Ki-Hun Kim

University of Ulsan, Urusan, Ulsan, South Korea

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Publications (110)246.18 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: According to the 7th AJCC TNM staging system, solitary hepatocellular carcinoma (HCC) is classified as T1 or T2 based on microvascular invasion (MVI) regardless of tumor size. This study intended to evaluate the prognostic impact of tumor size on survival outcomes after macroscopic curative resection of solitary HCC. Patients who underwent R0 resection of solitary HCC <10 cm (n = 2558) were selected for study. Follow-up lasted ≥24 months or until death. HCC was detected during regular health screening or routine follow-up in 2054 cases (80.3 %). Hepatitis B virus (HBV) infection was associated in 2127 (83.2 %). Mean patient age was 54.4 ± 9.9 years. Anatomical resection was performed in 1786 (69.8 %). MVI was identified in 407 (16.0 %) which therefore became stage T2; the other 2150 became stage T1. Tumor recurrence and patient survival rates were 24.9 and 95.0 % after 1 year, 49.6 and 84.1 % after 3 years, 57.7 and 75.0 % after 5 years, and 67.3 and 56.6 % after 10 years, respectively. Multivariate analysis showed that non-anatomical resection, MVI, and tumor size >5 cm were independent risk factors for both tumor recurrence and overall patient survival. Long-term survival correlated negatively with tumor size and MVI. Subgroup analysis with MVI and size cutoff of 5 cm revealed a significant survival difference (p = 0.000). Tumor size >5 cm was not a significant prognostic factor in non-HBV patients. These results suggest that the prognostic impact of tumor size may be underestimated in the current version of the AJCC staging system and that solitary HCC staging could be improved with inclusion of tumor size cutoff of 5 cm in HBV-associated patients. Further validation is necessary with multicenter studies.
    Journal of Gastrointestinal Surgery 05/2015; 19(7). DOI:10.1007/s11605-015-2849-5 · 2.39 Impact Factor
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    ABSTRACT: Preoperative risk assessment for post-hepatectomy liver failure (PHLF) is essential for major hepatectomy. We intended to establish a standard liver volume (SLV) formula for Korean patients and validate the predictive power of the indocyanine green clearance rate constant (ICG-K) fraction of future remnant liver (FRL) (FRL-kICG) to total liver volume (TLV). This study comprised 2 retrospective studies. Part I established SLV formula and acquired ICG pharmacokinetic data from 2155 living donors. In part II, FRL-kICG cutoff was determined using 723 patients who underwent right liver resection for hepatocellular carcinoma. In part I, the formula SLV (mL) = -456.3 + 969.8 × BSA (m(2)) (r = 0.707, r (2) = 0.500, p = 0.000) was derived with mean volume error of 10.5 %. There was no correlation between TLV and ICG retention rate at 15 min. With a cutoff of 0.04 with hepatic parenchymal resection rate (PHRR) limit of 70 %, 99.0 % of our living donors were permissible for left or right hepatectomy. In part II, 25 hepatocellular carcinoma patients (3.5 %) showed an FRL-kICG or SLV-corrected FRL-kICG <0.05. Of these, 4 (16 %) died of PHLF, whereas only 2 (0.3 %) died in the other patient group with both an FRL-kICG and SLV-corrected FRL-kICG ≥ 0.05 (P = 0.000). The FRL-kICG appears to reliably predict PHLF risk quantitatively. We suggest FRL-kICG cutoffs of 0.04 and 0.05 with PHRR limits of 70 % and 65 % for normal and diseased livers, respectively. Further validation with large patient population in multicenter studies is necessary to improve FRL-kICG predictability.
    Journal of Gastrointestinal Surgery 05/2015; 19(7). DOI:10.1007/s11605-015-2846-8 · 2.39 Impact Factor
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    ABSTRACT: Because noticeable changes were made to the 7th American Joint Committee on Cancer (AJCC) tumor-node-metastasis (TNM) staging for intrahepatic cholangiocarcinoma (IHCC), we validated the prognostic impact of tumor staging after macroscopic curative resection of IHCC. A cohort of 659 IHCC patients who underwent R0 (n = 539) or R1 (n = 120) resection were selected with exclusion of R2 resection (n = 111). Study patients were followed up for ≥24 months or until death with no patient lost during survival analysis. Anatomical resection was performed in 599 (90.9 %) and concurrent bile duct resection was conducted in 97 (14.7 %). Median survival periods following R0, R1, and R2 resections were 28, 12, and 3 months, respectively (p = 0.000). In the R0 resection group, the 1-, 3-, 5-, and 10-year tumor recurrence rates were 36.4 %, 57.9 %, 64.7 %, and 65.0 %, respectively, and the 1-, 3-, 5-, and 10-year patient survival rates were 73.1 %, 44.2 %, 33.0 %, and 23.1 %, respectively. Independent risk factors for tumor recurrence and patient survival were tumor growth type, tumor size > 5 cm, perineural invasion, and lymph node metastasis. According to the 7th AJCC staging system, the prognostic contrast was marginal in stage T2-4 tumors without lymph node metastasis (p > 0.8). With our redefined staging system with tumor growth types and risk factors including tumor number and perineural/lymphovascular invasion, clear prognostic contrast was achieved among T1-3 stages (p = 0.000). Growth type of IHCC seems to be essential for determining tumor stage. Although the stratification of the 7th AJCC IHCC staging system seems reasonably established, refinements and further validation could improve prognostic predictability.
    Journal of Gastrointestinal Surgery 03/2015; DOI:10.1007/s11605-015-2803-6 · 2.39 Impact Factor
  • Liver Transplantation 03/2015; 21(5). DOI:10.1002/lt.24101 · 3.79 Impact Factor
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    ABSTRACT: Metabolic liver disease (MLD) often progresses to life-threatening conditions. This study intends to describe the outcomes of liver transplantation (LTx) for MLD at a living donor-dominant transplantation center where potentially heterozygous carrier grafts are employed. We retrospectively evaluated the medical records of 54 patients with MLD who underwent LTx between November 1995 and February 2012 at Asan Medical Center in Seoul, Korea. The cumulative graft and patient survival rates were analyzed according to patient age, and living or deceased donor LTx. Recurrence of the original disease was also investigated. The post-transplant cumulative patient survival rates at one, five, and 10 years were 90.7%, 87.5% and 87.5%, and the graft survival rates were 88.8%, 85.5%, and 85.5%, respectively. There were no differences in the patient survival rates according to the recipient age, human leukocyte antigen matching, and living or deceased donor LTx. There were also no differences in the patient survival rates between the MLD and the non-MLD groups for children. Recurrence of the original metabolic disease was not observed in any patient during the follow-up period. Our results suggest that the living donor-dominant transplantation program is well-tolerated in MLD without recurrence of the original MLD using all types of transplantation.
    03/2015; 18(1):48-54. DOI:10.5223/pghn.2015.18.1.48
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    ABSTRACT: Background: This study analyzed the patient survival outcomes following the resection of hepatocellular carcinoma (HCC) metachronous adrenal metastasis (MAM) in patients who had undergone liver resection or liver transplantation (LT). Methods: Clinical results were analyzed retrospectively in 26 patients with MAM-HCC who underwent adrenalectomy. Results: The mean interval between initial surgery and adrenalectomy was significantly shorter in the resection group than in the LT group (18.3 ± 14.4 vs. 42.6 ± 13.8 months, p < 0.001). Of 19 resected patients, four had adrenal metastases on the right side, 12 on the left side and three bilaterally, with a mean tumor diameter of 3.6 ± 1.5 cm. Ten of these patients underwent open surgery and nine underwent laparoscopic surgery; all patients experienced recurrences within 18 months and 20.3% survived 5 years after adrenalectomy. Of 7 patients who underwent LT, four had adrenal metastases on the right side and three on the left side, with a mean tumor diameter of 3.4 ± 1.8 cm. Six of these patients underwent open surgery and one underwent laparoscopic surgery. Five-year recurrence and patient survival rates after adrenalectomy were 28.6 and 85.7%, respectively. Conclusions: Adrenalectomy is indicated in patients with isolated MAM-HCC. Comparisons with other locoregional treatment modalities and multicenter studies with additional patients are needed to validate the role of adrenalectomy. © 2015 S. Karger AG, Basel.
    Digestive surgery 01/2015; 31(6):428-435. DOI:10.1159/000370078 · 1.74 Impact Factor
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    ABSTRACT: Polycystic liver disease (PCLD) is characterized by a large number of liver cysts scattered throughout the liver parenchyma. We herein intend to present the beneficial effect of palliative fenestration treatment on quality of life in a patient with symptomatic PCLD. A 48-year-old female patient had been followed up for 5 years for both polycystic liver and kidney diseases at another institution. During follow-up for last 1 year, we recognized that she had barely maintained her ability of function in daily activities due to progressive worsening of fatigue and dyspnea on exertion. The patient finally underwent surgical fenestration treatment. Multiple cysts in the enlarged liver were opened and the cyst walls were excised with electrocautery. No surgical complication occurred and the patient was discharged 10 days after the open fenestration surgery. The total liver volume was 3,870 ml before surgery and 3,125 ml at 1 week after surgery, showing a volume reduction of 19.3%. After surgery, her performance status improved significantly. In the present case, significant improvement in quality of life and daily activity performance was achieved after open fenestration treatment over 18 months of follow-up without disease recurrence.
    01/2015; 19(1). DOI:10.14701/kjhbps.2015.19.1.40
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    ABSTRACT: Pneumatosis intestinalis (PI) is a condition in which multiple gas-filled mural cysts develop in the gastrointestinal tract. Although its exact etiology remains obscure, PI is rarely observed in liver transplant (LT) recipients.
    01/2015; 19(1). DOI:10.14701/kjhbps.2015.19.1.25
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    ABSTRACT: According to 7th AJCC TNM staging system, gallbladder carcinoma (GBC) with lymph node (LN) metastasis is classified as N1 or N2; thus making the stage IIIB (N1) or IVB (N2). Stage IIIB consists of N1 status with wide coverage of T1-3, but T3N1 group often showed poorer outcomes than T1-2N1 groups. This study intended to assess post-resection prognosis of T3N1 versus other stage III subgroups.
    01/2015; 19(1). DOI:10.14701/kjhbps.2015.19.1.11
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    ABSTRACT: Background: Prevalence of hepatic steatosis following pylorus-preserving pancreaticoduodenectomy (PPPD) is high. This study intended to reveal the prevalence and patterns of de novo hepatic steatosis following PPPD. Methods: We investigated postoperative de novo hepatic steatosis following PPPD (n = 101) with a control group of bile duct resection (BDR) (n = 54). Results: At postoperative 1 year, hepatic steatosis occurred in 21 of 82 patients (25.6%) of PPPD group and in 2 of 47 patients (4.3%) of BDR group (p = 0.001). Thereafter, at 2 to 5 years, a high prevalence of hepatic steatosis persisted in the PPPD group, but no further occurrence developed in BDR group. Once steatosis developed, it persisted until the end of the study period or patient death. Five-year cumulative incidence of hepatic steatosis was 26.7% in the PPPD group and 3.7% in BDR group (p < 0.001). Univariate analyses showed that patient sex, age, body mass index, blood lipid profile, recurrence of tumor, and diabetes did not have significant influence on the development of hepatic steatosis following PPPD. Conclusions: De novo hepatic steatosis may develop in a not negligible proportion of patients undergone PPPD. Multicenter studies with a high number of patients are needed to elucidate its pathogenesis and to find effective treatment for pancreaticoduodenectomy-associated hepatic steatosis. © 2014 S. Karger AG, Basel.
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    ABSTRACT: The purpose of this study is the evaluation of the surgical and oncological results of laparoscopic liver resection (LLR) for hepatocellular carcinoma (HCC) by comparing laparoscopic and open liver resection (OLR) in the treatment of this disease. Retrospective analysis of laparoscopic and OLR for HCC (<5 cm) performed over a 4-year period was conducted. The LLR was done by a single surgeon. The study was performed on patients who received liver resection for HCC between July 2007 and August 2011 in our institution. Propensity-based matched analyses were used to account for operative method selection biases. During the 4 years, 1,050 patients with HCC received an operation. Among them patients who never received TACE or RFA before surgery and had HCC (<5 cm) were selected for this study. 174 patients had OLR, and 58 patients underwent LLR. Patients who received LLR had lower operative time, transfusion rate, complication rate, and shorter hospital days. There were significant differences in hospital mortality and morbidity between the two groups. Dietary recovery was relatively fast in the group of LLR. Overall and disease-free survival rates during the 4 years were also not significantly different between the two groups. LLR is a developing and safe technique in a select group of patients including those with malignancies, and use of this procedure is associated with short hospital stays, a rapid return to a normal diet, full mobility, and minimal morbidity, with acceptable oncological parameters. It may be an optimal method of hepatectomy in HCC (<5 cm). Further, long-term follow-up should be acquired for adequate evaluation for survival.
    Surgical Endoscopy 12/2014; DOI:10.1007/s00464-014-3980-1 · 3.31 Impact Factor
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    ABSTRACT: A small proportion of gallbladder carcinomas (GBC) are incidentally detected after laparoscopic cholecystectomy (LC). This study intended to analyze the effect of extended reoperation on the long-term outcome of patients with pT1b/T2 GBC who had initially undergone LC.
    Journal of Gastrointestinal Surgery 11/2014; 19(2). DOI:10.1007/s11605-014-2692-0 · 2.39 Impact Factor
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    ABSTRACT: The significant advantages of robotic surgery have expanded the scope of surgical procedures that can be performed through minimally invasive techniques. The aim of this study was to compare the perioperative outcomes between robotic and laparoscopic liver surgeries at a single center.
    Langenbeck s Archives of Surgery 11/2014; DOI:10.1007/s00423-014-1238-y · 2.16 Impact Factor
  • Seong-Ryong Kim, Ki-Hun Kim
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    ABSTRACT: Liver resection has long been a complicated challenge in terms of minimally invasive surgery. However, robotic surgery has expanded the number of surgical procedures that can be performed using minimally invasive techniques. This study describes the authors’ experience of 17 robotic liver resections performed using the da Vinci Surgical System. From May 2010 to May 2012, 17 patients underwent robotic liver resection at Asan Medical Center, Seoul, Korea. Only patients who underwent left hepatectomy or left lateral sectionectomy were included in the study. Thirteen patients had hepatocellular carcinoma, one had a biliary cyst, one had a dysplastic nodule, one had fibronodular hyperplasia, and one had a left intrahepatic duct stone. The mean operative time was 267.06 ± 84.62 minutes and the mean estimated blood loss was 264.71 ± 104.23 mL. No open conversion was required. The mean tumor size was 2.98 ± 1.47 cm and the mean hospital stay was 7.58 ± 2.26 days. The results confirm the safety and feasibility of robotic liver resection. As surgeons become more experienced with robotic liver resection and the technology improves, more patients will benefit from this approach.
    Hepato-gastroenterology 10/2014; 61(135):2062-7. DOI:10.5754/hge14594 · 0.91 Impact Factor
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    ABSTRACT: Atrophy of the pancreatic parenchyma, which occurs frequently after pylorus-preserving pancreaticoduodenectomy (PPPD), is often associated with pancreatic exocrine insufficiency. Many surgeons prefer to insert a drainage tube into the remnant pancreatic duct primarily to prevent pancreatic leakage at the pancreaticojejunostomy (PJ) after PPPD. Drainage methods vary widely but can be roughly classified as internal or external drainage. This study intended to evaluate their effects on pancreatic parenchymal atrophy following PPPD.
    Journal of Gastrointestinal Surgery 07/2014; 18(9). DOI:10.1007/s11605-014-2583-4 · 2.39 Impact Factor
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    ABSTRACT: Although benefits of surgical resection of residual gastrointestinal stromal tumors (GISTs) after imatinib therapy have been suggested, those benefits over imatinib alone have not been proven. We compared the clinical outcomes of surgical resection of residual lesions after imatinib treatment (S group) with imatinib treatment alone (NS group) in patients with recurrent or metastatic GISTs. A total of 134 patients (42 in the S group, 92 in the NS group) with recurrent or metastatic GIST who had stable disease for more than 6 months after responding to imatinib were included. There were no statistically significant differences in the baseline characteristics of the S and NS groups except for age and number of peritoneal metastases. The median follow-up period was 58.9 months. Progression-free survival (PFS) and overall survival (OS) were significantly longer in the S group compared with the NS group (median PFS: 87.7 vs. 42.8 months, p = 0.001; median OS: not reached vs. 88.8 months, p = 0.001). Multivariate analysis revealed that S group, female sex, KIT exon 11 mutations, and low initial tumor burden were associated with longer PFS, and S group and low initial tumor burden were associated with a longer OS. Even after applying inverse probability of treatment weighting adjustment, the S group demonstrated significantly better outcomes in terms of PFS (HR 2.326; 95 % confidence interval [CI] 1.034-5.236; p = 0.0412) and OS (HR 5.464; 95 % CI 1.460-20.408; p = 0.0117). Surgical resection of residual lesions after disease control with imatinib is likely to be beneficial to patients with recurrent or metastatic GISTs.
    Annals of Surgical Oncology 07/2014; 21(13). DOI:10.1245/s10434-014-3866-4 · 3.94 Impact Factor
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    ABSTRACT: In total portosplenomesenteric thrombosis patients, cavoportal hemitransposition (CPHT) is indicated but rarely applicable for adult-to-adult (A-to-A) living donor liver transplantation (LDLT) because partial liver graft requires splanchno-portal inflow for liver graft regeneration. If intra- & peri-pancreatic collaterals draining into pericholedochal varix were present, pericholedochal varix may provide splanchnic blood flow to the transplanted liver and also relieve recipient's portal hypertension. To date, however, there is no successful report using pericholedochal varix in liver transplantation (LT). We successfully performed A-to-A LDLTs using pericholedochal varix for those 2 patients. The surgical strategies are followings: (a) dissection of hepatic hilum to isolate left hepatic artery using for arterial reconstruction of implanted right lobe graft, (b) en-mass clamping of the undissected remaining hilum if we can leave adequate length of stump from the clamping site, and then hilum is divided, (c) delay the donor hepatectomy until the feasibility of the recipient operation is confirmed. Portal flow was established between the sizable pericholedochal varix (caliber > 1cm) and graft portal vein, but the individually designed approaches were used for each patients. Currently, they have been enjoying normal life on posttransplant 92 and 44 months respectively. In conclusion, enlarged pericholedochal varix in patients with totally obliterated splanchnic veins might be an useful inflow to restore portal flow and secure good outcome in A-to-A LDLT. Liver Transpl, 2014. © 2014 AASLD.
    Liver Transplantation 05/2014; 20(5). DOI:10.1002/lt.23850 · 3.79 Impact Factor
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    ABSTRACT: Background. The use of rituximab (Rit) to prevent antibodymediated rejection (AMR) of ABO-incompatible (ABOi) adult living donor liver transplants (ALDLTs) has raised questions about the role of local graft infusion therapy (LGIT) and splenectomy (SPN); however, they are still regarded as essential components of the desensitization (DSZ) protocol. Methods. The DSZ protocol consisted of plasma exchange and Rit. None of the patients underwent SPN. The patients were divided into two groups. The patients in Group I (n=20) received LGIT via the hepatic artery or portal vein. The patients in Group II (n=100) did not receive LGIT. Results. One hundred twenty ABOi ALDLTs were performed from November 2008 to June 2012, and there was only one case of operative mortality (0.8%). There was no significant difference in the 3-year patient survival rates between patients receiving ABO-compatible and ABOi ALDLT (88.8% vs. 94.8%; P=0.11). LGIT catheter-related complications occurred in six patients (30.0%). There was no statistically significant difference in the 3-year patient survival rates between the groups (90.0% vs. 95.0%; P=0.26). One patient in Group 1 (0.8%) experienced AMR. Diffuse intrahepatic biliary stricture occurred in two patients (10.0%) in Group I and in five patients (5.0%) in Group II, although the difference was not statistically significant (P=0.11). The incidence of biliary stricture was similar in both groups (P=0.06), but the incidence of infection was significantly higher in Group I (P=0.03). Conclusion. The DSZ protocol without LGIT and splenectomy is a safe and effective method of attaining a successful outcome of ABOi ALDLT.
    Transplantation 04/2014; 97 Suppl 8(8):S59-66. DOI:10.1097/ · 3.78 Impact Factor
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    ABSTRACT: Patent portal vein (PV) and adequate portal inflow is essential for successful living donor liver transplantation (LDLT). In extensive portal vein thrombosis (PVT) patients, however, complete PV thrombectomy is not feasible particularly at intrapancreatic portion, and subsequently portal flow steal through preexisting sizable collaterals or rethrombosis can occur. To overcome those problems, we introduced interruption of sizable collaterals and intraoperative cine-portogram (IOP), which is useful for diagnosis and treatment of residual PVT and sizable collaterals.
    Transplantation 04/2014; 97 Suppl 8(8):S23-30. DOI:10.1097/ · 3.78 Impact Factor
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    ABSTRACT: Background. An exchange living donor program for liver transplantation, similar to the exchange living donor kidney program, was proposed to avoid ABO-incompatible adult living donor liver transplantation (LDLT). The objective of this study was to present updated changes in exchange adult LDLT program at our institution. Methods. Between January 2003 and December 2011, approximately 2,182 adult LDLT cases were included in this study. During this period, 26 paired-exchange donor LDLT cases were performed (1.2%). Results. Of the 26 paired-exchange donor LDLT cases, 22 pairs were matched due to ABO-incompatibility, and 4 pairs were matched because of cascade allocation of unrelated donors or relatively small graft volume to the recipients. A total of 28 living donors were included in the 26 paired-exchange donor LDLT cases because of inclusion of two dual-graft transplants. Elective surgery was performed in 22 cases, and urgent operation was performed in 4 cases. The overall 1-year and 5-year patient and graft survivals were both 96.2% and 90.1%, respectively. Conclusions. Our experience suggests that the paired-exchange donor program for adult LDLT seems to be a feasible modality to overcome donor ABO incompatibility. Reasonably acceptable indications for donor exchange LDLT will be proposed in near future.
    Transplantation 04/2014; 97 Suppl 8(8):S66-9. DOI:10.1097/ · 3.78 Impact Factor

Publication Stats

1k Citations
246.18 Total Impact Points


  • 2007–2015
    • University of Ulsan
      • • Department of Surgery
      • • Asan Medical Center
      • • College of Medicine
      Urusan, Ulsan, South Korea
  • 2004–2014
    • Ulsan University Hospital
      Urusan, Ulsan, South Korea
  • 2008
    • Asan Medical Center
      • Division of Liver Transplantation and Hepato-Biliary Surgery
      Seoul, Seoul, South Korea