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ABSTRACT: Abstract Objective. The presence of mural nodules is a strong predictor of malignancy in patients with branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs). Endoscopic ultrasound (EUS) is the most sensitive imaging for the detection of mural nodules. The aim was to evaluate whether initial EUS evaluation is necessary to detect mural nodules in all patients with BD-IPMNs. Material and methods. We reviewed retrospectively the medical records of all 104 patients with BD-IPMNs diagnosed by EUS from January 2008 to December 2011. Of the 104 patients, 13 (12.5%) had mural nodules (MN-positive group) and 91 (87.5%) did not (MN-negative group). Results. Patients in the MN-positive group were significantly older (69 years vs. 61 years, p = 0.013), had larger-sized cysts on EUS (24.1 ± 8.3 mm vs. 16.2 ± 8.0 mm, p = 0.001), a higher rate of main pancreatic duct dilatation (30.8% vs. 3.3%, p = 0.004), and higher serum CA 19-9 concentrations (67.8 ± 109.4 U/mL vs. 17.5 ± 27.0 U/mL, p = 0.012), than patients in the MN-negative group. Cyst sizes measured by EUS, CT, and MRCP did not differ significantly. Multivariate logistic regression analysis showed that cysts ≥16 mm in size on CT (odds ratio [OR], 9.84; 95% confidential interval [CI], 1.08-89.93; p = 0.043) and main pancreatic duct dilatation (OR, 12.65; 95% CI, 1.62-98.99; p = 0.016) were independent predictors of mural nodules. Conclusions. Patients with BD-IPMNs, cyst size ≥16 mm, and main pancreatic duct dilatation should be further evaluated by EUS for the presence of mural nodules.
Scandinavian journal of gastroenterology 05/2013; 48(5):610-616. · 2.08 Impact Factor
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ABSTRACT: There is controversy concerning the effect of a positive T-lymphocytotoxic crossmatch (TLC) on clinical outcomes in adult living donor liver transplantation (LDLT). The aim of this study was to investigate the effect of TLC on clinical outcomes in LDLT and to determine how long a pretransplant positive TLC continues after liver transplantation (LT).
Between January 2005 and June 2010, 219 patients underwent adult LDLT at National Cancer Center. The TLC test was routinely performed before LDLT. TLC test results were positive in 8 patients (3.7%). Patients were divided into 2 groups according to the result of TLC: positive TLC (n = 8) and negative TLC (n = 211) groups. All patients with a pretransplant positive TLC (n = 6) underwent a TLC test every week until negative conversion of TLC, except 2 patients who refused to receive the TLC test.
Acute cellular rejection, surgical complications and patient or graft survival were not significantly different between both groups. All patients with a positive TLC (n = 6) had a posttransplant negative TLC. The median time to negative conversion of TLC was 1.5 weeks (range, 1 to 3 weeks).
A pretransplant positive TLC does not affect clinical outcomes in adult LDLT. Moreover, T-lymphocytotoxic cross-reactivity disappeared within 3 weeks (range, 1 to 3 weeks) after LT.
Journal of the Korean Surgical Society 04/2013; 84(4):245-51. · 0.12 Impact Factor
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ABSTRACT: Several studies have reported that ABO blood group, hepatitis B virus (HBV) and hepatitis C virus (HCV) infection contribute to the development of pancreatic cancer. The aim of this study was to evaluate the association between these factors and pancreatic cancer in the Korean population. We retrospectively recruited 753 patients with pancreatic cancer and 3,012 healthy controls, matched 4 to 1 with cancer patients for age and sex, between 2001 and 2011, at the National Cancer Center, Korea. A multivariate logistic regression analysis was employed to estimate adjusted odds ratios (AORs). The AOR for pancreatic cancer in subjects with non-O blood types (A, AB, and B), compared to blood type O, was 1.29 (95% CI, 1.05-1.58; P = 0.01). Seropositivity for hepatitis B virus surface antigen was not significantly related to pancreatic cancer, either in univariate (odds ratio 1.03; 95% CI, 0.69-1.53; P = 0.91) or multivariate analysis (AOR, 1.02; 95% CI, 0.67-1.56; P = 0.93). The AOR for pancreatic cancer in subjects displaying seropositivity for anti-HCV was 2.30 (95% CI, 1.30-4.08; P < 0.01). Our results suggest that the non-O blood types and anti-HCV seropositivity, but not HBV infection, may increase the risk of developing pancreatic cancer in Korea, where HBV is endemic.
Journal of Korean medical science 02/2013; 28(2):247-51. · 0.84 Impact Factor
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ABSTRACT: BACKGROUND: Currently, no treatment guidelines are available for posttransplant hepatitis B virus (HBV) recurrence. We retrospectively evaluated the rate of clearance of hepatitis B surface antigen (HBsAg) from serum according to various treatment regimens in two large Korean liver transplantation centers. METHODS: Between 1996 and 2008, HBV recurred in 59 patients among 933 HBV liver recipients (6.3 %). Patients with HBV recurrence were divided into four groups according to their treatment: group L (lamivudine-based therapy n = 21) and group N [new nucleos(t)ide analogue (NA)-based therapy, n = 38]. Intravenous hepatitis B immunoglobulin (ivHBIG) had been simultaneously administered to 10 patients in group L and 26 patients in group N. The mean posttransplant follow-up duration and time to HBV recurrence were 69 (14-152) months and 37 (3-120) months. RESULTS: Overall, 22 patients (37.3 %) showed seronegative conversion of HBsAg for a median 8 months after treatment (range 1-15 months). The seroclearance rate was significantly higher in group N (n = 20, 52.6 %) than in group L (n = 2, 9.5 %) (p < 0.000). The time to seroconversion did not differ between group L (7 months, range 5-16) and group N (7 months, range 1-15) (p = 0.428). Subgroup analysis showed that the HBsAg seroconversion rate was much higher for patients given combined ivHBIG and new NAs (15/26 patients, 58.0 %) than the others (p = 0.006). CONCLUSIONS: Seroclearance of HBsAg could be achieved using new NAs in half of the patients after posttransplant HBV recurrence. Combined ivHBIG may add a synergistic effect to new NAs for clearing HBsAg.
World Journal of Surgery 01/2013; · 2.36 Impact Factor
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ABSTRACT: BACKGROUND: Few clinical studies to date have compared different types of self-expandable metallic stents (SEMS) and their outcomes in patients with pure duodenal obstruction caused by pancreaticobiliary cancer. The aim of this study was to compare the clinical effectiveness and side effects of uncovered and covered SEMS for the palliation of duodenal obstruction caused by pancreaticobiliary cancer. METHODS: We retrospectively analyzed all patients with pancreaticobiliary cancer who underwent upper endoscopy with SEMS placement for malignant duodenal obstruction at the National Cancer Center of Korea between April 2003 and December 2010. The technical and clinical success rates of the procedure, complications, and durations of stent patency and overall survival were evaluated. RESULTS: We identified 70 patients with a mean age of 51.2 years (range = 39-81 years); of these, 46 (65.7 %) had pancreatic cancer, 9 (12.9 %) had bile duct cancer, 11 (15.7 %) had gallbladder cancer, and 4 (5.7 %) had cancer of the ampulla of Vater. Twenty-four patients (34.3 %) received covered SEMSs and 46 (65.7 %) received uncovered SEMSs. Technical and clinical success rates were similar for the covered and uncovered stent groups. The complication rate was higher in the covered than in the uncovered group (62.5 vs. 34.8 %, P = 0.025), due primarily to a significantly higher stent migration rate (20.8 vs. 0 %, P = 0.004). Perforation as a late complication occurred in four patients, two in each group (8.3 vs. 4.3 %, P = 0.425). Stent patency tended to be shorter for covered than for uncovered duodenal stents (13.7 ± 8.6 weeks vs. not reached, P = 0.069). CONCLUSIONS: The use of uncovered stents may be a preferred option for duodenal obstruction secondary to pancreaticobiliary malignancies, since they were effective in preventing stent migration and tended to have longer patency than covered stents. Careful attention should be paid to signs and symptoms of perforation during follow-up.
Surgical Endoscopy 01/2013; · 4.01 Impact Factor
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ABSTRACT: The prognosis including (18) F-fluorodeoxyglucose positron emission tomography/computed tomography ((18) F-FDG-PET/CT) for the early recurrence for hepatocellular carcinoma (HCC) after living donor liver transplantation (LDLT) was not well established. Consecutive patients who underwent (18) F-FDG-PET/CT and subsequent LDLT for HCC from March 2005 to June 2011 were enrolled. The 191 patients with a median follow-up of 26.1 months were evaluated. There were 20 patients (10.5%) with early recurrence (≤6 months), 18 patients (9.4%) with late recurrence (>6 months), and 153 patients (80.1%) with no recurrence. Fifty-five patients (28.8%) displayed increased PET/CT tumor uptake. Three-year overall and disease-free survival for PET/CT-positive patients were 65.5% and 57.1%, respectively, while PET/CT-negative patients showed respective values of 89.8% and 86.8% (P = 0.001 vs. P < 0.001). Tumor variables associated with PET/CT-positive finding were preoperative AFP level, Milan, UCSF criteria, maximum tumor size, total tumor size, differentiation, vascular invasion, and serosal invasion. PET/CT-positive status was identified as an independent prognostic factor for disease-free survival influencing early recurrence in multivariable analysis (HR 3.945, 95% CI 1.196-13.016, P = 0.024). (18) F-FDG-PET/CT is an independent and significant predictor of early tumor recurrence in LDLT for HCC.
Transplant International 10/2012; · 2.92 Impact Factor
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ABSTRACT: To evaluate the surgical outcomes following radical antegrade modular pancreatosplenectomy (RAMPS) for pancreatic cancer.
Twenty-four patients underwent RAMPS with curative intent between January 2005 and June 2009 at the National Cancer Center, South Korea. Clinicopathologic data, including age, sex, operative findings, pathologic results, adjuvant therapy, postoperative clinical course and follow-up data were retrospectively collected and analyzed for this study.
Twenty-one patients (87.5%) underwent distal pancreatectomy and 3 patients (12.5%) underwent total pancreatectomy using RAMPS. Nine patients (37.5%) underwent combined vessel resection, including 8 superior mesenteric-portal vein resections and 1 celiac axis resection. Two patients (8.3%) underwent combined resection of other organs, including the colon, stomach or duodenum. Negative tangential margins were achieved in 22 patients (91.7%). The mean tumor diameter for all patients was 4.09 ± 2.15 cm. The 2 patients with positive margins had a mean diameter of 7.25 cm. The mean number of retrieved lymph nodes was 20.92 ± 11.24 and the node positivity rate was 70.8%. The median survival of the 24 patients was 18.23 ± 6.02 mo. Patients with negative margins had a median survival of 21.80 ± 5.30 mo and those with positive margins had a median survival of 6.47 mo (P = 0.021). Nine patients (37.5%) had postoperative complications, but there were no postoperative mortalities. Pancreatic fistula occurred in 4 patients (16.7%): 2 patients had a grade A fistula and 2 had a grade B fistula. On univariate analysis, histologic grade, positive tangential margin, pancreatic fistula and adjuvant therapy were significant prognostic factors for survival.
RAMPS is a feasible procedure for achieving negative tangential margins in patients with carcinoma of the body and tail of the pancreas.
World Journal of Gastroenterology 10/2012; 18(39):5595-600. · 2.47 Impact Factor
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ABSTRACT: Palliative chemotherapy is currently the primary therapeutic approach in the treatment of advanced biliary tract cancer (BTC). Our aim was to assess the efficacy and safety of capecitabine plus cisplatin as first-line chemotherapy for patients with advanced BTC and to analyze the relationship between the level of CA19-9 and clinical outcome.
We retrospectively reviewed the records of patients who had unresectable, metastatic or recurrent BTC who were treated with capecitabine plus cisplatin. Capecitabine was administered orally at a dose of 1,000 mg/m(2) twice a day for 14 days, followed by a 1-week rest period. Cisplatin was administered intravenously on days 1 and 8 at a dose of 30 mg/m(2) for 60 min every 3 weeks.
A total of 176 patients were enrolled. Among the 143 assessable patients, 24 (17%) had a partial response. A complete response was radiologically confirmed in 1 patient who had gallbladder cancer. Sixty-two patients (43%) had stable disease and 56 patients (39%) had progressive disease. With a median follow-up of 5.7 months, the median time-to-progression (TTP) was 3.7 months (95% CI 3.1-4.3) and the median overall survival (OS) was 7.4 months (95% CI 6.1-8.7). There was a significant positive correlation between CA19-9 response and TTP (r = 0.66, p = 0.01). CA19-9 response was also significantly correlated with OS (r = 0.57, p < 0.01). The most common grade 3/4 toxicities were nausea/vomiting [12 patients (6.8%)].
Our results indicate that the capecitabine/cisplatin regimen is well tolerated and has moderate activity against advanced BTC. The CA19-9 response may be a suitable surrogate marker for patients with BTC who are treated with capecitabine/cisplatin.
Chemotherapy 07/2012; 58(3):225-32. · 1.82 Impact Factor
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Se Jin Jung,
Sang Myung Woo,
Hyung Ki Park,
Woo Jin Lee,
Mi Ah Han,
Sung-Sik Han,
Seong Hoon Kim, Sang-Jae Park,
Tae Hyun Kim,
Young Hwan Koh,
Eun Kyung Hong
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ABSTRACT: This study aimed to provide further insights into the indications for adjuvant therapeutic strategies via analysis of the sites of initial recurrence after resection of gallbladder cancer (GBC) and intrahepatic (IHC) and extrahepatic cholangiocarcinoma (EHC).
Patients with biliary tract cancer who underwent potentially curative resection were identified from the database. Sites of initial disease recurrence were categorized as locoregional or distant.
Between March 2001 and April 2009, 231 patients underwent curative resection. Initial GBC and IHC recurrence involving a distant site occurred in 70.8 and 86.8% patients, respectively, compared to 56.9% patients with EHC (p = 0.002). The median time to disease recurrence (TTR) was shorter among the GBC and IHC groups compared with that in EHC patients (6.3 and 6.7 vs. 13.1 months, respectively; p = 0.003). Moreover, median times to distant recurrence in GBC and IHC groups were shorter than that in EHC (5.8 and 6.5 vs. 14.1 months, respectively; p = 0.002).
After resection, recurrent GBC and IHC are more likely to involve a distant site and are associated with significantly shorter TTR than recurrent EHC. These findings suggest that an adjuvant therapeutic strategy targeting distant disease is likely to have a significant impact on the overall management of GBC and IHC.
Oncology 07/2012; 83(2):83-90. · 2.27 Impact Factor
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Joon Seong Park,
Ho-Seong Han,
Dae Wook Hwang,
Yoo-Seok Yoon,
Jai Young Cho,
Yang-Seok Koh,
Choon Hyuck David Kwon,
Kyung Sik Kim,
Sang Bum Kim,
Young Hoon Kim, [......],
Yung Kyung Yoo,
Hee Chul Yu,
Dong Sup Yoon,
Min-Koo Lee,
Hyeon Kook Lee,
Seog Ki Min,
Chi-Young Jeong,
Soon-Chan Hong,
In Seok Choi,
Kyung Yul Hur
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ABSTRACT: Since laparoscopic liver resection was first introduced in 2001, Korean surgeons have chosen a laparoscopic procedure as one of the treatment options for benign or malignant liver disease. We distributed and analyzed a nationwide questionnaire to members of the Korean Laparoscopic Liver Surgery Study Group (KLLSG) in order to evaluate the current status of laparoscopic liver resection in Korea. Questionnaires were sent to 24 centers of KLLSG. The questionnaire consisted of operative procedure, histological diagnosis of liver lesions, indications for resection, causes of conversion to open surgery, and postoperative outcomes. A laparoscopic liver resection was performed in 416 patients from 2001 to 2008. Of 416 patients, 59.6% had malignant tumors, and 40.4% had benign diseases. A total laparoscopic approach was performed in 88.7%. Anatomical laparoscopic liver resection was more commonly performed than non-anatomical resection (59.9% vs 40.1%). The anatomical laparoscopic liver resection procedures consisted of a left lateral sectionectomy (29.3%), left hemihepatectomy (19.2%), right hemihepatectomy (6%), right posterior sectionectomy (4.3%), central bisectionectomy (0.5%), and caudate lobectomy (0.5%). Laparoscopy-related serious complications occurred in 12 (2.8%) patients. The present study findings provide data in terms of indication, type and method of liver resection, and current status of laparoscopic liver resection in Korea.
Journal of Korean medical science 07/2012; 27(7):767-71. · 0.84 Impact Factor
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ABSTRACT: Steroid use after liver transplantation is known to increase the risk of new-onset diabetes mellitus (NODM). In this study, we tried to identify a patient subgroup who would benefit with regard to NODM by an early steroid withdrawal regimen (ESWR) after living donor liver transplantation (LDLT) METHODS: Among 100 adult LDLT patients, 65 were on a conventional immunosuppressive regimen (CIR), and 35 were on an ESWR. With the ESWR, the steroid was tapered off mostly within 7 days with induction of basiliximab in combination with tacrolimus and mycophenolate mofetil (MMF). The CIR was a combination of tacrolimus and steroid. MMF was added in selected patients. Steroid was tapered off 2-6 months after LT. The presence of NODM was investigated cross-sectionally 6 months after LT.
There was no significant difference in terms of acute cellular rejection, sepsis, or death during follow-up. NODM had developed in 13 patients (13 %). Old recipient age (≥55) and pretransplant history of hypertension were significant risk factors for NODM. The type of immunosuppression was the single risk factor for NODM in subgroup of old-age recipients (≥55 years) on the CIR (hazard ratio 13.34, p = 0.04).
ESWR can safely reduce the incidence of NODM after LDLT in old-age recipients. Therefore, ESWR should be considered first in old-age recipients undergoing LDLT.
World Journal of Surgery 06/2012; 36(10):2443-8. · 2.36 Impact Factor
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Mi Ah Han,
Myueng Guen Oh,
Sang Myung Woo,
Woo Jin Lee, Sang-Jae Park,
Sung-Sik Han,
Young Hwan Koh,
Tae Hyun Kim,
Eun Kyung Hong,
Sohee Park,
Joong-Won Park,
Chang-Min Kim
Pancreas 05/2012; 41(4):648-9. · 2.39 Impact Factor
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ABSTRACT: The aim of this study was to investigate the epidemiologic characteristics and changing patterns of gallstone disease in Korea
over a recent 20-year period. A total of 4020 gallstone patients who had undergone surgery at Seoul National University Hospital
during 1981–2000 were analyzed according to periods: period I (1981–1985: 831 cases); period II (1986–1990: 888 cases); period
III (1991–1995: 1040 cases); period IV (1996–2000:1261 cases). The literature from 13 institutes in Korea reporting a total
of 13,101 gallstone cases were reviewed to elucidate the nation-wide trend. The number of gallstone cases gradually increased.
A female predominance was not noted (F/M = 1.17–1.37) as is seen in Western countries. The patients with common bile duct
(CBD) stones were older than those with gallbladder (GB) stones or intrahepatic duct (IHD) stones. Over time, the relative
proportion of those with a GB stone increased, plateauing (80–85%) during the 1990s; that of patients with CBD stones decreased
(34% → 19%); and that of those with IHD stones remained unchanged (11–15%). Over the entire period, the rural pattern of gallstone
formation (low number of GB stones, high numbers of CBD and IHD stones) has become similar to the urban pattern. The body
mass index (BMI) of the GB stone group was above average, as were the BMIs of the CBD stone and IHD stone groups. Throughout
the literature review, this same changing pattern of the relative proportion of gallstone disease was confirmed. Thus the
pattern of gallstone disease in Korea has become similar to that seen in Western countries except for a high prevalence of
hepatolithiasis.
Le but de cette étude a été de déterminer les caractéristiques épidémiologiques et leurs éventuels aspects évolutifs de la
maladie lithiasique en Corée pendant les 20 dernières années. On a analysé les dossiers de 4020 patients présentant une lithiase
à l’Hôpital National Universitaire de Seoul (1981–2000) pendant plusieurs périodes différentes: période I 1981–1985:831 cas),
période II (1986–1990:888 cas), période III (1991–1995:1040 cas) et période IV (1996–2000:1261 cas). La littérature provenant
de 13 institutions en Corée rapportant 13101 cas de lithiase a été revue pour élucider la tendance nationale. Le nombre de
cas de lithiase a augmenté. Comme dans les pays Occidentaux, on a noté une prédominance féminine (F/M = 1.17–137). Les patients
ayant une lithiase de la voie biliaire principale (VBP) était plus âgés que les patients ayant une lithiase biliaire simple
ou les patients ayant une lithiase intrahépatique (LIH). Avec le temps, la proportion relative de patients ayant une lithiase
vésiculaire a augmenté pour atteindre un plateau (80–85%) dans les années 1990, la proportion de patients porteur de lithiase
de la VBP a diminué (34% → 19%) et le groupe de patients porteurs de LIH est restée inchangée (11–15%). De même, le site de
la lithiase (bas, haut, intrahépatique) dans la population rurale s’est rapproché de ce que l’on observe en ville. L’indexe
de masse corporelle dans le groupe porteur de lithiase vésiculaire était plus élevé que la moyenne, et plus élevé que celui
des patients porteur de lithiase de la VBP ou de LIH. A travers une revue de la littérature, cette même tendance s’est confirmée
en ce qui concerne la proportion relative de patients porteurs de maladie lithiasique. Les tendances de la maladie lithiasique
en Corée sont devenues similaires à celles des pays occidentaux sauf en ce qui concerne la prévalence élevée de lithiase intrahépatique.
Investigar la evolución de las características epidemiológicas de la litiasis biliar a lo largo de los últimos 20 años en
Corea. Se analizaron 4020 pacientes con litiasis biliar tratados quirúrgicamente en el Hospital Nacional Universitario de
Seoul. Se dividieron, de acuerdo con diferentes periodos de tiempo: periodo I (1981–1985; n = 831), periodo II (1986–1990;
n = 888) periodo III (1991–1995, n = 1,040) y periodo IV (1996–2000; n = 1,261). Además, se revisaron 13,101 casos de litiasis
biliar de 13 Instituciones Hospitalarias de Corea, con objeto de averiguar la tendencia de esta enfermedad a escala nacional.
La incidencia de la litiasis biliar se ha incrementando paulatinamente; sin embargo, no se constató una predominancia por
el sexo femenino (M/V = 1.77–137) como ocurre en países occidentales. Los pacientes con coledocolitiasis (CBD) eran más viejos
que los que aquejaban una colelitiasis (GB) o una hepatolitiasis (IHD). A lo largo del tiempo, los pacientes con GB aumentaron
hasta alcanzar una meseta (80–85%) en los años noventa. La coledocolitiasis disminuyó (34% → 19%) y la hepatolitiasis no se
modificó (11–15%). A lo largo de estos 20 años, las características de la litiasis biliar en zonas rurales (escasos casos
de GB y muchos de CBD y IHD) se fue equiparando a los de las ciudades. El índice de masa corporal era superior en pacientes
con GB que en los que presentaron una CBD o IHD. Nuestras observaciones coinciden con las referidas en la literatura mundial
al respecto. Las características de la litiasis biliar en Corea son semejantes a las observadas en los países occidentales,
excepto por lo que a la alta incidencia de hepatolitiasis (IHD) se refiere.
World Journal of Surgery 04/2012; 28(2):206-210. · 2.36 Impact Factor
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Young Seung Park,
Chong Woo Yoo,
Seok Cheol Lee, Sang Jae Park,
Jae Hwan Oh,
Byong Chul Yoo,
Seung Sam Paik,
Kyeong Geun Lee,
So Young Jin,
Song Cheol Kim,
Kwang Pyo Kim,
Young Hwan Kim,
Dongho Choi,
Hark Kyun Kim
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ABSTRACT: We evaluated whether direct tissue matrix-assisted laser desorption/ionization (MALDI) mass spectrometry (MS) analysis of lipids may distinguish intrahepatic cholangiocarcinomas from adjacent normal tissue and from other adenocarcinomas that frequently metastasize to liver.
Four pairs of frozen surgical specimens of cholangiocarcinomas and adjacent normal tissue were analyzed using histology-directed, MALDI MS analysis. 2,5-dihydroxybenzoic acid / α-cyano-4-hydroxycinnamic acid were manually deposited on tumor-rich areas, and mass spectra were acquired using a MALDI-time of flight instrument.
Cholangiocarcinomas and adjacent normal tissue samples demonstrated different lipid profiles, as evidenced by permutation P value<0.05 for the cross-validated misclassification rate. Cancer-associated lipid alteration was similar between cholangiocarcinomas and pancreatic cancers, but not between cholangiocarcinomas and colorectal cancers. Baseline lipid profiles were different between cholangiocarcinoma and colorectal cancers.
MALDI MS analysis of lipid distinguishes cancerous epithelium of cholangiocarcinoma from adjacent normal tissue, and between cholangiocarcinomas and colorectal cancers.
Clinica chimica acta; international journal of clinical chemistry 10/2011; 412(21-22):1978-82. · 2.54 Impact Factor
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Jaihwan Kim,
Woo Jin Lee,
Sang Hyub Lee,
Kyoung Bun Lee,
Ji Kon Ryu,
Yong-Tae Kim,
Sun-Whe Kim,
Yong Bum Yoon,
Jin Hyeok Hwang,
Ho-Seong Han,
Sang Myung Woo, Sang Jae Park
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ABSTRACT: Neuroendocrine tumours very rarely occur in the biliary tract; information about them is limited.
To present the clinical characteristics and prognosis of curatively resected biliary neuroendocrine tumours.
Review of medical records dated between 2000 and 2010 of 20 patients from three medical centres with biliary neuroendocrine tumour based on curative resection.
Based on the World Health Organization 2010 classification, five and one patients had neuroendocrine tumour grades 1 and 2, seven had neuroendocrine carcinoma, and seven were diagnosed with mixed adenoneuroendocrine carcinoma. The locations were the following: seven in the gallbladder, four in the extrahepatic bile duct, and nine in the ampulla of Vater. Lymph node and hepatic metastases were noted in 11 and 4 patients, respectively. Fourteen patients experienced recurrence; most had recurrence in the liver. Patients with neuroendocrine tumour grade 1 had a lower rate of recurrence compared to others (p=0.001). The median disease-free and overall survival times were 5.8 (0.4-53.6) and 13.7 (1.9-102.1) months for all four subtypes. However, the median disease free and overall survival rates of neuroendocrine tumours were significantly longer than those of neuroendocrine carcinomas or mixed adenoneuroendocrine carcinoma.
Patients with biliary neuroendocrine tumour showed extremely different clinical outcomes according to histopathologic subtypes by World Health Organization 2010 classification.
Digestive and Liver Disease 08/2011; 43(12):965-70. · 3.05 Impact Factor
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ABSTRACT: The purpose of this study was to determine the significance of portal vein-superior mesenteric vein (PV-SMV) invasion on survival in patients who underwent margin-negative pancreatoduodenectomy (PD) with PV-SMV resection for pancreatic adenocarcinoma.
We retrospectively reviewed the records of 60 patients who underwent margin-negative PD with or without PV-SMV resection for pancreatic adenocarcinoma between August 2001 and December 2007. The depth of vessel invasion was investigated and was categorized into 3 groups: tunica adventitia, media, and intima. Clinicopathologic factors and survival were analyzed.
Portal vein-superior mesenteric vein resection was performed on 19 patients, but only 15 patients (78.9%) had histologically true invasion and showed poorer survival (median survival, 14 vs 9 months; P < 0.05). Univariate analysis revealed that poorly differentiated tumor, lymphatic invasion, endovascular invasion, PV-SMV invasion, and invasion into the intima of PV-SMV were statistically significant. Poorly differentiated tumor and invasion into the intima of PV-SMV were significant in multivariate analysis.
Aggressive surgical resection should be attempted in cases with suspected PV-SMV invasion because 21.1% of patients had no true invasion and showed better survival than those with true invasion. However, invasion into the tunica intima may be a poor prognostic factor for survival even after margin-negative PD for pancreatic adenocarcinoma.
Pancreas 07/2011; 41(1):102-6. · 2.39 Impact Factor
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ABSTRACT: The purpose of this study was to document the prevalence of shoulder osteoarthritis (OA) in the elderly population in South Korea, to determine the risk factors for shoulder OA, and to evaluate the relationship with function.
This project was part of a population-based prospective cohort study of health, aging, and common geriatric diseases in the elderly population of the authors' area of Seongnam. A total of 1118 residents were randomly invited, and 679 participated. The mean age of respondents was 71.8 ± 5.7 years (range, 65-97 years), and 396 (58.3%) were women. Bilateral shoulder radiographs were taken, and the grade of OA was evaluated using the Samilson-Prieto method. Functional status was evaluated using the Disabilities of Arm, Shoulder and Hand (DASH) instrument.
Radiographic primary shoulder OA was detected in 109 people (16.1%), and secondary OA in 9 (1.3%). There were 77 shoulders of grade 1 (11.3%), 23 of grade 2 (3.4%), and 9 of grade 3 (1.3%). The risk of shoulder OA increased according to age, with odds ratio (OR) of 2.20 in patients aged 70 to 74 years (P = .004) and 3.42 in patients aged 75 years and older (P < .001). Knee OA was also a significant risk factor for shoulder OA (OR, 1.96; P = .002). The DASH score was significantly higher in the OA group and increased according to the grade of shoulder OA (P < .001).
Primary shoulder OA is not as rare as previously reported. Our data also demonstrated that older age and knee OA were determining risk factors for shoulder OA, and shoulder OA was related to poor function.
Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 07/2011; 20(5):756-63. · 1.93 Impact Factor
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Dae Wook Hwang,
Jin-Young Jang,
Chang-Sup Lim,
Seung Eun Lee,
Yoo-Seok Yoon,
Young Joon Ahn,
Ho-Seong Han,
Sun-Whe Kim,
Sang Geol Kim,
Young Kook Yun, [......],
Dong Wook Choi,
Kyung Yul Hur,
Dong-Shik Lee,
Sung-Su Yun,
Hong-Jin Kim,
Chul Kyoon Cho,
Hyun Jong Kim,
Hee Chul Yu,
Baik Hwan Cho,
In-Sang Song
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ABSTRACT: Prediction of malignancy or invasiveness of branch duct type intraductal papillary mucinous neoplasm (Br-IPMN) is difficult, and proper treatment strategy has not been well established. The authors investigated the characteristics of Br-IPMN and explored its malignancy or invasiveness predicting factors to suggest a scoring formula for predicting pathologic results. From 1994 to 2008, 237 patients who were diagnosed as Br-IPMN at 11 tertiary referral centers in Korea were retrospectively reviewed. The patients' mean age was 63.1 ± 9.2 yr. One hundred ninty-eight (83.5%) patients had nonmalignant IPMN (81 adenoma, 117 borderline atypia), and 39 (16.5%) had malignant IPMN (13 carcinoma in situ, 26 invasive carcinoma). Cyst size and mural nodule were malignancy determining factors by multivariate analysis. Elevated CEA, cyst size and mural nodule were factors determining invasiveness by multivariate analysis. Using the regression coefficient for significant predictors on multivariate analysis, we constructed a malignancy-predicting scoring formula: 22.4 (mural nodule [0 or 1]) + 0.5 (cyst size [mm]). In invasive IPMN, the formula was expressed as invasiveness-predicting score = 36.6 (mural nodule [0 or 1]) + 32.2 (elevated serum CEA [0 or 1]) + 0.6 (cyst size [mm]). Here we present a scoring formula for prediction of malignancy or invasiveness of Br-IPMN which can be used to determine a proper treatment strategy.
Journal of Korean medical science 06/2011; 26(6):740-6. · 0.84 Impact Factor
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Tae Yoo,
Woo Jin Lee,
Sang Myung Woo,
Tae Hyun Kim,
Sung-Sik Han, Sang-Jae Park,
Sung Ho Moon,
Kyung Hwan Shin,
Sang Soo Kim,
Eun Kyung Hong,
Dae Yong Kim,
Joong-Won Park
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ABSTRACT: The use of chemoradiotherapy (CRT) for localized and unresectable pancreatic cancer has been disputed because of high probability of distant metastasis. Thus, we analyzed the effect of clinical parameters on tumor response, early distant metastasis within 3 months (DM(3m)), and overall survival to identify an indicator for selecting patients who would benefit from CRT.
This study retrospectively analyzed the data from 84 patients with localized and unresectable pancreatic cancer who underwent CRT between August 2002 and October 2009. Sex, age, tumor size, histological differentiation, N classification, pre- and post-treatment carbohydrate antigen (CA) 19-9 level, and CA 19-9 percent decrease were analyzed to identify risk factors associated with tumor response, DM(3m), and overall survival.
For all 84 patients, the median survival time was 12.5 months (range, 2-31.9 months), objective response (complete response or partial response) to CRT was observed in 28 patients (33.3%), and DM(3m) occurred in 24 patients (28.6%). Multivariate analysis showed that pretreatment CA 19-9 level (≤400 vs. >400 U/ml) was significantly associated with tumor response (45.1% vs. 15.2%), DM(3m) (19.6% vs. 42.4%), and median overall survival time (15.1 vs. 9.7 months) (p < 0.05 for all three parameters).
For patients with localized and unresectable pancreatic cancer, pretreatment CA 19-9 level could be helpful in predicting tumor response, DM(3m), and overall survival and identifying patients who will benefit from CRT.
International journal of radiation oncology, biology, physics 05/2011; 81(4):e623-30. · 4.59 Impact Factor
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ABSTRACT: Over a period of 2 years, we used an upper midline incision (UMI) without laparoscopic assistance in 143 consecutive living donor partial hepatectomy (LDPH) procedures, regardless of the graft type or the donor age, sex, body mass index, or body shape. Here we report surgical recommendations based on our experience with the use of UMIs in this context. The celiac axis (CA) depth ratio (the depth-to-width ratio for the trunk at the CA) was measured to define the shape of the abdominal cavity. A questionnaire was used to assess satisfaction and cosmetic outcomes in this population of donors. One hundred forty-one of the grafts (98.6%) were right grafts or extended right grafts; there were no donor deaths. The mean time of the operation up to graft retrieval in 141 right side grafts was 3 hours 1 minute. All donors recovered fully and returned to their previous activities. Major complications occurred in 9 patients (6.4%) and included reoperation due to bleeding (4), the insertion of a percutaneous drain (4), and rhabdomyolysis (1). Male sex, a large graft (>900 kg), a fatty liver (large fatty changes ≥ 10%), and a deep truncal cavity (a CA depth ratio > 0.35) were significant risk factors for a long graft retrieval time. The use of a wound protector significantly reduced wound complications. The cosmetic outcomes were more satisfactory when a UMI preceded partial hepatectomy instead of a conventional J-shaped incision (P = 0.01). In conclusion, a UMI without laparoscopic assistance can be safely used for LDPH, regardless of the graft type or the donor characteristics. However, the procedure after a UMI is more difficult in male donors with large fatty livers and deep truncal cavities. Accordingly, these features can be used as exclusion criteria for surgeons not accustomed to this modified procedure.
Liver Transplantation 05/2011; 17(8):969-75. · 3.39 Impact Factor
