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갑상선암의 내시경 갑상선 절제술에서 근전절제술 및 전절제술의 임상적 비교
유한모,김태원,배자성<SUP>1<,SUP>,조항주,김기환,안창혁,박우찬<SUP>2<,SUP>,이동호<SUP>3<,SUP>,김정수,Han Mo Yoo,M,D,Tae Won Kim,M,D,Ja Sung Bae,M,D,<SUP>1<,SUP>,Hang Joo Cho,M,D,Kee Hwan Kim,M,D,Chang Hyuk An,M,D,Woo Chan Park,M 대한갑상선-내분비외과학회 2009 The Koreran journal of Endocrine Surgery Vol.9 No.4
Purpose: The aim of this study was to evaluate and compare the surgical outcomes of endoscopic total and near-total thyroidectomies in patients with thyroid cancer. Methods: Between February 2000 and January 2009, among 387 patients who underwent endoscopic thyroidectomy in our hospital, we evaluated 50 patients who underwent endoscopic total or near-total thyroidectomy. Thirty- five and 15 patients underwent endoscopic total thyroidectomy and near-total thyroidectomy, respectively. We analyzed the patients' clinicopathologic characteristics and post-operative complications between the two groups. Results: The mean size of tumors was 1.08 cm (range, 0.1∼3.5 cm) and the mean operative time was 192 minutes. Forty-nine tumors were papillary cancers and 1 tumor was a follicular cancer. Two patients in the endoscopic total thyroidectomy group underwent re-operation because of bleeding. In the near-total thyroidectomy group, one patient had transient hypocalcemia and one patient had temporary recurrent laryngeal nerve palsy. In the total thyroidectomy group, nine patients had transient hypocalcemia and one patient had temporary recurrent laryngeal nerve palsy. There was no statistical difference in the post-operative complicationrates between the two groups (P=0.254 for hypocalcemia and P=0.470 for injury to the recurrent laryngeal nerve). Conclusion: Based on our experience, endoscopic total thyroidectomy is a safe and feasible alternative to endoscopic near-total thyroidectomy. (Korean J Endocrine Surg 2009; 9:201-205)
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Metabolic and Bariatric Surgery Accreditation Program and National Health Insurance System in Korea
유한모,이상권,김종한 대한내시경복강경외과학회 2019 Journal of Minimally Invasive Surgery Vol.22 No.3
Since the first laparoscopic bariatric surgery in Korea introduced in January 2003, the number of metabolic and bariatric surgery has been steadily increasing. According to the report from National Health Insurance big data analysis, the prevalence of morbid and super obesity has greatly increased and metabolic and bariatric surgery also increased in the last 10 years. As the incidence of morbid obesity is more frequent in people of poor socioeconomic status, the need for a reimbursement by the government seemed to be necessary. Finally, the national health insurance system decided to financially cover metabolic and bariatric surgery from January 2019. In order to improve the safety and qualify of metabolic and bariatric surgery, the Korean Society for Bariatric and Metabolic Surgery (KSMBS) introduced surgeon’s and institution’s accreditation system. The authors intend to introduce comprehensive overview of accreditation system of bariatric surgery and discuss the contents of national health insurance for metabolic and bariatric surgery.
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박준홍,유한모,Hae Jung Sul,신소영,이승우,김정구 대한위암학회 2020 Journal of gastric cancer Vol. No.
Purpose: Gastrointestinal stromal tumors (GISTs) frequently harbor activating gene mutations in either KIT or platelet-derived growth factor receptor A (PDGFRA) and are highly responsive to several selective tyrosine kinase inhibitors. In this study, a targeted next-generation sequencing (NGS) assay with an Oncomine Focus Assay (OFA) panel was used for the genetic characterization of molecular targets in 30 Korean patients with GIST. Materials and Methods: Using the OFA that enables rapid and simultaneous detection of hotspots, single nucleotide variants (SNVs), insertion and deletions (Indels), copy number variants (CNVs), and gene fusions across 52 genes relevant to solid tumors, targeted NGS was performed using genomic DNA extracted from formalin-fixed and paraffin-embedded samples of 30 GISTs. Results: Forty-three hotspot/other likely pathogenic variants (33 SNVs, 8 Indels, and 2 amplifications) in 16 genes were identified in 26 of the 30 GISTs. KIT variants were most frequent (44%, 19/43), followed by 6 variants in PIK3CA, 3 in PDGFRA, 2 each in JAK1 and EGFR, and 1 each in AKT1, ALK, CCND1, CTNNB1, FGFR3, FGFR4, GNA11, GNAQ, JAK3, MET, and SMO. Based on the mutation types, majority of the variants carried missense mutations (60%, 26/43), followed by 8 frameshifts, 6 nonsense, 1 stop-loss, and 2 amplifications. Conclusions: Our study confirmed the advantage of using targeted NGS with a cancer gene panel to efficiently identify mutations associated with GISTs. These findings may provide a molecular genetic basis for developing new drugs targeting these gene mutations for GIST therapy.
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최영선,김동진,유한모,송교영,박조현 대한내시경복강경외과학회 2017 Journal of Minimally Invasive Surgery Vol.20 No.3
Purpose: In this study, we explored the safety of laparoscopic gastrectomy in obese gastric cancer patients compared with conventional open gastrectomy based on early surgical outcomes. Methods: A total of 462 patients who underwent curative gastrectomy for early gastric adenocarcinoma from January 2000 to December 2014 were enrolled. Two obesity cohorts were defined according to a body mass index (BMI) of ≥25 kg/m2 versus ≥30 kg/m2. Those cohorts were further divided into the laparoscopic distal gastrectomy (LDG) and open distal gastrectomy (ODG) groups, and clinicopathologic characteristics were compared with early surgical results. Results: There were no significant differences in clinicopathologic characteristics between the LDG and ODG groups in the BMI ≥25 or BMI ≥30 cohorts. For the overall complication rate, fewer complications were observed in the LDG than ODG group in both cohorts. Among the overall complications, significant differences were observed in the minor complication rates (Clavien-Dindo I or II), but no significant difference was observed in the rate of Clavien-Dindo III or higher complications. For risk factor analysis of postoperative complications, open distal gastrectomy, age >60 years, and BMI ≥30 were independent risk factors for postoperative morbidity among all obese patients. Conclusion: LDG may be a better procedure to improve surgical outcomes in patients with obesity undergoing surgery for early gastric cancer in terms of less excessive blood loss, shorter operation time, and lower complication rates.
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