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Kim, Hyeong Seok,Jang, Jin-Young,Han, Youngmin,Lee, Kyoung Bun,Joo, Ijin,Lee, Doo-Ho,Kim, Jae Ri,Kim, Hongbeom,Kwon, Wooil,Kim, Sun-Whe The Korean Surgical Society 2017 Annals of Surgical Treatment and Research(ASRT) Vol.93 No.4
<P><B>Purpose</B></P><P>Neoadjuvant treatment may provide improved survival outcomes for patients with borderline resectable pancreatic cancer (BRPC). The purpose of this study is to evaluate the clinical outcomes of neoadjuvant treatment and to identify prognostic factors.</P><P><B>Methods</B></P><P>Forty patients who met the National Comprehensive Cancer Network definition of BRPC and received neoadjuvant treatment followed by surgery between 2007 and 2015 were evaluated. Prospectively collected clinicopathological outcomes were analyzed retrospectively.</P><P><B>Results</B></P><P>The mean age was 61.7 years and the male-to-female ratio was 1.8:1. Twenty-six, 3, and 11 patients received gemcitabine-based chemotherapy, 5-fluorouracil, and FOLFIRINOX, respectively. The 2-year survival rate (2YSR) was 36.6% and the median overall survival (OS) was 20 months. Of the 40 patients, 34 patients underwent resection and the 2YSR was 41.2% while the 2YSR of patients who did not undergo resection was 16.7% (P = 0.011). The 2YSR was significantly higher in patients who had partial response compared to stable disease (60.6% <I>vs</I>. 24.3%, P = 0.038), in patients who did than did not show a CA 19-9 response after neoadjuvant treatment (40.5% <I>vs</I>. 0%, P = 0.039) and in patients who did than did not receive radiotherapy (50.8% <I>vs</I>. 25.3%, P = 0.036). Five patients had local recurrence and 17 patients had systemic recurrence with a median disease specific survival of 15 months.</P><P><B>Conclusion</B></P><P>Neoadjuvant treatment followed by resection is effective for BRPC. Pancreatectomy and neoadjuvant treatment response may affect survival. Effective systemic therapy is needed to improve long-term survival since systemic metastasis accounts for a high proportion of recurrence.</P>
Kim, Hongbeom,Yoon, Yoo-Seok,Han, Youngmin,Kwon, Wooil,Kim, Sun-Whe,Han, Ho-Seong,Yoon, Dong-Sup,Park, Joon Seong,Park, Sang-Jae,Han, Sung-Sik,Lee, Seung Eun,Choi, Seong Ho,Han, In Woong,Kim, Eunjung Elsevier 2020 Clinical gastroenterology and hepatology Vol.18 No.4
<P><B>Background & Aims</B></P> <P>We studied the effects of pancreatic enzyme replacement therapy (PERT) on body weight, nutritional status, and quality of life (QoL) in patients with pancreatic exocrine insufficiency after pancreatoduodenectomy.</P> <P><B>Methods</B></P> <P>We performed a randomized, double-blind trial of 304 patients who underwent pancreatoduodenectomy at 7 tertiary referral hospitals in South Korea. Patients with fecal levels of elastase of 200 μg/g or less, before and after surgery, were assigned randomly to groups that received PERT (a single capsule of 40,000 IU pancreatin, Norzyme (40,000 IU, Pankreatan; Nordmark Arzneimittel GmbH & Co, Uetersen, Germany), 3 times each day during meals for 3 months; n = 151) or placebo (n = 153). Protocol completion was defined as taking more than two thirds of the total dose without taking other digestive enzymes; the protocol was completed by 71 patients in the PERT group and 93 patients in the placebo group. Patients underwent a physical examination, oral glucose tolerance tests, and blood tests at baseline and at month 3 of the study period. The primary end point was change in body weight. Secondary end points were changes in bowel habits, nutritional parameters, and QoL.</P> <P><B>Results</B></P> <P>In the per-protocol analysis, 3 months after the study began, patients in the PERT group gained a mean of 1.09 kg in weight and patients in the placebo group lost a mean of 2.28 kg (difference between groups, 3.37 kg; <I>P</I> < .001). However, no difference in body weight was observed between groups in the intent-to-treat analysis. Three months after the study began, the mean serum levels of prealbumin increased by 10.9 mg/dL in the PERT group and increased by 7.8 mg/dL in the placebo group (<I>P</I> = .002). Poor compliance to PERT was a significant risk factor for weight loss (<I>P</I> < .001). There was no significant difference in QoL scores between groups.</P> <P><B>Conclusions</B></P> <P>In the intent-to-treat analysis of data from a randomized trial, we found no significant effect of PERT on mean body weights of patients with pancreatic exocrine insufficiency after pancreatoduodenectomy. However, with active education and monitoring, PERT could increase body weight and nutritional parameters. ClinicalTrials.gov no: NCT02127021.</P>
Kim, Hyeong Seok,Han, Youngmin,Kang, Jae Seung,Kim, Hongbeom,Kim, Jae Ri,Koon, Wooil,Kim, Sun‐,Whe,Jang, Jin‐,Young John WileySons Ltd 2018 Journal of hepato-biliary-pancreatic sciences Vol.25 No.2
<P>ConclusionRobot PD is comparable to open PD in early outcomes. Robot PD is safe and feasible and enables early recovery; indication for robot PD is expected to expand in the near future.</P>
( Hongbeom Kim ),( Jae Ri Kim ),( Wooil Kwon ),( Jin-young Jang ),( Sun-whe Kim ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1
Purpose: Ampulla of Vater (AoV) cancer have better prognosis than other peri-ampullary cancers. However, prognosis of AoV cancer is different according to the stage, so it is necessary to establish treatment guideline according to the stage. Optimal treatment strategy must be based on tumor biology and recurrence pattern. The aim of this study was to figure out recurrence patterns of AoV ca. according to the stage and to suggest optimal treatment on AoV cancer. Methods: From January 2000 to June 2012, 259 patients who underwent pancreaticoduodenectomy (PD) with R0 resection due to AoV cancer in Seoul National University Hospital were analyzed. Pylorus preserving PD (PPPD) was preferred, and lymph node (LN) dissection was performed around right side of superior mesenteric artery (SMA) and celiac axis. Survival and recurrence pattern was analyzed and its risk factors were explored. Results: The mean age of total patients was 61.7 years and male to female ratio was 53:47. The median follow up duration was 40.7 month (range: 6-171) and 5 years disease free survival rate of total patients was 62.1%. Recurrence was occurred in 89 cases (34.4%) with 15.3 month median recurrence time. In 89 recurrence patients, total 149 recurrence sites were identified. The most common recurrence site was liver (n=52) in systemic recurrence and SMA LN in local recurrence (n=21). The risk factors of recurrence were poorly differentiated pathology (p=0.002), advanced T stage (0.032) and LN metastasis (p=0.010). Local recurrence was developed in 19 patients (21.3%), distant and both recurrence were 14 (15.7%) and 56 (62.9%) cases, respectively. Early T stage had a tendency of local recurrence especially around SMA, on the other hands, systemic recurrence was developed in advanced T stage (p=0.003). In above T2 stage, chemo therapy (CTx.) reduced recurrence, statistical insignificantly (5 year recurrence free survival rate in CTx (+) group: 62.2%, CTx. (-) group: 45.4%, p=0.072). In LN metastasis group, radio therapy (RTx.) reduced recurrence significantly (p=0.028), especially local recurrence (5 year local recurrence free survival rate in RTx. (+) group: 91.2%, RTx. (-) group: 57.9%, p=0.005) Conclusion: Recurrence of AoV cancer after curative PPPD was 34.4%. Pattern of recurrence was different according to the T stage. Recurrence of T1 stage of AoV cancer was local recurrence especially SMA area LN. It need to be considered to dissect LN around SMA area. In above T2 stage recurrence was developed systemic pattern, therefore, adjuvant therapy need to be considered.
Hyeong Seok Kim,Jin-Young Jang,Youngmin Han,Kyoung Bun Lee,Ijin Joo,Doo-Ho Lee,Jae Ri Kim,Hongbeom Kim,Wooil Kwon,Sun-Whe Kim 대한외과학회 2017 Annals of Surgical Treatment and Research(ASRT) Vol.93 No.4
Purpose: Neoadjuvant treatment may provide improved survival outcomes for patients with borderline resectable pancreatic cancer (BRPC). The purpose of this study is to evaluate the clinical outcomes of neoadjuvant treatment and to identify prognostic factors. Methods: Forty patients who met the National Comprehensive Cancer Network definition of BRPC and received neoadjuvant treatment followed by surgery between 2007 and 2015 were evaluated. Prospectively collected clinicopathological outcomes were analyzed retrospectively. Results: The mean age was 61.7 years and the male-to-female ratio was 1.8:1. Twenty-six, 3, and 11 patients received gemcitabine-based chemotherapy, 5-fluorouracil, and FOLFIRINOX, respectively. The 2-year survival rate (2YSR) was 36.6% and the median overall survival (OS) was 20 months. Of the 40 patients, 34 patients underwent resection and the 2YSR was 41.2% while the 2YSR of patients who did not undergo resection was 16.7% (P = 0.011). The 2YSR was significantly higher in patients who had partial response compared to stable disease (60.6% vs. 24.3%, P = 0.038), in patients who did than did not show a CA 19-9 response after neoadjuvant treatment (40.5% vs. 0%, P = 0.039) and in patients who did than did not receive radiotherapy (50.8% vs. 25.3%, P = 0.036). Five patients had local recurrence and 17 patients had systemic recurrence with a median disease specific survival of 15 months. Conclusion: Neoadjuvant treatment followed by resection is effective for BRPC. Pancreatectomy and neoadjuvant treatment response may affect survival. Effective systemic therapy is needed to improve long-term survival since systemic metastasis accounts for a high proportion of recurrence.
Hongbeom Kim,In Woong Han,Jin Seok Heo,Min Gu Oh,Chi Yeon Lim,Yoo Shin Choi,Seung Eun Lee 대한외과학회 2018 Annals of Surgical Treatment and Research(ASRT) Vol.95 No.3
Purpose: Postcholecystectomy syndrome (PCS) is characterized by abdominal symptoms following gallbladder removal. However, there is no consensus for the definition or treatment for PCS. The purpose of this study was to define PCS among various symptoms after laparoscopic cholecystectomy, and to identify risk factors affecting PCS. Methods: This study was conducted at Dongguk University Ilsan Hospital and Chung-Ang University Hospital (2012–2013). Outcomes were assessed using European Organization for Research and Treatment of Cancer QLQ-C30 questionnaire. Symptom cluster for determining PCS was made by factor analysis. Cluster analysis evaluating risk factors of PCS was made by Ward methods and Dentogram. Results: Factor analysis revealed three distinct symptom clusters, those are "insomnia and financial difficulties (eigenvalue, 1.707; Cronbach α, 0.190)," "appetite loss and constipation (eigenvalue, 1.413; Cronbach α, 0.480)," and "right upper quadrant (RUQ) pain and diarrhea (eigenvalue, 1.245; Cronbach α, 0.315)." Among these symptom clusters, the cluster of "RUQ pain and diarrhea" was determined as PCS. However, we could not find any risk factors between high symptomatic group and low symptomatic group. Conclusion: PCS could consist of RUQ pain and diarrhea. Well-designed prospective trials are needed to determine risk factors of PCS.