Prognostic Significance of the Lymph Node Ratio Regarding Recurrence and Survival in Rectal Cancer Patients Treated with Postoperative Chemoradiotherapy

BACKGROUND/AIMS: To evaluate the prognostic impact of the lymph node ratio (LNR: the ratio of positive lymph nodes to the total number of lymph nodes examined) on disease recurrence and survival among rectal cancer patients who received curative surgery and postoperative chemoradiotherapy (CRT). METHODS: Between 1995 and 2008, 124 patients with pathologic T3-4 or node-positive rectal cancer underwent curative surgery and postoperative CRT. Postoperative radiotherapy was delivered at a median dose of 50.4 Gy (range, 45 to 59.4 Gy) for 6 weeks. Chemotherapy consisted of a bolus injection of 5-fluorouracil and leucovorin in the first and last week of radiotherapy (91.9%) or daily capecitabine during radiotherapy (8.1%). Further adjuvant chemotherapy was administered after chemoradiation. RESULTS: The median follow-up was 5.1 years. In the multivariate analysis, pathologic N (pN) stage and lymphovascular invasion were significantly associated with disease-free survival and disease-specific survival (p0.05). CONCLUSIONS: The LNR predicts recurrence and survival more accurately than pN stage. The pN stage and the LNR should be considered together when estimating the risk of disease recurrence among rectal cancer patients.

Chylous Leakage: A Rare Complication after Axillary Lymph Node Dissection in Breast Cancer and Surgical Management / 한국유방암학회지

Chylous leakage is an extremely rare complication of surgery for breast cancer. We experienced a case of chylous leakage after axillary lymph node dissection. A 38-year-old woman with invasive ductal carcinoma in the left breast underwent a modified radical mastectomy after four cycles of neoadjuvant chemotherapy. The postoperative serosanguinous drainage fluid became "milky" on the fourth postoperative day. After trying conservative management, we re-explored the axilla and ligated the lymphatic trunk. Although the success of many cases supports conservative management, timely surgical intervention represents an alternative in cases where leakage persists or where the output is high.

The Prognostic Significance of the Lymph Node Ratio in Axillary Lymph Node Positive Breast Cancer / 한국유방암학회지

PURPOSE: This study evaluated the prognostic impact of the lymph node ratio (LNR; i.e., the ratio of positive to dissected lymph nodes) on recurrence and survival in breast cancer patients with positive axillary lymph nodes (LNs). METHODS: The study cohort was comprised of 330 breast cancer patients with positive axillary nodes who received postoperative radiotherapy between 1987 and 2004. Ten-year Kaplan-Meier locoregional failure, distant metastasis, disease-free survival (DFS) and disease-specific survival (DSS) rates were compared using Kaplan-Meier curves. The prognostic significance of the LNR was evaluated by multivariate analysis. RESULTS: Median follow-up was 7.5 years. By minimum p-value approach, 0.25 and 0.55 were the cutoff values of LNR at which most significant difference in DFS and DSS was observed. The DFS and DSS rates correlated significantly with tumor size, pN classification, LNR, histologic grade, lymphovascular invasion, the status of estrogen receptor and progesterone receptor. The LNR based classification yielded a statistically larger separation of the DFS curves than pN classification. In multivariate analysis, histologic grade and pN classification were significant prognostic factors for DFS and DSS. However, when the LNR was included as a covariate in the model, the LNR was highly significant (p0.05). CONCLUSION: The LNR predicts recurrence and survival more accurately than pN classification in our study. The pN classification and LNR should be considered together in risk estimates for axillary LNs positive breast cancer patients.

Necrotizing Pancreatitis with Gas Gangrene

Acute necrotizing pancreatitis is a disease with high morbidity and mortality despite the progress made in intensive care. Gas gangrene of the pancreas, usually caused by anaerobe infection, is an extremely rare, but severe form of acute necrotizing pancreatitis. Several severity-of-illness classifications for acute pancreatitis are used to identify patients at risk for complications. Pancreatic necrosis is diagnosed radiographically by dynamic intravenous contrast-enhanced computed tomography (CT) of the abdomen. Early CT in patients with suspected necrotizing pancreatitis contributes to early intervention and many advantageously enhance survival. We report here on two cases of necrotizing pancreatitis with gas gangrene in 49-year-old male patient and 86-year-old female patient.

Wernicke's Encephalopathy following Gastrectomy in Patients with Gastric Cancer

Wernicke's encephalopathy is a neurological disorder that is caused by a thiamine deficiency, and characterized by acute confusion, ataxia, a change in the patient's state of mind and abnormal eye movement (op-thalmophlegia and nystag-mus). This encephalopathy can be found in patients with chronic alcoholism, anorexia nervosa, hemodialysis, AIDS and gastroplasty for morbid obesity. The diagnosis of this disease is difficult because not all cases display the typical symptoms. However, this disease can be confirmed not only by the clinical symptoms but also by the brain MRI findings, low thiamine level and clinical response to thiamine replacement therapy. We experienced two cases of Wer-nicke's encephalopathy in patients who underwent a gas-trec-tomy for gastric cancer. However, this condition was not diagnosed until the patients showed neurological symptoms and the typical MRI findings. These patients improved after vitamin B(1) (thiamine) replacement.

The Effect of Simulation on Recurrence after Breast-Conserving Surgery and Radiotherapy : Preliminary Results / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: To evaluate the effect of the simulation method on recurrence among the patients who received radiotherapy after breast-conserving surgery (BCS) for early breast carcinoma. METHODS AND MATERIALS: Between 1995 and 2000, 70 patients with stage I-II breast carcinoma underwent breast-conserving surgery and adjuvant radiotherapy. Twenty nine patients (41.4%) were simulated with the 2D contour-based method (September 1995 to August 1997) and 41 patients (58.6%) were simulated with the 3D CT-based method (September 1997 to February 2000). To analyze the effect of the simulation method, the patient and treatment characteristics were compared. RESULTS: The characteristics were similar for the patients between the 2D contour-based simulation group and the 3D CT-based simulation group. During a median follow-up period of 75 months, 4 (13.8%) of 29 patients who were treated with 2D simulation and 1 (2.4%) of 41 patients who were treated with 3D simulation group devel-oped treatment failure. The five-year survival rates were 89.2% and 95.1% between the 2D and 3D simulation groups (p=0.196). The five-year disease free survival (DFS) rates were 86.2% and 97.5% between the 2D and 3D simulation groups (p=0.0636). On univariate analysis, age > 40 (p= 0.0226) and the number of dissected axillary lymph node > or = 10 (p=0.0435) were independent predictors of improved 5-year DFS. CONCLUSIONS: Although our data showed marginal significance for the DFS between the two groups, it is insufficient, due to the small number of patients in our study, to prove whether 3D CT-based simulation might improve the DFS and reduce the risk of recurrence when compared with 2D contour-based simulation. Further study is needed with a larger group of patients.

A Comparison between Endoscopic Thyroidectomy Performed by the Axillary Approach and by a Conventional Thyroidectomy / 대한내분비외과학회지

PURPOSE: Endoscopic thyroidectomy has not become a widespread procedure because of limited advantages to its use. We have performed endoscopic thyroidectomies by use of the axillary approach. The purpose of this study was to determine the efficacy of this surgical procedure. METHODS: Between June of 2002 and December of 2002, 17 patients underwent an endoscopic thyroidectomy by use of the axillary approach while 11 patients underwent a conventional thyroidectomy. Each procedure was performed by one surgeon under general anesthesia. Patients with thyroid carcinoma at the preoperative diagnosis or who received a bilateral thyroidectomy were excluded. We compared the age, size of the tumor, postoperative pain (48 hours after surgery), surgical time, cosmetic result, length of hospital stay, and paresthesia. Statistical analysis was determined by use of the Mann-Whitney test and the chi-square test using SPSS software. RESULTS: The mean age of the patients was 46.6 years who received a conventional thyroiodectomy and 32.9 years who underwent the axillary approach. The size of the tumor was 3.1 cm for patients who received conventional thyroiodectomy and 3.3 cm for patients who underwent the axillary approach. The operation time was 80.91±16.1 (65~100) minutes for the conventional thyroiodectomy and 135.3± 34.6 (80~210) minutes for the axillary approach. The difference between the two approaches in regards to parameters such as postoperative pain, parethesia, and total hospital days was negligible. The degree of satisfaction was 2.7±0.8 for the conventional thyroiodectomy and 1.1±0.3 for the axillary approach. CONCLUSION: While conventional thyroidectomy still offers an advantage in terms of surgical time, performance of endoscopic thyroidectomy by the axillary approach has an advantage in producing better cosmetic results. Although a multitude of patients will be necessary to follow in further studies, the use of endoscopic thyroidectomy by the axillary approach could become the procedure of choice by offering better cosmetic results to young patients who present with thyroid nodules.

Clinical Experience of Patients with Ductal Carcinoma In Situ of the Breast Treated with Breast-Conserving Surgery plus Radiotherapy: A Preliminary Report / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Breast-conserving therapy (BCT) is a practical alternative to mastectomy for treating ductal carcinoma in situ (DCIS). We reviewed our experience for treating patients with DCIS of the breast to evaluate the outcome after performing breast-conserving surgery plus radiotherapy (BCS-RT). MATERIALS AND METHODS: Between January 1983 and December 2002, 25 patients with clinically or mammographically detected DCIS were treated by BCS-RT. One patient was diagnosed with bilateral DCIS. Thirteen cases (50%) had symptomatic lesions at presentation. All 26 cases of 25 patients underwent BCS such as lumpectomy, partial mastectomy or quadrantectomy. All of them received whole breast irradiation to a median dose of 50.4 Gy. Twenty-four cases (92.3%) received a boost to the tumor bed for a median total dose of 59.4 Gy. The median follow up period was 67 months (range: 38 to 149 months). RESULTS: Two cases (7.7%) experienced ipsilateral breast tumor recurrence (IBTR) after BCS-RT. The histology results at the time of IBTR showed invasive ductal carcinoma (IDC), and the median time to IBTR was 25.5 months. On the univariate analysis, there were no significant factors associated with IBTR in the DCIS patients. The three-year local recurrence free survival rate was 96.0% and the overall survival rate was 96.3%. CONCLUSION: After the treatment for DCIS, the IBTR rate in our study was similar to other previous studies. Considering that we included patients who had many symptomatic lesions, close or positive margins and less that complete early data, our result is comparable to the previous studies. We could not find the prognostic significant factors associated with IBTR after BCS-RT. A longer follow up period with more patients would be required to evaluate the role of any predictive factors and to confirm these short-term results.

Parathyroid Cyst: Description of Two Cases and Review of the Literature / 대한내분비외과학회지

Parathyroid cysts are uncommon causes of neck or mediastinal masses. They have been mistaken for cystic thyroid nodules, brachial cleft cysts, or thyroglossal duct cysts. Two types of parathyroid cysts have been recognized; the non- functioning forms, which are more frequent and the functioning paratyroid cysts, which are rarer and cause hyperparathyroidism. Parathyroid cysts are usually located in the inferior parathyroid gland, which are most commonly involved with a left-sides predominance. Although their location in mediastinum has also been described. Parathyroid cysts may present as a diagnostic problem. It is sometimes difficult that parathyroid lesions are distinguished from thyroid ones with current imaging techniques. Diagnosis is based on the histopathological appearance of the cyst and PTH level in the cystic fluid. Percutaneous needle aspiration of parathyroid cysts reveals crystal clear fluid. Elevated PTH levels in the cystic fluid confirms the diagnosis. The presence of parathyroid tissue within the cyst wall is diagnostic. Nonfunctioning cyst may be treated with aspiration alone, surgical excision is indicated for functioning cyst. We present the case of two patients with a parathyroid cyst.

Expression of estrogen receptor beta, estrogen receptor alpha and cyclooxygenase II in advanced breast cancer / 한국유방암학회지

PURPOSE: Although the role of the estrogen receptor alpha (ER alpha, previously called the estrogen receptor) in breast cancer is well established, that of the second human estrogen receptor (ER), estrogen receptor beta (ER beta), remains uncertain. The expression of cyclooxygenase II (COX II) could also be regulated by sex steroids such as estrogen and progesterone. To investigate whether the expressions of the ER beta, ER alpha, and COX II are elevated in more aggressive breast cancers, the expression of the ER beta was studied by immunohistochemical staining in 20 primary breast cancer and original breast cancer tissues from 20 recurrent cancer patients, and its associations with ER alpha and cyclooxygenase (COX) II were evaluated. METHODS: Paraffin tissue sections from 40 breast cancers, surgically excised at the Department of Surgery, the Catholic University of Korea. were obtained. The immunohistochemical analysis was conducted on 20 non-recurrent, and 20 recurrent primary breast cancer tissues, using polyclonal antibodies to ER beta, ER alpha, and the corresponding monoclonal antibodies to COX II. RESULTS: Of the 40 patients, 15 (37.5%) were ER beta-positive, 30 (75%) were ER alpha-positive, and 24 (60%) were COX II-positive. The ER bata status was not related to the tumor size or menopausal status, but was related to the nodal status. The stati of ER alpha and COX II were not related to other clinico-pathological factors. The ER beta positivity was significantly more frequent in the study than the control group. (ER beta, p = 0.0222; ER alpha p = 0.1441; COX II, p = 1.00) The presence of ER beta was significantly related to the expression of ER alpha and COX II (p = 0.0455, p = 0.0381, respectively). CONCLUSION: These results suggest that the expression of ER beta is associated with early recurrence in breast cancer and the expression of COX II in the presence of ER beta implies the possibility of prognostic significance.

Expression of estrogen receptor beta, estrogen receptor alpha and cyclooxygenase II in advanced breast cancer / 한국유방암학회지

PURPOSE: Although the role of the estrogen receptor alpha (ER alpha, previously called the estrogen receptor) in breast cancer is well established, that of the second human estrogen receptor (ER), estrogen receptor beta (ER beta), remains uncertain. The expression of cyclooxygenase II (COX II) could also be regulated by sex steroids such as estrogen and progesterone. To investigate whether the expressions of the ER beta, ER alpha, and COX II are elevated in more aggressive breast cancers, the expression of the ER beta was studied by immunohistochemical staining in 20 primary breast cancer and original breast cancer tissues from 20 recurrent cancer patients, and its associations with ER alpha and cyclooxygenase (COX) II were evaluated. METHODS: Paraffin tissue sections from 40 breast cancers, surgically excised at the Department of Surgery, the Catholic University of Korea. were obtained. The immunohistochemical analysis was conducted on 20 non-recurrent, and 20 recurrent primary breast cancer tissues, using polyclonal antibodies to ER beta, ER alpha, and the corresponding monoclonal antibodies to COX II. RESULTS: Of the 40 patients, 15 (37.5%) were ER beta-positive, 30 (75%) were ER alpha-positive, and 24 (60%) were COX II-positive. The ER bata status was not related to the tumor size or menopausal status, but was related to the nodal status. The stati of ER alpha and COX II were not related to other clinico-pathological factors. The ER beta positivity was significantly more frequent in the study than the control group. (ER beta, p = 0.0222; ER alpha p = 0.1441; COX II, p = 1.00) The presence of ER beta was significantly related to the expression of ER alpha and COX II (p = 0.0455, p = 0.0381, respectively). CONCLUSION: These results suggest that the expression of ER beta is associated with early recurrence in breast cancer and the expression of COX II in the presence of ER beta implies the possibility of prognostic significance.

Male Breast Cancer / 한국유방암학회지

PURPOSE: Carcinomas of the male breast constitutes only 1% of all breast cancer and less than 1.5% of all malignant tumors in men. The low incidence of this disease prevents therapeutic questions from being addressed in prospective randomized trials. Our aim was to cover the characteristics of the etiology, presentation and treatment of male breast cancer; and therefore provide an overview of knowledge in this area. METHODS: We retrospectively analyzed 16 male breast cancer patients, who had been treated between 1983 and 1992 at the Department of Surgery, College of Medicine, The Catholic university of Korea. RESULTS: The peak age of incidence was in the 7th and 8th decades. The most common symptom was a palpable mass in the breast (75.1%), and the duration of symptom varied between 3 days and 10 years. According to the TNM staging system, there were 18.8%, 31.3%, 18.8%, 12.5%, 6.3%, at stages 0, I, II, III and IV, respectively, and 12.5% with an unknown stage. A modified radical mastectomy was performed in 11 patients (68.8%) and postoperative adjuvant therapy in 12 patients (75.1%). The mean duration of following up was 41.2 months, during which time 2 patients were lost. CONCLUSION: Sixteen male breast cancer patients were encountered and men with breast cancer were observed to be older, have a longer duration of symptom, and more likely to have a familial tendency. However, our review revealed that male breast cancer was not as far advanced and had more chance of cure than initially thought. Therefore, the early detection and aggressive treatment of breast cancer are important for improving the survival.

A Carcinosarcoma of the Esophagus

A carcinosarcoma of the esophagus is an uncommon malignancy accounting for approximately 1~2% of all esophageal neoplasms. Histologically, both carcinomatous and sarcomatous components are observed. The terms used to describe this lesion include carcinosarcoma, pseudosarcoma, polypoid carcinoma, pseudosarcomatous carcinoma pseudosarcomatous squamous cell carcinoma and a spindle cell variant of a squamous cell carcinoma. It presents as a bulky intraluminal polypoid lesion mainly in the mid to lower esophagus. It often presents relatively early because of its rapid intraluminal growth. Ultimately, the treatment is similar to that of an esophageal carcinoma requiring an esophagectomy for resectable lesions. We report a case of a 64-year-old man with a carcinosarcoma of the esophagus. Endoscopy revealed a 1.5 cm sized polypoid mass located 25 cm from the incisor with friable nature. Radiological studies revealed a bulky polypoid intraluminal mass with a lobulated border, measuring approximately 7 cm in length, in the mid esophagus that expands the lumen in conjunction with the enlargement of the regional lymph nodes. An esophagectomy was performed.

Jejunal Pouch Interposition (JPI) after Distal Gastrectomy in Patients with Gastric Cancer

PUPOSE: Recently, because of the increasing numbers of early gastric cancer patients and improvements in their survivals, greater attention has been directed towards the quality of life and nutritional status of gastric cancer patients after surgery. However, conventional reconstructions, Billroth- I, -II (B-I and B-II) or Roux-en-Y, have proven to have certain limitations, such as a small reservoir, and a malabsorption for iron, fat, calcium, and carotene. To overcome these limitations, we used a jejunal pouch interposition(JPI) after a distal gastrectomy not only to substitute for the small reservoir but also to maintain a physiologic pathway for ingested foods. MATERIALS AND METHODS: A total of 196 gastric cancer patients who underwent a distal gastrectomy between March 2001 and February 2004 were divided into 3 groups: JPI group (n=100), B-I group (n=29), and B-II group (n=67). We assessed the patient's nutritional status, gastric emptying time, and gastrofiberscopic findings. RESULTS: The percents of body weight loss at 6 months, 1 year, and 2 years postoperatively in the JPI group (5.14%, 3.01%, 2.37%) were significantly less than those of the conventional B-I (8.41%, 6.69%, 5.90%) and B-II groups (7.50%, 7.65%, 5.86%) (P=0.011, 0.000, 0.013). The laboratory findings showed no significant differences between the 3 groups, except for a higher total protein level in the JPI group after 6 months postoperatively. Especially, stage I and II cancers in the JPI group showed much higher total protein levels after 1 year postoperatively. The gastric emptying times in the 99mTc- semisolid scans at 6 months, 1 year, and 2 years postoperatively were 102.5, 83.1, and 58.1 minutes in the JPI group, 95.5, 92.0, and 58.5 minutes in the B-I group, and 53.9, 69.1, and 50.2 minutes in the B-II group, respectively. Also, the symptomatic gastric stasis detected with a gastrofiberscope during the early postoperative period (6 months) was gradually improved. CONCLUSION: From a nutritional aspect, a jejunal pouch interposition after a distal gastrectomy could be an alternative reconstruction method, especially in stage I and II gastric cancer patients, in spite of the longer operation time and the probable delayed gastric emptying.

Central Vein Catheterization with an Electrocardiogram

PURPOSE: This study analyzed the value of an electrocardiogram (ECG) using an arterial pulsator in central vein catheterization (CVC). METHODS: In 442 patients who underwent CVC with an ECG and an arterial pulsator, this study evaluated the rates of change in the P wave and the QRS wave at the limb lead II before and after insertion. After insertion, a plain chest X-ray was checked in order to locate the catheter tip. RESULTS: After catheterization, the P wave and the QRS wave increased together at 97% but the P wave (change rate: 0.5~21.0) was more sensitive than the QRS wave (change rate: 0.5~5.8). For an abnormal location (3%), the rate of change in the P wave was 2.0 were 95% and 100%, and those of the QRS wave >1.4 were 90% and 100%. CONCLUSION: In central vein catheterization, an electrocardiogram with an arterial pulsator can be a useful method, and the normal position of the catheter tip can be estimated by using a rate of change in the P wave >2.0 or a rate of change in QRS wave >1.4.

Macromastia with Multiple Fibroadenomas in a Wilson's Disease Patient / 대한내분비외과학회지

Wilson's disease is an autosomal recessive disorder of copper metabolism in individuals with mutant ATP7B genes. Impairment of normal excretion of hepatic copper results in toxic accumulation of the metal in liver, brain and other organs. Clinical manifestations include hepatic, neurologic or psychiatric disturbances. Penicillamine, as a chelator of copper, is the drug of choice in the treatment of Wilson's disease but after treatment of penicillamine, granulocytopenia, thrombocytopenia, the nephrotic syndrome, Goodpasture's syndrome, pemphigus vulgaris or pleural effusion may supervene. We report a case of macromastia with multiple fibroadenomas in a patient who was treated with penicillamine for Wilson's disease.

A Clinical Analysis of Endoscopic Thyroidectomy by the Axillary and Anterior Chest Approach / 대한내분비외과학회지

PURPOSE: The thyroid suregry has recently become one of the newest fields for the application of endoscopic surgery. We have performed endoscopic thyroidectomy by an anterior chest approach and an axillary approach. In this study, we evaluated these two types of endoscopic procedures with regard to efficacy and patients' complaints after surgery. METHODS: Between December 2000 and March 2002, 41 patients were treated by endoscopic thyroidectomy via axillary or anterior chest approach. Each procedure was performed by one surgeon under a general anesthesia. We analysed the operating time, postoperative complications, postoperative scar, the degree of pain to assess the surgical invasiveness of each procedure. RESULTS: Three cases treated using anterior chest approach, and 2 cases treated using axillary approach were converted to conventional thyroidectomy. The mean age of patients was 36 years in anterior chest approach group and 30 years in axillary approach group. The operation time was 238±60 (160~370) minutes in anterior chest approach and 178±71 (100~295) minutes in axillary approach. Postoperative complications are; 1 case of a minimal hematoma, 3 cases of minor wound infection, 3 cases of chest pain in anterior chest approach group, and 1 case of a minimal hematoma, 1 case of transient recurrent laryngeal nerve injury, 1 cases of transient swallowing difficulties in axillary approach group. CONCLUSION: Endoscopic (gasless and axillary approach) thyroidectomy is a safe and effective procedure. Gasless endoscopic thyroidectomy is a useful procedure for unexperienced surgeon due to safety. Endoscopic thyroidectomy by the axillary approach is a better effective procedure with good cosmetic result for a unilateral tumor especially in young women.

Deep Vein Thrombosis Casused by Congenital Absence of Inferior Vena Cava Combined with Hyperhomocysteinemia Due to C677T Methylenetetrahydrofolate Reductase Homozygos Mutation

We present a case of suprarenal & infrarenal absence of inferior vena cava combined with hyperhomocysteinemia in a 39-year-old woman who presented with symptoms of deep venous thrombosis. The patient has also C677T methylenetetrahydrofolate reductase homozygous mutation. Deep vein thrombosis has multifactorial etiology involving both genetic and acquired factors. Absence of inferior vena cava is a rare congenital anomaly, but recently it was confirmed as important risk factor for the development of deep vein thrombosis especially young person. Hypercoagulability by the hyperhomocysteinemia with suggested tendency to venous stasis mediated by agenesis of inferior vena cava must have caused the deep vein thrombosis in our patient. To our knowledge, such an association has not been reported. Clinical features and prognosis of this entity are discussed.

Biliary Manometry in Patients with Common Bile Duct Stones / 한국간담췌외과학회지

BACKGROUND/AIMS: The conventional treatment of patients with common bile duct (CBD) stones was to insert a T-tube via the duct after stone removal. But since the placement of T-tubes resulted in a lot of complications, a few alternative methods have been suggested lately, such as primary closure or intraductal drainage etc. Deciding whether to perform primary closure or to insert a stent or a T-tube is usually based on objective findings such as inspection, palpation or intraoperative cholangiogram. We made a study using the intraoperative biliary manometry as an objective indicator in decision making among the procedures. METHODS: The study was based on 23 patients (10 male, 13 female) who underwent common bile duct exploration for stone removal from March 2002 to May 2003. The basal pressure and frequency of phasic contraction of the Sphincter of Oddi were measured intraoperatively by manometry RESULTS: Primary closure after CBD exploration was performed in 15 cases, intraductal drainage in the remaining 8 cases. No complication such as bile leakage or postoperative obstructive jaundice was observed. CONCLUSION: The intraoperative biliary manometry is a simple and useful tool that can be used as an indicator in deciding whether to perform a drainage procedure after common bile duct stone removal.

Three Cases of Biliary Cystadenoma and Biliary Cystadenocarcinoma

A biliary cystadenoma and a cystadenocarcinoma are rare intrahepatic cystic neoplasm. The clinical feature is not marked but abdominal fullness and mass are the most common symptoms. The tumor is commonly a large multilocular cystic mass which requires hepatectomy for cure. We experienced one case of biliary cystadenoma and two cases of biliary cystadenocarcinoma. The biliary cystadenoma case was a 58-year-old female with right upper quadrant discomfort for 5 months and a 17 cm sized multilocular cystic mass. The serum CA 125 level was elevated but returned to normal level after resection. A right hepatectomy was performed and the patient has had no recurrence for 14 months after the resection. One of the biliary cystadenocarcinoma cases was a 42-year-old man with a 12 cm sized multilocular cystic mass in the right upper quadrant of his abdomen. A right hepatectomy was performed and the patient has had no recurrence for 12 months after the resection. The other biliary cystadenocarcinoma case was a 70-year-old man with right upper quadrant pain and a 5 cm sized cystic mass. A left hepatecomy was performed and the patient has had no recurrence for 8 month after the resection. The treatment of choice for a biliary cystadenoma or cystadenocarcinoma is complete resection. We report three cases of biliary cystadenoma and cystadenocarcinoma with a review of the literature.