Woong Youn Chung

Wonju Severance Christian Hospital, Genshū, Gangwon-do, South Korea

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Publications (118)322.21 Total impact

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    ABSTRACT: The radioiodine ablation therapy is required for patients who underwent a total thyroidectomy. Through a comparative review of a low iodine diet (LID) and a restricted iodine diet (RID), the study aims to suggest guidelines that are suitable for the conditions of Korea. The study was conducted with 101 patients. With 24-hour urine samples from the patients after a 2-week restricted diet and after a 4-week restricted diet, the amount of iodine in the urine was estimated. The consumed radioiodine amounts for 2 hours and 24 hours were calculated. This study was conducted with 47 LID patients and 54 RID patients. The amounts of iodine in urine, the 2-week case and 4-week case for each group showed no significant differences. The amounts of iodine in urine between the two groups were both included in the range of the criteria for radioiodine ablation therapy. Also, 2 hours and 24 hours radioiodine consumption measured after 4-week restrictive diet did not show statistical differences between two groups. A 2-week RID can be considered as a type of radioiodine ablation therapy after patients undergo a total thyroidectomy.
    Yonsei medical journal 07/2015; 56(4):1021-1027. DOI:10.3349/ymj.2015.56.4.1021 · 1.26 Impact Factor
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    ABSTRACT: Acellular dermal matrix (ADM) has been used for antiadhesion formation along with wound healing in various surgical fields. The aim is to assess the efficacy of ADM implantation in the prevention of postoperative scars and adhesions after conventional, open, total thyroidectomy. Forty-four patients with papillary thyroid carcinoma undergoing thyroidectomy were randomly assigned to the study (ADM implantation) or control group (without ADM). Global photographic assessment, Vancouver scar scale (VSS), objective scar assessment, and swallowing impairment index were assessed at baseline, immediately after surgery, and at 1 and 2 months after surgery. Nineteen control and 20 study group participants completed the study. The mean VSS score of the study group was significantly lower than the controls at both 1 month (3.06 ± 1.25 vs 4.41 ± 1.54, respectively) and 2 months (2.76 ± 1.56 vs 4.35 ± 1.58, respectively) after surgery. Scar quality measures (mean melanin and erythema indexes) were significantly lower in the study group compared with controls. Study group participants had significantly lower swallowing impairment scores than controls. The mean postoperative hospitalization of both groups was not significantly different. Acellular dermal matrix-assisted implants appear to improve post-thyroidectomy scar and swallowing impairments without delays in operation time.
    Dermatologic Surgery 06/2015; DOI:10.1097/DSS.0000000000000410 · 1.56 Impact Factor
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    ABSTRACT: This phase 2 study investigated the efficacy and safety of dovitinib (TKI258), a receptor tyrosine kinase inhibitor with potent activity against fibroblast growth factor receptor (FGFR) and vascular endothelial growth factor receptor (VEGFR), in locally advanced or metastatic thyroid cancer patients. Patients with advanced thyroid cancer that was refractory or not appropriate for (131)I received dovitinib orally, 500mg once daily for five consecutive days, followed by a 2-day rest every week. The primary end-point was objective response rate. Secondary end-points were progression-free survival (PFS), overall survival (OS), duration of response, changes in tumour markers and safety. Between January 2013 and October 2014, a total of 40 patients were enrolled. There were 23 (57.5%) papillary thyroid cancer, 12 (30%) medullary thyroid cancer and 5 (12.5%) follicular thyroid cancer patients. One patient had withdrawn consent before the administration of dovitinib. The overall response rate was 20.5% (8/39) and disease control rate was 69.1% (26/39). Median PFS was 5.4months (95% confidence interval (CI), 2.0-8.8) and median OS was not reached with 8.4months follow-up duration. Common treatment-related adverse events were diarrhoea (53.8%), anorexia (35.8%), vomiting (25.6%), fatigue (23%) and nausea (20.5%), most of which were grade 1 or 2. There were no grade 4 events or treatment-related deaths. Dose interruption occurred in 12 (30.7%) patients, and 19 (48.7%) patients experienced dose reduction due to adverse events. Dovitinib has a modest activity with manageable toxicity in locally advanced or metastatic thyroid cancer. Copyright © 2015 Elsevier Ltd. All rights reserved.
    European journal of cancer (Oxford, England: 1990) 06/2015; 361. DOI:10.1016/j.ejca.2015.05.020 · 4.82 Impact Factor
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    ABSTRACT: Although some studies have reported that preoperative vitamin D deficiency (VDD) is a risk factor for hypocalcemia after total thyroidectomy (TT) in patients with nontoxic multinodular goiter or Graves' disease, the association between VDD and postoperative hypocalcemia in thyroid cancer patients undergoing TT plus central compartment neck dissection (CCND) remains unclear. We evaluated whether preoperative VDD was associated with postoperative symptomatic hypocalcemia. Data were collected prospectively between September 2012 and May 2013. A total of 267 consecutive thyroid cancer patients who underwent TT with CCND were analyzed. Patients were divided into two groups, VDD or non-VDD, by preoperative vitamin D level of <10 or ≥10 ng/ml. Symptomatic hypocalcemia was defined as serum calcium <8.2 mg/dL and symptoms or signs of hypocalcemia. The rates of postoperative symptomatic hypocalcemia and clinicopathological features were compared between the two patient groups Results: The rate of postoperative symptomatic hypocalcemia was higher in the VDD group than in the non-VDD group (43.8% vs. 30.4%, p = 0.043). By logistic regression analysis, predictive factors for postoperative symptomatic hypocalcemia included a preoperative vitamin D level of <10 ng/ml (p = 0.007; odds ratio = 3.00). In patients who had postoperative intact parathyroid hormone (iPTH) levels <15 pg/ml, symptomatic hypocalcemia was more common in the VDD group than in the non-VDD group. (77.5% vs. 53.2%, p = 0.008). Our findings show that a preoperative vitamin D threshold level of >20 ng/ml reduced the risk of symptomatic hypocalcemia by 72% when compared with patients with VDD (p = 0.003). VDD is significantly associated with postoperative symptomatic hypocalcemia in thyroid cancer patients undergoing TT plus CCND. VDD was predictive for symptomatic hypocalcemia when patients had postoperative serum iPTH levels <15 pg/ml. Thus, we suggest that preoperative supplementation with oral vitamin D should be considered to minimize postoperative symptomatic hypocalcemia.
    Thyroid: official journal of the American Thyroid Association 05/2015; DOI:10.1089/thy.2014.0522 · 3.84 Impact Factor
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    ABSTRACT: Decision to perform concurrent ipsilateral thyroidectomy on patients with hypopharyngeal cancer is important, and unnecessary thyroidectomy should be avoided if oncologically feasible. We hypothesized that concurrent ipsilateral thyroidectomy is not routinely required to prevent occult metastasis. This study aimed to determine the prevalence of histological thyroid invasion in patients with hypopharyngeal cancer, and to refine the indications for prophylactic ipsilateral thyroidectomy in patients with hypopharyngeal cancer. A retrospective review of the medical records from the Department of Otolaryngology at Yonsei University College of Medicine was conducted from January 1994 to December 2009. A total of 49 patients underwent laryngopharyngectomy with thyroidectomy as a primary treatment of hypopharyngeal cancer. The incidence of thyroid gland involvement was 10.2%. The most common route of invasion was direct extension through the thyroid cartilage. Thyroid cartilage invasion (p=0.034) was the most significant factor associated with thyroid invasion. Disease-specific survival at 5 years was lower in patients with than without thyroid gland invasion (26.7% vs. 55.2%, respectively; p=0.032). Disease-free survival at 5 years was also lower in patients with than without thyroid gland invasion (20.0% vs. 52.1%, respectively; p=0.024). Ipsilateral thyroidectomy in combination with total laryngopharyngectomy is indicated when invasion of the thyroid cartilage is suspected in patients with hypopharyngeal cancer.
    Yonsei medical journal 05/2015; 56(3):812-8. DOI:10.3349/ymj.2015.56.3.812 · 1.26 Impact Factor
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    ABSTRACT: Aberrant expression of Cancer Osaka Thyroid Oncogene mitogen-activated protein kinase kinase kinase 8 (COT) (MAP3K8) is a driver of resistance to B-RAF inhibition. However, the de novo expression and clinical implications of COT in papillary thyroid cancer (PTC) have not been investigated.The aim of this study is to investigate the expression of A-, B-, C-RAF, and COT in PTC (n = 167) and analyze the clinical implications of aberrant expression of these genes.Quantitative polymerase chain reaction (qPCR) and immunohistochemical staining (IHC) were performed on primary thyroid cancers. Expression of COT was compared with clinicopathological characteristics including recurrence-free survival. Datasets from public repository (NCBI) were subjected to Gene Set Enrichment Analysis (GSEA).qPCR data showed that the relative mRNA expression of A-, B-, C-RAF and COT of PTC were higher than normal tissues (all P < 0.01). In addition, the expression of COT mRNA in PTC showed positive correlation with A- (r = 0.4083, P < 0.001), B- (r = 0.2773, P = 0.0003), and C-RAF (r = 0.5954, P < 0.001). The mRNA expressions of A-, B,- and C-RAF were also correlated with each other (all P < 0.001). In IHC, the staining intensities of B-RAF and COT were higher in PTC than in normal tissue (P < 0.001). Interestingly, moderate-to-strong staining intensities of B-RAF and COT were more frequent in B-RAF-positive PTC (P < 0.001, P = 0.013, respectively). In addition, aberrant expression of COT was related to old age at initial diagnosis (P = 0.045) and higher recurrence rate (P = 0.025). In multivariate analysis, tumor recurrence was persistently associated with moderate-to-strong staining of COT after adjusting for age, sex, extrathyroidal extension, multifocality, T-stage, N-stage, TNM stage, and B-RAF mutation (odds ratio, 4.662; 95% confidence interval 1.066 - 21.609; P = 0.045). Moreover, moderate-to-strong COT expression in PTC was associated with shorter recurrence-free survival (mean follow-up duration, 14.2 ± 4.1 years; P = 0.0403). GSEA indicated that gene sets related to B-RAF-RAS (P < 0.0001, false discovery rate [FDR] q-value = 0.000) and thyroid differentiation (P = 0.048, FDR q-value = 0.05) scores were enriched in lower COT expression group and gene sets such as T-cell receptor signaling pathway and Toll-like receptor signaling pathway are coordinately upregulated in higher COT expression group (both, P < 0.0001, FDR q-value = 0.000).Aberrant expression of A-, B-, and C-RAF, and COT is frequent in PTC; increased expression of COT is correlated with recurrence of PTC.
    Medicine 02/2015; 94(6):e548. DOI:10.1097/MD.0000000000000548 · 4.87 Impact Factor
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    ABSTRACT: Kinase suppressor of RAS (KSR) and connector enhancer of KSR (CNKSR) have been regarded as scaffold proteins in RAS-mediated RAF activation. This study aimed to characterize the molecular-biological role of two scaffolds, KSR and CNKSR, in patients with PTC. qRT-PCR and immunohistochemistry (IHC) revealed inter-tumor heterogeneities in the expression of KSR and CNKSR in PTC. Gene Set Enrichment Analysis (GSEA) using public repositories showed that high KSR1 expression coordinately up-regulated Notch signaling (nominal p = 0.019, FDR q-value = 0.165); this finding was supported by GeneNetwork analysis, which indicated that Ksr1 expression is positively correlated with Notch1 expression (Rho = 0.677, p = 6.15E-09). siRNA against KSR1 (siKSR1) significantly decreased ERK phosphorylation induced by BRAFV600E, resulting in reduced expression of Notch1 and HES1, which are both targets of Notch signaling. GSEA also revealed that high KSR1 expression was also associated with down-regulation of genes related to oxidative phosphorylation (OxPhos). Consistent with this, EM showed that PTCs with high KSR1 expression exhibited structural defects of the mitochondrial cristae. Furthermore, siKSR1-transfected cells generated fewer colonies in colony-forming assays. GSEA showed that high expression of KSR2 and CNKSR1 also coordinately up-regulated Notch signaling (KSR2: nominal p = 0.0097, FDR q-value = 0.154; CNKSR1: nominal p < 0.0001, FDR q-value = 0.00554), and high CNKSR2 was associated with down-regulation of the OxPhos gene set (nominal p < 0.0001, FDR q-value < 0.0001). In conclusion, KSR and CNKSR are coordinately regulated with Notch signaling and OxPhos in PTCs which might require these two scaffold proteins to sustain proliferative signaling and metabolic remodeling.
    Journal of Molecular Endocrinology 01/2015; 54(2). DOI:10.1530/JME-14-0270 · 3.62 Impact Factor
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    ABSTRACT: Metabolic reprogramming has been regarded as an essential component of malignant transformation. However, the clinical significance of metabolic heterogeneity remains poorly characterized.The aim of this study was to characterize metabolic heterogeneity in thyroid cancers via the analysis of the expression of mitochondrial ribosomal proteins (MRPs) and genes involved in oxidative phosphorylation (OxPhos), and investigate potential prognostic correlations.Gene set enrichment analysis (GSEA) verified by reverse transcription polymerase chain reaction and gene network analysis was performed using public repository data. Cross-sectional observational study was conducted to classify papillary thyroid cancer (PTC) by the expression of MRP L44 (MRPL44) messenger RNA (mRNA), and to investigate the clinicopathological features.GSEA clearly showed that the expression of OxPhos and MRP gene sets was significantly lower in primary thyroid cancer than in matched normal thyroid tissue. However, 8 of 49 primary thyroid tumors (16.3%) in the public repository did not show a reduction in OxPhos mRNA expression. Remarkably, strong positive correlations between MRPL44 expression and those of OxPhos and MRPs such as reduced nicotinamide adenine dinucleotide dehydrogenase (ubiquinone) 1 α subcomplex, 5; succinate dehydrogenase complex, subunit D; cytochrome c, somatic; adenosine triphosphate synthase, H+ transporting, mitochondrial Fo complex, subunit C1 (subunit 9); and MRP S5 (MRPS5) (P < 0.0001) were clearly denoted, suggesting that MRPL44 is a representative marker of OxPhos and MRP expressions. In laboratory experiments, metabolic heterogeneity in oxygen consumption, extracellular acidification rates (ECARs), and amounts of OxPhos complexes were consistently observed in BCPAP, TPC1, HTH-7, and XTC.UC1 cell lines. In PTCs, metabolic phenotype according to OxPhos amount defined by expression of MRPL44 mRNA was significantly related to lymph node metastasis (LNM) (P < 0.001). Furthermore, multivariate analysis clearly indicated that expression of MRPL44 is associated with an increased risk of lateral neck LNM (odds ratio 9.267, 95% confidence interval 1.852-46.371, P = 0.007).MRPL44 expression may be a representative marker of metabolic phenotype according to OxPhos amount and a useful predictor of LNM.
    Medicine 01/2015; 94(2):e380. DOI:10.1097/MD.0000000000000380 · 4.87 Impact Factor
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    ABSTRACT: Background The purpose of this study was to examine whether the time required for recovery from transient hypoparathyroidism is correlated with the onset of hypocalcemic symptoms in patients with total thyroidectomy. Methods Medical records of 54 patients were retrospectively reviewed. The correlation between the onset of hypocalcemic symptoms and the recovery time were compared for all patients divided into 3 groups based on first appearance of hypocalcemic symptoms; group 1, onset within 24 hours; group 2, onset at 24 to 48 hours; and group 3, onset >48 hours. ResultsThere was a negative correlation between onset and recovery times (p<.001). Serum parathyroid hormone levels 1 year after surgery were significantly lower in group 1 than in groups 2 or 3 (p<.001). Conclusion Recovery time can be predicted by time of onset of hypocalcemic symptoms and signs. Earlier onset leads to longer recovery times. (c) 2014 Wiley Periodicals, Inc. Head Neck 36: 1732-1736, 2014
    Head & Neck 12/2014; 36(12). DOI:10.1002/hed.23530 · 3.01 Impact Factor
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    ABSTRACT: The aim of this study was to evaluate the diagnostic utility of PAI at detecting thyroid microcalcifications at 700 nm laser wavelengths. This study included 36 resected samples in 18 patients. To evaluate the PA manifestation of microcalcifications in PAI, gray level histogram and co-occurrence matrix (COM) texture parameters were extracted from the 3 fixed ROI US and PA images, respectively, per sample. We compared the textural parameters obtained from specimen PAIs between samples with punctate microcalcifications on specimen radiography and those without microcalcifications. On specimen US, the mean value (2748.4±862.5) of samples with microcalcifications on specimen radiography was higher than that (1961.9±780.2) of those without microcalcifications (P = 0.007). However, there were no significant differences in textural parameters obtained from specimen PAIs between samples with punctate microcalcifications on specimen radiography and those without when applying both the mean value of the three slices of thyroid specimens and the value of the thyroid specimen slice which had the highest value of the mean values in specimen US. PAI did not show significant PA contrast on thyroid microcalcifications indicating that the experimental setup and protocols should be enhanced, e.g., method of complete blood rejection from ex vivo specimens, the multi-wavelength spectroscopic PA imaging method which can solely extract the PA signal from microcalcifications even with high spectral interferences, or PA imaging with narrower slice thickness using 2-dimensional array transducer, etc.
    PLoS ONE 11/2014; 9(11):e113358. DOI:10.1371/journal.pone.0113358 · 3.53 Impact Factor
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    ABSTRACT: Background: This study assessed the results of robotic thyroidectomy by fellowship-trained surgeons in their initial independent practice, and whether standard fellowship training for robotic surgery shortens the learning curve.Materials & Methods: This prospective cohort study evaluated outcomes in 125 patients who underwent robotic thyroidectomy using gasless transaxillary single-incision technique by two recently graduated fellowship-trained surgeons. Learning curves were analyzed by operation time, with proficiency defined as the point at which the slope of the time curve became less steep.Results: Of the 125 patients, 113 underwent robotic less-than-total thyroidectomy (LT), 9 underwent robotic total thyroidectomy (TT) and 3 underwent robotic TT with modified radical neck dissection (MRND). Mean total times for these three operations were 100.8 ±20.6 min, 134.2 ± 38.7 min, and 284.7 ± 60.4 min respectively. For both surgeons, the operation times gradually decreased, reaching a plateau after 20 robotic LTs.Conclusions: The surgical learning curve for robotic thyroidectomy performed by recently graduated fellowship-trained surgeons with little or no experience in endoscopic surgery showed excellent results compared with those in a large series of more experienced surgeons. Head Neck, 2014
    Head & Neck 09/2014; DOI:10.1002/hed.23824 · 3.01 Impact Factor
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    ABSTRACT: Despite the favorable therapeutic outcomes reported in differentiated thyroid cancer (DTC), a significant proportion of DTC patients present with refractory behavior to conventional therapy. The sirtuin (Sirt) family has recently been implicated in the maintenance of cellular homeostasis under genotoxic stress. Here, we investigated the induction of Sirt1 expression by etoposide-induced genotoxic stress to gain insights into thyroid carcinogenesis and identify novel therapeutic targets. Immunohistochemical staining analyses of Sirt1 and Sirt3 were performed using human thyroid cancer tissues and matched normal tissues, and bioinformatic analyses were done using public repositories, including the Human Protein Atlas, BioGPS, NCBI Gene Expression Omnibus (GEO) profiles, and GeneNetwork. TPC1, FTC133 and FRO cells were used for molecular biological experiments including apoptosis assays, MTT, immunofluorescence staining and qRT-PCR assays. The IHC data and public repositories data consistently showed variable Sirt1 and Sirt3 expression patterns in normal thyroid follicular cells and papillary thyroid cancer cells. The induction of Sirt1 and Sirt3 was cell type-specific and the expression levels of these genes correlated with apoptotic cell death and cell viability after etoposide-induced genotoxic stress. Sirt1‑Foxp3 signaling-mediated regulation of Bax and p21 mRNA expression was a signature molecular event in TPC1 cells, which showed remarkable resistance to etoposide-induced genotoxic stress. The induction of Sirt1 and Sirt3 may be a determinant of thyroid cancer cell survival under genotoxic stress conditions. Further examination of the Sirt1-Foxp3 signal may improve our understanding of thyroid carcinogenesis and help identify new druggable targets.
    International Journal of Oncology 08/2014; 45(5). DOI:10.3892/ijo.2014.2585 · 2.77 Impact Factor
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    ABSTRACT: Tumor multifocality is frequently observed in papillary thyroid carcinoma (PTC), but its prognostic value is controversial. We investigated the prognostic significance of multifocality in PTCs larger than 1 cm and papillary thyroid microcarcinomas (PTMC). Medical records and pathologic results of 2,309 patients who received thyroidectomy and lymph node dissection for PTC were retrospectively reviewed. We identified 648 patients who had PTC with a primary tumor exceeding 1 cm, and 1,661 patients with PTMC. In each group, we compared patients with unifocal and multifocal disease. Cox regression analyses of disease persistence and recurrence were performed to identify the prognostic significance of multifocality. The mean follow-up period was 5.6 years. In the analyses of PTCs larger than 1 cm, the multifocal group included more extensive thyroid surgeries (p = 0.039), radioactive iodine therapies with higher doses (p < 0.001), and significantly higher rates of disease persistence and recurrence (p = 0.001) compared with the unifocal group. In analogous analyses of patients with PTMC, disease persistence and recurrence did not differ significantly between the unifocal and multifocal groups. Cox regression analyses indicated that multifocality was an independent risk factor for disease persistence and recurrence in patients who had PTC with a tumor exceeding 1 cm, but not in patients with PTMC. Tumor multifocality appears to be an important prognostic factor for PTCs larger than 1 cm, but may have little or no prognostic significance for PTMC.
    Annals of Surgical Oncology 08/2014; 22(1). DOI:10.1245/s10434-014-3899-8 · 3.94 Impact Factor
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    ABSTRACT: Background: The aim of this study was to investigate the correlation between B-type Raf kinase (BRAF) mutation and clinicopathological features of follicular variant of papillary thyroid carcinoma (FVPTC). Methods: 84 patients with pathologically confirmed FVPTC, who underwent preoperative BRAF(V600E) study, were analyzed. Clinicopathological parameters and ultrasonographic features were compared between BRAF(V600E) positive and negative groups. Results: 41.7% of patients showed BRAF(V600E) . BRAF(V600E) positive group showed the smaller tumor size (7.3 ± 3.6 mm vs. 10.7 ± 8.9 mm, p = 0.018) and the more frequent multifocality (25.7% vs. 8.2%, p = 0.028). FVPTC with BRAF(V600E) showed suspicious ultrasonographic features (88.6% vs. 57.1%, p = 0.002) more frequently. BRAF(V600E) positivity is associated with multifocality after adjusting for age, sex, the presence of suspicious ultrasonographic features, pathological tumor size, and thyrotropin level. Conclusions: BRAF(V600E) was correlated with smaller tumor size and suspicious ultrasonographic features in FVPTC. BRAF(V600E) was significant parameter for predicting multifocality of FVPTC. Head Neck, 2014.
    Head & Neck 08/2014; DOI:10.1002/hed.23793 · 3.01 Impact Factor
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    ABSTRACT: Background Body image is associated with self-esteem and identity and has a close relationship with quality of life (QoL). We compared the impact of surgical scars on patient body image between conventional open thyroidectomy (OT) and robotic thyroidectomy (RT) in female papillary thyroid carcinoma (PTC) patients. Methods From October 2009 to December 2010, 116 PTC patients who underwent total thyroidectomy at the Yonsei University Health System (Seoul, Korea) were prospectively enrolled. Of these 116 patients, 56 had OT, and 60 had RT. Their scars were assessed using the Vancouver Scar Scale (VSS), and psychometric properties were evaluated using the body image scale (BIS) questionnaire postoperatively. Both groups were compared using cross-sectional and time series methods. Results The mean age was significantly younger in the RT group. Regarding scar quality, the OT group showed superiority in scar pigmentation and the total VSS score during the early postoperative period, but the VSS score improved over time and was similar between both groups at 9 months. The RT group received better scores regarding most of the BIS items, a trend that remained relatively constant over time. In patients with noticeable scars (VSS ≥2) at 9 months, the RT group received better BIS scores regarding almost all items, including “self-conscious,” “physical attractiveness,” “feeling of less feminine,” “sexual attractiveness,” “dissatisfaction with body, scar and appearance when dressed,” and “avoidance of people due to appearance.” Conclusions RT provides better self-body image and improves QoL compared with conventional OT by avoiding a noticeable cervical scar.
    Surgery 07/2014; DOI:10.1016/j.surg.2014.02.007 · 3.11 Impact Factor
  • F Christopher Holsinger, Woong Youn Chung
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    ABSTRACT: Robotic thyroidectomy is ideal for patients with indeterminate, likely benign lesions less than 3 cm, and a body mass index less than 35 kg/mg(2). Proper arm position and padding are important to facilitate exposure and development of the working space from axilla to thyroid bed. The working space is developed using headlight and retractors without robotic assistance, establishing exposure of the thyroid bed from a 5-cm incision in the axilla. Three robotic instruments and a stereoscopic endoscope provide excellent visualization of the associated thyroid neurovasculature anatomy.
    Otolaryngologic Clinics of North America 06/2014; 47(3):373-378. DOI:10.1016/j.otc.2014.03.001 · 1.34 Impact Factor
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    ABSTRACT: Transaxillary robotic thyroidectomy is considered a technically feasible and safe treatment option for patients with low-risk papillary thyroid carcinoma (PTC). The aim of the present study was to determine the factors that contribute to the perioperative surgical outcomes of robotic thyroidectomy and to suggest guidelines for patient selection to be used by surgeons inexperienced in the technique. We reviewed the records of 275 patients with PTC who underwent robotic total thyroidectomy using a gasless, transaxillary single-incision approach at Yonsei University Health System, South Korea, between January 2011 and May 2012. The association between surgical outcomes and clinicopathologic factors was assessed using linear and logistic regression analysis. The contributing factors for surgical outcomes of robotic thyroidectomy were categorized as patient factors, including gender and body mass index (BMI), and thyroid-specific factors, including thyroid gland size, coexistent thyroiditis, tumor size, and serum anti-thyroglobulin antibody and anti-microsomal antibody titers. Of these, male gender, a large thyroid gland, and thyroiditis significantly increased the total operation time. Male gender, thyroiditis, and overweight BMI increased the working space time, and a large thyroid gland and overweight BMI affected the console time. A large thyroid gland and histological thyroiditis were associated with increased intraoperative blood loss. There was no association between postoperative complications and clinicopathologic parameters. Male gender, overweight BMI, a large thyroid gland, and coexistent thyroiditis adversely affected the surgical outcome of robotic thyroidectomy. Surgeons inexperienced in the technique should avoid or carefully approach individuals with these factors.
    Surgical Endoscopy 05/2014; 28(11). DOI:10.1007/s00464-014-3567-x · 3.31 Impact Factor
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    ABSTRACT: Background The association between the BRAF mutation and persistence/recurrence was investigated in patients with classical papillary thyroid carcinoma (PTC) at a BRAF mutation prevalent area.MethodsA total of 282 patients with total thyroidectomy and prophylactic central neck dissection were included in this study. The BRAF mutation was evaluated with cytology specimen using dual priming oligonucleotide (DPO)-based multiplex polymerase chain reaction (PCR) and direct sequencing preoperatively.ResultsThirty-four patients (12%) had persistence/recurrence. In all PTC, the BRAF mutation on both methods was not associated with persistence/recurrence. In PTC >10 mm, the BRAF mutation on DPO-based multiplex PCR was significantly associated with persistence/recurrence and a potential predictor for persistence/recurrence. In PTC ≤10 mm, none of the covariates were significantly different between patients with and without persistence/recurrence.Conclusion The BRAF mutation was significantly associated with persistence/recurrence and a potential predictor in patients with classical PTC >10 mm at a BRAF mutation prevalent area. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
    Head & Neck 05/2014; DOI:10.1002/hed.23770 · 3.01 Impact Factor
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    ABSTRACT: Abstract Background: Epidermal growth factor (EGF) decreases inflammatory cell infiltration and TGF-β expression during wound healing. Several clinical studies show that recovery of various ulcer wounds, such as diabetic and radiation ulcer, is promoted by EGF. Objective: To evaluate effects of recombinant human epidermal growth factor (rhEGF) on cutaneous scar quality after thyroidectomy. Method: Scar quality was evaluated by Vancouver scar scale (VSS) in two groups of female thyroidectomy patients (control, n = 11; rhEGF-treated, n = 10). Scar erythema, pigmentation, elasticity and hydration were measured by mexameter, cutometer and corneometer. Results: Scar pliability (at 4 weeks) and thickness (2 weeks) after surgery were significantly lower in the rhEGF group than control. Total VSS score was significantly lower in the rhEGF group after 4 weeks. However, erythema, pigmentation, elasticity and hydration of the scar were not significantly different between groups. Conclusion: The early use of rhEGF in surgical wound healing may improve cutaneous scar quality.
    Journal of Dermatological Treatment 04/2014; 26(2). DOI:10.3109/09546634.2014.906034 · 1.76 Impact Factor

Publication Stats

2k Citations
322.21 Total Impact Points

Institutions

  • 2015
    • Wonju Severance Christian Hospital
      Genshū, Gangwon-do, South Korea
  • 2006–2015
    • Yonsei University Hospital
      • • Surgery
      • • Department of Internal Medicine
      Sŏul, Seoul, South Korea
    • Yonsei University
      • Department of Surgery
      Sŏul, Seoul, South Korea