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The Surgeon’s Expertise-Outcome Relationship in Gastric Cancer Surgery
Wansik Yu,Young Kook Yun,Ilwoo Whang,최규석 대한암학회 2005 Cancer Research and Treatment Vol.37 No.3
Purpose: The surgical caseload or duration of practice of a surgeon may influence the outcomes of gastric cancer surgery. This study aimed to clarify the surgical quality provided by specialized gastric cancer surgeons.Materials and Methods: The postoperative courses of 1,877 patients who underwent surgery for gastric cancer were retrospectively reviewed. For classification of the surgeon's expertise, the number of yearly resections performed by, and consecutive years of practice of, the surgeons were used. The outcome measures used were the 30-day mortality and long-term survival.Results: Surgical mortalities of patients who underwent surgery by a specialized surgeon and those by a general surgeon revealed no statistically significant difference. A significant difference in the five-year survival rates was found with surgeons with at least two consecutive years of practice compared to those with less than two years, when 50 or more cases had been conducted per year (63.9% and 59.7%; p=0.0380). In cases of four-years of consecutive practice, the five-year survival rate was significantly improved, even if only 10 cases were performed annually (64.9% and 58.3%; p=0.0023), although the best survival rate was found with surgeons that had performed 50 or more surgeries per year.Conclusion: Improved survival rates, with acceptable surgical mortality, can be achieved for gastric cancer when the surgery is performed by a specialized surgeon. A specialized gastric cancer surgeon can be defined as one who has operated on more than 50 new cases per year, with 2 or more consecutive years of surgical practice.
Wansik Yu,Ho Young Chung 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.79 No.3
Purpose: We evaluated the clinical implication of Resection A surgery retrospectively to identify whether quality of surgery can be used as a selection factor for adjuvant therapy in patients with gastric cancer. Methods: Prognosis of 902 patients with gastric cancer who underwent Resection A surgery was evaluated. Results: Among all discharged patients, 77 patients (8.5%) died of recurrent disease, 55 patients (6.1%) died without recurrent disease. Five-year survival rate of all discharged patients was 91.6% and 10-year survival rate 87.1%. Statistically significant prognostic factors were depth of invasion (P<0.001), lymph node metastasis (P<0.001), stage (P<0.001), tumor location (P=0.036) and size (P=0.001), extent of gastric resection (P<0.001), and chemotherapy (P<0.001) on univariate analyses. However, depth of invasion (P=0.001), lymph node metastasis (P<0.001), and total gastrectomy (P<0.001) emerged as statistically significant poor prognostic factor on a multivariate analysis. Adjuvant chemotherapy did not increase the survival rate of patients after Resection A surgery, even in patients with stage Ⅱ disease. Conclusion: In selecting the patients for adjuvant therapy, both the stage of gastric cancer and the quality of surgery should be considered.
Wansik Yu,Ho Young Chung,So Hyang Park,Yong Baik Cho,Yang Soo Lim 대한암학회 2003 Cancer Research and Treatment Vol.35 No.1
Purpose: Heptaplatin, a new platinum analog, has favorabletoxicity profiles and antitumor activity, comparableto those of cisplatin, in the treatment of gastriccancer. This study was designed to define the maximumtolerated dose (MTD), dose-limiting toxicity (DLT) andpharmacokinetics of heptaplatin administered by an intraperitonealroute in patients with resected advancedgastric cancer.Materials and Methods: Seventeen patients with resectedadvanced gastric cancer were entered onto thestudy. After completion of a curative resection and anastomosis,heptaplatin was administered intraperitoneallyin one liter of 5% dextrose solution. The startingheptaplatin dose was 400 mg/m2 of the body surface area,and was escalated in 200 mg/m2 increments, to cohortsof three patients. A pharmacokinetic analysis was carriedout to determine the total and ultrafiltratable platinumconcentrations in the plasma, peritoneal fluid, and urine.Results: Patients were unable to tolerate a 1,000 mg/m2dose level, and at 800 mg/m2, reversible Grade III toxicities,including elevated creatinine, proteinuria, hyponatremia,abdominal pain, and intraabdominal bleedingwere noted. No significant toxicity was noted up to a 600mg/m2 dose level. The ratio of the peak peritoneal to peakplasma drug concentrations were 19.4, 16.6 and 22.8 atdoses of 400 mg/m2, 600 mg/m2 and 800 mg/m2, respectively.The pharmacological advantage, expressed asthe peritoneal to plasma AUC ratio ranged from 4.3 to 7.0.Conclusion: Heptaplatin can be delivered by an intraperitonealroute, with both an acceptable toxicity profileand a major pharmacokinetic advantage for cavity exposure.The MTD of intraperitoneal heptaplatin was 800mg/m2. The major DLTs were nephrotoxicity and intraabdominalbleeding. The recommended starting dose for asubsequent study would be 600 mg/m2. (Cancer Res Treat. 2003;35:25-29)
Wansik Yu,Eiichi Nakakita,Kosei Yamaguchi,정관수 충북연구원 2016 지역정책연구 Vol.27 No.1
In early September, 2011, local heavy rainfalls due to season’s 12th typhoon, “Talas” caused large flooding and enormous landslide disasters over the Kinki, Chugobku, Shikoku, and 16 missing persons. In these types of extreme events, it is essential to be able to provide as much advance warning as possible. This advance warning requires both quantitative precipitation forecasting (QPF) and quantitative flood forecasting (QFF). In this study, we assessed the ensemble NWP rainfall with 2km horizontal resolution and 30hr forecast time whether it can produce suitable rainfall or not. This study also proposes pre-processing methodology with a spatial shift of ensemble NWP rainfall fields, in order to improve the accuracy of the ensemble flood forecasting. Our study is carried out and verified using the largest flood event by typhoon ‘Talas’ of 2011 over the two catchmetns, which are Futatsuno (356.1㎢) dam catchments of Shingu river basin (2,360㎢), which is located in the Kii peninsula, Japan.