intestinal content from tumor, or surgery for gastrointestinal tract. Because most patients with gastrointestinal cancers undergo the curative surgery, the consideration on the change of their nutritional status according to the each time point (preoperative vs postoperative) may be very important. Purpose: In this study, we intended to investigate the change of the nutritional status after curative surgery in patients with gastric cancer (GC) or colorectal cancer (CRC) using various nutritional screening tools at each time point (preoperative vs postoperative). Also, we intended to compare our data related to nutritional issues among the types of surgery in GC and CRC group respectively. Materials & Methods: In our hospital, total 407 patients (206 patients with GC and 201 patients with CRC) underwent surgery for their diseases between July 2011 and June 2012. Of these, 195 patients with GC and 176 patients with CRC underwent curative resection. We tried to match patients from two groups using the propensity score. After matching patients with the propensity score, we analyzed the data from 170 patients (85 patients in GC group and 85 patients in CRC group). And then, we retrospectively evaluated patients` nutritional status at the time of admission for surgery and discharge after surgery with 4 nutritional screening tools including malnutrition screening tool for cancer patients (MSTC), the Seoul National University Bundang Hospital Nutritional Screening Tool (SNUBH-NST), Malnutrition Universal Screening Tool (MUST), and Nutritional Risk Screening (NRS) 2002. Although significance was defined as P ≤ 0.05, P ≤ 0.1 was regarded as marginal significance. Results: There was no postoperative mortality in our study. In preoperative period, the nutritional status in GC group was slightly better than that in CRC group according to MUST (P<0.001) and NRS 2002 (P=0.079). The preoperative risk of malnutrition was not related to incidence of postoperative morbidity. In both groups, the postoperative nutritional status was significantly impaired, compared with the preoperative status. In contrast to before the surgery, the postoperative nutritional status of CRC patients was significantly better than that of GC patients according to the MSTC (P=0.004) and MUST (P=0.007). At the time of hospital discharge after surgery, the incidence of lower serum albumin level (P=0.002) and more than 5% weight loss (P=0.013) were higher in GC group than in CRC group. Comparing the postoperative nutritional status among the type of surgery in each group, total gastrectomy in GC group (P=0.015) and proctectomy with diverting stoma in CRC (P=0.06) were related to more than 5% weight loss. Conclusions: The gastrointestinal cancer surgery might affect the postoperative nutritional status negatively, especially in GC surgery. Therefore, we should realize that the consecutive assessments of nutritional status and the appropriated nutritional supports are necessary to enhance the recovery after surgery and to introduce the additional oncological care on time.

Treatment of Right Colonic Diverticulitis: The Role of Nonoperative Treatment

김마루,계봉현,김형진,조현민,오승택,김준기 대한대장항문학회 2010 Annals of Coloproctolgy Vol.26 No.6

Purpose: The purpose of this study is to evaluate the value of nonoperative treatment for right-sided colonic diverticulitis. Methods: One hundred fifty-eight patients with right-sided colonic diverticulitis were evaluated. Clinical history, physical and radiologic findings, and treatments were reviewed retrospectively. Also, additional episodes and treatment modalities were checked. Results: Our patients were classified according to treatment modality; 135 patients (85.4%) underwent conservative treatment,including antibiotics and bowel rest, and 23 patients (14.6%) underwent surgery. The mean follow-up length was 37.3 months, and 17 patients (17.5%) underwent recurrent right-sided colonic diverticulitis. Based on treatment modality,including surgery and antibiotics, no significant differences in the clinical features and the recurrence rates were noted between the two groups. Conclusion: Conservative management with bowel rest and antibiotics could be considered as a safe and effective option for treating right-sided colonic diverticulitis. This treatment option for right-sided colonic diverticulitis, even if the disease is complicated, may be the treatment of choice.