Hyeong Ryul Kim

Asan Medical Center, Seoul, Seoul, South Korea

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Publications (21)78.33 Total impact

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    ABSTRACT: Melanoma that involves the upper gastrointestinal (GI) tract is rare and studies relating to endoscopic and pathologic findings with clinical outcomes are lacking. We reviewed the gross and microscopic patterns of the upper GI tract in primary and metastatic melanoma, and examined their association with clinical outcomes. Twenty-nine cases of primary esophageal (n = 19) and metastatic gastric and/or duodenal melanoma (n = 10) that were detected during upper GI endoscopy between 1995 and 2011 were retrospectively analyzed. Three types of gross patterns were recognized-nodular pattern in 7 cases, mass-forming pattern in 18 cases, and flat pigmented pattern in 4 cases. In primary esophageal melanoma, 13 patients (68.4 %) underwent surgery and 9 received palliative therapy. Of all cases, 22 patients (75.9 %) died of disease progression; the median overall survival period was 12 months (interquartile range [IQR] 4.5-24.5 months), and from recognition of upper GI tract melanoma the median overall survival period was 9 months (IQR 3.5-17.0 months). In primary esophageal cases, skin melanoma stage better discriminated the patients with good prognosis than the esophageal cancer stage. The flat pigmented gross pattern proved to be a good prognostic factor in primary and metastatic GI tract melanomas (p = 0.016 and p = 0.046, respectively). Melanoma of the GI tract is a highly aggressive disease with a poor prognosis, both in primary and metastatic cases. However, in primary esophageal melanoma, careful inspection of the mucosa during endoscopic examination followed by surgical resection may result in extended survival.
    Annals of Surgical Oncology 03/2014; · 4.12 Impact Factor
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    ABSTRACT: With recent advances in radiology, the detection of ground-glass nodules (GGNs) has become increasingly common. However, there still is no consensus on management, especially on the need for systemic lymph node (LN) dissection. The purpose of this study was to evaluate the surgical outcomes on the basis of the extent of resection of the primary lesion and mediastinal LN dissection and to carefully suggest appropriate treatment strategies in the patients with pulmonary adenocarcinoma presenting as pure ground-glass opacities. From January 2006 to December 2010, 1267 patients with pulmonary adenocarcinoma, including adenocarcinoma in situ, underwent curative-intent surgical resection. Among these patients, pure GGNs were confirmed in 48 patients on preoperative chest computed tomography (CT) by an experienced radiologist, and 42 underwent systemic LN dissection or sampling. We retrospectively reviewed the perioperative data and postoperative outcomes. The median age of the patients was 56 (range, 35-78) years, and 26 (54.2%) patients were male. The median size of the nodules was 12 (5-30) mm, and 8 (16.7%) had multiple lesions at the time of operation. The median duration between the initial diagnosis and operation was 4 (0-45) months. Preoperative positron emission tomography/CT was taken in 36 (75.0%) patients, which showed no significant metabolic uptake. For curative resection, lobectomy was performed in 32 (66.7%) patients, segmentectomy in 4, and wedge resection in 12. Clear resection margins were reported in all patients. Forty-two patients underwent systemic mediastinal LN dissection or sampling, and the median number of dissected LNs was 23 (7-53). No LN was reported as positive for malignancy. The median follow-up duration after the first operation was 39 (23-77) months, and there were no cases of late mortality, local recurrence or nodal recurrence. Recurrent GGNs have been developed in 6 (12.5%) patients. For pure GGNs, limited resection can be performed when complete resection is obtained, as it was sufficient for cure and especially because there is high probability of multiple lesions. We were unable to demonstrate any additional therapeutic benefit with mediastinal LN dissection in patients with pure GGNs.
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 02/2014; · 2.40 Impact Factor
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    ABSTRACT: Most cases of Ewing's sarcoma are reported in the bone, and extraosseous Ewing's sarcoma is an extremely rare disease. Here, we report a rare case of primary pulmonary Ewing's sarcoma in a patient with hemoptysis. The patient underwent right upper lung lobe lobectomy with adjuvant chemotherapy and radiation therapy and has been free of recurrent disease for 4 years.
    The Korean journal of thoracic and cardiovascular surgery. 02/2014; 47(1):47-50.
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    ABSTRACT: Chylothorax associated with pulmonary resection for lung cancer, although rare, must be considered as a potential complication during thoracic surgery. In the present study, we investigated the effectiveness of a conservative approach (diet or pleurodesis) to the management of chylothorax. Between January 2000 and December 2010, 3,120 consecutive patients underwent pulmonary resection and mediastinal lymph node dissection at our institution. Among them, 67 patients with confirmed chylothorax were retrospectively reviewed. Right-sided chylothorax was more common than left-sided chylothorax (p = 0.033). All patients were initially treated with nil per os (NPO; n = 46) or a low long-chain triglyceride (LCT) diet (n = 21). In the NPO group, 24 patients were successfully treated with diet alone and 20 underwent pleurodesis. In the LCT group, 10 patients were successfully treated with diet alone; of the 11 remaining patients, 4 patients improved after NPO. The 7 patients who did not improve with NPO underwent pleurodesis. No significant differences in chest tube output before and after initial treatment, length of stay, or success rate were observed between patients initially treated with NPO and those receiving low LCT. All 32 pleurodeses performed in 27 patients were successful. Two patients underwent surgery without pleurodesis after dietary treatment failure. Postoperative air leakage or drainage for 5 days greater than 21.6 mL/kg were independent risk factors for dietary treatment failure. Conservative treatment, including pleurodesis, should be the first choice of treatment for chylothorax complicating pulmonary resection.
    The Annals of thoracic surgery 12/2013; · 3.74 Impact Factor
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    ABSTRACT: To determine the role of surgery in complete responders on FDG-PET after CRT and the prognostic significance of metabolic response in locally advanced esophageal squamous cell carcinoma. We retrospectively reviewed 154 patients with locally advanced esophageal cancer with increased uptake on FDG-PET. Eighty-one patients received definitive CRT and 73 received trimodality therapy. We defined metabolic complete remission (PET-CR) when FDG uptake of the primary tumor and lymph nodes were decreased and was indistinguishable from surrounding normal tissue. Oncologic outcomes were compared between trimodality group, definitive CRT group, and PET-CR subgroup of definitive CRT. Thirty-one (38.3%) of the definitive CRT patients and 39 (53.4%) of the trimodality therapy patients achieved PET-CR after CRT. The 2-year OS of the trimodality group was higher than that of the definitive CRT group, but equivalent to that of the PET-CR subgroup of definitive CRT. The 2-year LRFS and DFS of the trimodality group were higher than that of the PET-CR subgroup or the entire of definitive CRT group. The addition of surgery showed higher DFS and LRFS rates than those of the PET-CR subgroup of definitive CRT. Despite achieving PET-CR, surgery still seems to improve local tumor control. J. Surg. Oncol. © 2013 Wiley Periodicals, Inc.
    Journal of Surgical Oncology 12/2013; · 2.64 Impact Factor
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    Joo Yeon Kim, Soyeon An, Se Jin Jang, Hyeong Ryul Kim
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    ABSTRACT: Extrauterine epithelioid trophoblastic tumors constitute an extremely rare gestational trophoblastic disease. We report the case of an extrauterine trophoblastic tumor that was incidentally detected in the left lung. Squamous cell carcinoma was suspected after microscopically examining the specimen obtained upon preoperative needle biopsy. After surgery, the tumor was confirmed by microscopic findings and immunohistochemical features.
    The Korean journal of thoracic and cardiovascular surgery. 12/2013; 46(6):471-4.
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    ABSTRACT: Gastric conduit cancer (GCC), which is a carcinoma that arises in the gastric conduit after oesophagectomy, often negatively affects long-term survivors of oesophageal cancer. The aim of this study was to evaluate the incidence and clinical implications of GCC. We reviewed data for 863 patients who underwent an oesophagectomy and a reconstruction of the gastric conduit from 1993 to 2011 for oesophageal cancer. A total of 18 cases of GCC in 18 patients were identified. Cumulative incidence rates of GCC were 2.4% at 5 years and 5.7% at 10 years. The median interval between oesophagectomy and detection of gastric tube cancer was 5.0 years (range, 1-16 years). Ten patients were incidentally diagnosed with GCC under periodic endoscopy. All cases of gastric tube cancer were adenocarcinoma and 12 cases were located at the antrum of the gastric conduit. For GCC treatment, endoscopic submucosal dissection was performed in 6 patients, total gastric conduit gastrectomy with colon interposition in 3 patients and chemotherapy in 6 patients. Five patients received conservative treatment alone. The 5-year survival rate of all patients was 22.2%. The 3-year survival rates of the patients who underwent endoscopic resection, total gastrectomy with colon interposition or chemotherapy or conservative treatment were 100, 50, and 9.1%, respectively (P = 0.003). Patients had a constant risk of GCC occurrence after oesophagectomy for oesophageal cancer. Endoscopic or surgical resection for early GCC showed favourable outcomes compared with chemotherapy or conservative treatment for advanced GCC. A regular and long-term follow-up, including detailed endoscopy, is essential for the early detection of GCC in patients who underwent oesophagectomy for oesophageal cancer.
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 10/2013; · 2.40 Impact Factor
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    ABSTRACT: Epithelial-mesenchymal transition (EMT) is associated with reduced sensitivity to many chemotherapeutic drugs, including EGFR tyrosine kinase inhibitors. Here, we investigated if this reduced sensitivity also contributes to resistance to crizotinib, an ALK inhibitor of lung cancer that exhibits the EML4-ALK translocation. We established a crizotinib-resistant subline (H2228/CR), which was derived from the parental H2228 cell line by long-term exposure to increasing concentrations of crizotinib. Characteristics associated with EMT, including morphology, EMT marker proteins, and cellular mobility, were analyzed. Compared with H2228 cells, the growth of H2228/CR cells was independent of EML4-ALK, and H2228/CR cells showed cross-resistance to TAE-684 (a second-generation ALK inhibitor). Phenotypic changes to the spindle-cell shape were noted in H2228/CR cells, which were accompanied by a decrease in E-cadherin and increase in vimentin and AXL. In addition, H2228/CR cells showed increased secretion and expression of TGF-β1. Invasion and migration capabilities were dramatically increased in H2228/CR cells. Applying TGF-β1 treatment to parental H2228 cells for 72 h induced reversible EMT, leading to crizotinib resistance, but this was reversed by the removal of TGF-β1. Suppression of vimentin in H2228/CR cells by siRNA treatment restored sensitivity to crizotinib. Furthermore, these resistant cells remained highly sensitive to the Hsp90 inhibitors, similar to the parental H2228 cells. In conclusion, we suggest EMT is possibly involved in acquired resistance to crizotinib, and that HSP90 inhibitors could be a promising option for the treatment of EMT.
    Molecular oncology 08/2013; · 6.70 Impact Factor
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    ABSTRACT: Ectopic mediastinal parathyroid adenomas are rare, but can be life-threatening. Resection is indicated in those cases accompanied by hypercalcemia, especially in young patients. Although most mediastinal parathyroid adenomas can be removed by a cervical approach, a transthoracic approach is needed when the adenoid tissues are located deep within the thoracic cavity. We describe the case of a 37-year-old female who underwent excision of an intrathoracic ectopic parathyroid adenoma after parathyroidectomy four months earlier.
    The Korean journal of thoracic and cardiovascular surgery. 08/2013; 46(4):302-4.
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    Ho Jin Kim, Hyeong Ryul Kim
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    ABSTRACT: We report a rare case of rhabdomyosarcoma spontaneously arising in an anterior mediastinal teratoma in a 47-year-old male. The patient was found to have an anterior mediastinal mass on a chest X-ray, which was taken two months before his presentation to Asan Medical Center. A subsequent computed tomography scan revealed an 8.9×7.1×8.0 cm heterogeneous mass in the anterior mediastinum. He underwent an excision via median sternotomy. The histopathologic study identified a mature teratoma with embryonal rhabdomyosarcoma.
    The Korean journal of thoracic and cardiovascular surgery. 08/2013; 46(4):305-8.
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    ABSTRACT: The presence of multiple primary cancers (MPCs) in patients with esophageal cancer often presents physicians with a difficult therapeutic decision, because little is known about the appropriate treatment and long-term survival. The purpose of this study was to evaluate appropriate surgical approaches and long-term survival after surgery for esophageal cancer associated with MPCs. Data from 622 patients who underwent surgery for primary esophageal cancer between 1989 and 2008 were reviewed retrospectively to identify the presence of MPCs. A total of 96 MPCs were identified in 90 (14.5 %) patients. The three leading MPCs were stomach cancer (n = 36, 37.5 %), head and neck cancer (n = 18, 18.8 %), and lung cancer (n = 18, 18.8 %). The rate of curative resections for both esophageal cancer and MPCs was 87.5 % (28/32) in patients with stomach cancer, 47.1 % (8/17) in head and neck cancer, and 52.9 % (9/17) in lung cancer (P = 0.006). The 5-year survival rates after surgery for esophageal cancer in patients associated with stomach, lung, and head and neck cancer were 52.7, 27.0, and 9.2 %, respectively (P = 0.011). A range of surgical approaches for esophageal cancer is available in patients associated with MPCs. However, curative resections for primary esophageal cancer associated with MPCs are feasible in highly selected patients. Therefore, a multidisciplinary team management approach is essential for customized treatment strategies in patients with esophageal cancer associated with MPCs.
    Annals of Surgical Oncology 08/2013; · 4.12 Impact Factor
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    ABSTRACT: Background The aim of the present study was to evaluate the oncologic characteristics of pulmonary mucoepidermoid carcinoma (PMEC) and the efficacy of surgical resections.Materials and Methods The surgery for PMEC was performed in 23 patients at Asan Medical Center from January 2000 to December 2010. They accounted for 0.8% of all surgically resected pulmonary neoplasm in the center. The medical records of these patients were reviewed retrospectively.Results This study group was composed of 13 males (56.5%) and 10 females (43.5%). Median age was 41 years (range, 10 to 75 years). Complete resection with systematic mediastinal lymph node dissection was performed in all patients. There were three postoperative complications: atelectasis in one patient and chylothorax in two patients. There was no postoperative mortality. The median follow-up duration was 68 months (range, 13 to 115 months). In one patient, recurrent disease was found 73 months after surgery. All patients were followed without mortality until the end of this study. The 5- and 8-year disease-free survival rates were 100 and 90.9%, respectively.Conclusion Complete surgical resection with systematic lymph node dissection is an effective treatment for patients with PMEC and provides favorable prognosis.
    The Thoracic and Cardiovascular Surgeon 04/2013; · 0.93 Impact Factor
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    ABSTRACT: OBJECTIVE: The purpose of this study is to investigate the clinical characteristics, prognosis, and risk factors of patients in whom cervical lymph node cancer recurred after esophageal cancer surgery with 2-field lymph node dissection. METHODS: Between 2000 and 2010, 471 consecutive patients who had undergone esophagectomy with 2-field lymph node dissection for esophageal squamous cell carcinoma were enrolled in this study. RESULTS: Recurrence was seen in 96 patients. Isolated cervical lymph node recurrence (group A) developed in 21 patients, locoregional recurrence only and without cervical lymph node recurrence (group B) in 29, and distant recurrence with or without locoregional recurrence (group C) in 46 patients. The median times to recurrence after surgery in groups A, B, and C were 20, 16, and 12 months, respectively (P = .634). 2- and 5-year rates of isolated cervical lymph node recurrence were 4.1% and 5.6%, respectively. The median survival times from diagnosis of recurrence were 13, 7, and 5 months in groups A, B, and C, respectively. The difference in survival between groups A and C was statistically significant (P = .030). Upper thoracic esophageal cancer and positive recurrent laryngeal node at the time of initial surgery were independent risk factors for cervical recurrence-free survival as determined by univariate and multivariate analysis. CONCLUSIONS: This study shows that 2-field lymph node dissection can be performed with an acceptable rate of cervical lymph node recurrence. Patients with isolated cervical lymph node recurrence demonstrated longer survival from diagnosis of recurrence than patients with other sites of recurrence.
    The Journal of thoracic and cardiovascular surgery 02/2013; · 3.41 Impact Factor
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    ABSTRACT: Most patients treated with EGFR-tyrosine kinase inhibitors (EGFR-TKIs) eventually develop acquired resistance. Loss of expression of insulin-like growth factor (IGF)-binding protein-3 (IGFBP-3) has been suggested as a possible mechanism of resistance to EGFR-TKIs in the A431 and HN11 cell lines. Here, we investigated IGFBP-3 expression in two EGFR mutant lung cancer cell lines with resistance to EGFR-TKIs and examined the value of serum IGFBP-3 level as a marker of resistance. The effect of the induction or suppression of IGFBP-3 expression on resistance was also evaluated. HCC827 sublines with resistance to gefitinib (HCC827/GR) and erlotinib (HCC827/ER) were established. Loss of IGFBP-3 expression was detected by Western blotting in both cell lines without changes in transcriptional activity, and ELISA showed significantly lower amounts of secreted IGFBP-3 in the culture media of the mutant cell lines than in that of the parental line. Despite the loss of IGFBP-3 expression, IGFR signalling activity remained unchanged. Forced expression of IGFBP-3 by adenovirus-mediated transfection or recombinant IGFBP-3 slightly increased the growth-inhibitory and apoptotic effects of EGFR-TKIs, whereas suppression of IGFBP-3 did not affect sensitivity to EGFR-TKI. Serum IGFBP-3 levels measured by ELISA before and after the development of EGFR-TKI resistance in 20 patients showed no significant changes (1815.3±94.6 ng/mL before treatment vs. 1778.9±87.8 ng/mL after EGFR-TKI resistance). In summary, although IGFBP-3 downregulation is associated with the acquisition of resistance to EGFR-TKIs regardless of the mechanism, its effect on resistance was not significant, indicating that IGFBP-3 may not play an important role in resistance to EGFR-TKIs and serum IGFBP-3 level is not a reliable indicator of resistance.
    PLoS ONE 01/2013; 8(12):e81393. · 3.73 Impact Factor
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    ABSTRACT: BACKGROUND: Definitive chemoradiotherapy is associated with high local treatment failure rates, and surgical resection may be an appropriate salvage therapy. However, the efficacy and safety of salvage esophagectomy have not been elucidated fully. The clinical outcomes of salvage esophagectomy for locoregional failure after chemoradiotherapy were assessed. METHODS: Twelve patients who underwent salvage esophagectomy after chemoradiotherapy between January 2003 and November 2010 were included in this retrospective analysis. Baseline demographics and survivals of these patients were compared with 21 patients who did not receive salvage esophagectomy for locoregional failure only after chemoradiotherapy, identified from our own previous prospective trials. RESULTS: The median age was 62.5 years (range 50 to 69) and all patients had squamous cell carcinoma. The median radiation dose was 54.0 Gy (range 41.4 to 66.0) and the median interval between completion of chemoradiation and surgery was 8.0 months (range 2.0 to 32.9). There were no in-hospital deaths. Pulmonary complication was the most common postoperative morbidity (42%), and anastomotic leakage occurred in 1 patient (8%). With a median follow-up period of 29.3 months (range 5.8 to 73.0), the overall 3-year survival rate was 58%. Patients with early pathologic stage disease (T1/2 and N0) showed significantly prolonged survival (p = 0.03) compared with those with advanced pathologic stage (T3/T4 or N1). Patients with salvage esophagectomy had prolonged event-free survival and overall survival compared with those patients with locoregional failure who received primary chemotherapy or boost radiotherapy (p < 0.001). CONCLUSIONS: While salvage esophagectomy for locoregional failure after chemoradiotherapy should be employed with great caution, it appears to be a feasible and effective therapeutic option for highly selected patients, especially with early pathologic stage disease. Salvage esophagectomy can be recommended as the only current curative treatment option for patients with locoregional failure after chemoradiotherapy.
    The Annals of thoracic surgery 09/2012; · 3.74 Impact Factor
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    ABSTRACT: This study was intended to assess the effect of resection of pulmonary metastasis (PM) of hepatocellular carcinoma (HCC) after liver transplantation (LT). No effective treatment modality exists for PM-HCC, and little is known about the posttransplant outcomes of pulmonary metastasectomy (PMT). Of 587 adult LT recipients diagnosed with HCC, 43 had PM-HCC. We retrospectively compared outcomes in 23 patients who underwent PMT and 20 who did not. PMT was precluded in ten patients in the non-PMT group by multiple (usually ≥ 5) lung nodules, in nine by lung nodules with concurrent or residual extrapulmonary metastasis, and in one by comorbidity. Of the 23 patients in the PMT group, 14 underwent a single session of PMT, 7 underwent 2 sessions each, and 2 underwent 3 sessions each, for a total of 34 sessions. There were no surgery-related deaths or complications. After first PMT, 41 nodules, each 0.2-2.5 cm in diameter, were observed: 1-5 nodules per patient. Every available treatment was provided to patients with post-PMT recurrence and those in the non-PMT group to control pulmonary and extrapulmonary metastases. Patient survival rates before PM diagnosis did not differ between the two groups (p = 0.141). However, 2 year post-PM survival rate was significantly greater in the PMT group (30.6% vs. 0%, p = 0.007), resulting in a significantly greater overall 5 year survival rate (44.7% vs. 12.8%, p = 0.017). Univariate analysis showed no risk factor significantly associated with patient survival after PMT. PMT should be performed for resectable PM-HCC because it may provide a chance of long-term survival.
    World Journal of Surgery 03/2012; 36(7):1592-602. · 2.23 Impact Factor
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    ABSTRACT: The experience of a single-institution regarding surgery for small cell lung cancer (SCLC) was reviewed to evaluate the surgical outcomes and prognoses. From July 1990 to December 2009, thirty-four patients (28 male) underwent major pulmonary resection and lymph node dissection for SCLC. Lobectomy was performed in 24 patients, pneumonectomy in eight, bilobectomy in one, and segmentectomy in one. Surgical complications, mortality, the disease-free survival (DFS) rate, and the overall survival rate were analyzed retrospectively. The median follow-up period was 26 months (range, 4 to 241 months), and there was one surgical mortality (2.9%). Six patients (17.6%) experienced recurrence, all of which were systemic. Eight patients died during follow-up; four died of disease progression and the other four died of pneumonia or of another non-cancerous cause. The three-year DFS rate was 79.2±2.6% and the overall survival rate was 66.4±10.5%. Recurrence or death was significantly prevalent in the patients with lymph node metastasis (p=0.001) as well as in those who did not undergo adjuvant chemotherapy (p=0.008). The three-year survival rate was significantly greater in the patients with pathologic stage I/II cancer than in those with stage III cancer (84% vs. 13%, p=0.001). Major pulmonary resection for small cell lung cancer is feasible in selected patients. Patients with pathologic stage I or II disease showed an excellent survival rate after surgery and adjuvant treatment. Prospective randomized studies will be needed to define the role of surgery in early-stage small cell lung cancer.
    The Korean journal of thoracic and cardiovascular surgery. 02/2012; 45(1):40-4.
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    ABSTRACT: Applying a next-generation sequencing assay targeting 145 cancer-relevant genes in 40 colorectal cancer and 24 non-small cell lung cancer formalin-fixed paraffin-embedded tissue specimens identified at least one clinically relevant genomic alteration in 59% of the samples and revealed two gene fusions, C2orf44-ALK in a colorectal cancer sample and KIF5B-RET in a lung adenocarcinoma. Further screening of 561 lung adenocarcinomas identified 11 additional tumors with KIF5B-RET gene fusions (2.0%; 95% CI 0.8-3.1%). Cells expressing oncogenic KIF5B-RET are sensitive to multi-kinase inhibitors that inhibit RET.
    Nature medicine 01/2012; 18(3):382-4. · 27.14 Impact Factor
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    ABSTRACT: We report a rare case of a 38-year-old woman with a bronchial carcinoid tumor arising from an intralobar bronchopulmonary sequestration. The vascular supply to the sequestered left lower lobe originated from the descending thoracic aorta. A left lower lobe lobectomy was performed. The findings of the pathological examination revealed an atypical carcinoid tumor that was immunopositive for chromogranin and synaptophysin. At the 3-year follow-up examination, the patient was healthy.
    The Korean journal of thoracic and cardiovascular surgery. 12/2011; 44(6):444-7.
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    ABSTRACT: This study was performed to assess the clinical feasibility and surgical outcomes of video-assisted mediastinoscopic lymphadenectomy in the treatment of resectable lung cancer. Between July 2004 and December 2009, we retrospectively analyzed 108 consecutive video-assisted mediastinoscopic lymphadenectomies in lung cancer patients from a prospectively collected database. Ninety-seven (89.8%) patients underwent combined operation during the same anesthesia and six (5.3%) patients underwent a staged operation for the resection of lung cancer and systematic lymphadenectomy. We reviewed the indication and duration of video-assisted mediastinoscopic lymphadenectomy, its complication, combined or staged operation type, the number of dissected lymph nodes and nodal stations, and pathologic staging of the mediastinal node. Mean operative time of video-assisted mediastinoscopic lymphadenectomy was 39.8 ± 12.3 min (range of 14-85 min). Mean number of resected lymph nodes was 16.0 ± 7.7 (range of 3-37). In video-assisted mediastinoscopic lymphadenectomy, the rates of lymph node dissection of stations 4R, 4L, and 7 were 71.3%, 88.0%, and 100%, respectively, whereas the rates of dissection of lymph nodes in station 2R and 2L were only 22.2% and 17.6%, respectively. There was no operative mortality. We identified five complications of recurrent nerve palsy. Video-assisted mediastinoscopic lymphadenectomy is a clinically feasible procedure with acceptable complication rate and provides more accurate staging of mediastinal node in lung cancer patients. It may be also an excellent supplementary technique used for complete mediastinal node dissection at minimal invasive surgery for cancer resection, especially with left-sided video-assisted thoracoscopic lobectomy.
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 05/2011; 40(6):1483-6. · 2.40 Impact Factor