A Clinical Review of Initial 20 Cases of Laparoscopic Adrenalectomy / 대한내분비외과학회지

PURPOSE: The laparoscopic adrenalectomy (LA) has become the preferred procedure for adrenal tumors due to many advantages; a more rapid and comfortable recovery, shortened hospitalization period, and fewer complications. This study reports on an initial 4 year period of experience with LA and describes various unusual findings encountered during the treatment. METHODS: From February 1997 to November 2000, a total of 20 LA were performed. Of the several LA techniques previously described we prefer the transabdominal approach in the lateral decubitus position utilizing 3 or 4 trocars, and this method was employed in all the cases presented here. RESULTS: All 20 patients had a unilateral tumor. The pathological findings consisted of 11 aldosteronomas, 6 Cushing adenomas, 2 pheochromocytomas and 1 cortical carcinoma. Of the 20 patients, 18 were successfully operated with the laparoscopic procedure and the remaining 2 cases were converted to open adrenalectomy. The reasons for conversion were sudden cardiac arrest of unknown origin in one and intraoperative bleeding due to periadrenal massive fat in the other. During LA, 2 patients with non-catecholaminesecreting cortical adenomas pathologies displayed abnormal EKG findings, which reverted to normal after the operation. The average complete LA operation times was 186 minutes in the first 9 cases and 132 minutes in the next 9 cases. The first oral intake was started within 24 hours in all cases. There were no postoperative complications, operative morbidity or mortality. The average hospital stay was 6.2 days in the first 9 cases and 4.2 days in the next 9 cases. CONCLUSION: LA is a relatively fast and safe method and has become is accepted as the preferred procedure for adrenal tumors but it requires good perioperative preparation. Surgeons and anesthesiologists need to be aware of the possible cardiovascular complications and of the problems inherent in the manipulation of the adrenal gland during LA.

A Clinical Review of Initial 20 Cases of Laparoscopic Adrenalectomy / 대한내분비외과학회지

PURPOSE: The laparoscopic adrenalectomy (LA) has become the preferred procedure for adrenal tumors due to many advantages; a more rapid and comfortable recovery, shortened hospitalization period, and fewer complications. This study reports on an initial 4 year period of experience with LA and describes various unusual findings encountered during the treatment. METHODS: From February 1997 to November 2000, a total of 20 LA were performed. Of the several LA techniques previously described we prefer the transabdominal approach in the lateral decubitus position utilizing 3 or 4 trocars, and this method was employed in all the cases presented here. RESULTS: All 20 patients had a unilateral tumor. The pathological findings consisted of 11 aldosteronomas, 6 Cushing adenomas, 2 pheochromocytomas and 1 cortical carcinoma. Of the 20 patients, 18 were successfully operated with the laparoscopic procedure and the remaining 2 cases were converted to open adrenalectomy. The reasons for conversion were sudden cardiac arrest of unknown origin in one and intraoperative bleeding due to periadrenal massive fat in the other. During LA, 2 patients with non-catecholaminesecreting cortical adenomas pathologies displayed abnormal EKG findings, which reverted to normal after the operation. The average complete LA operation times was 186 minutes in the first 9 cases and 132 minutes in the next 9 cases. The first oral intake was started within 24 hours in all cases. There were no postoperative complications, operative morbidity or mortality. The average hospital stay was 6.2 days in the first 9 cases and 4.2 days in the next 9 cases. CONCLUSION: LA is a relatively fast and safe method and has become is accepted as the preferred procedure for adrenal tumors but it requires good perioperative preparation. Surgeons and anesthesiologists need to be aware of the possible cardiovascular complications and of the problems inherent in the manipulation of the adrenal gland during LA.

Risk Factors for Chronic Rejection after Renal Transplantation / 대한이식학회지

PURPOSE: Chronic allograft nephropathy is the most common cause of renal transplant failure in the first post-transplant decade, but its pathogenesis has remained unclear. The most effective option to prevent chronic allograft nephropathy is the prevention of graft injury from both immune and non-immune mechanisms. To prevent chronic allograft rejection as avoiding high risk factors in donor selection, we analyzed the potential risk factors of chronic allograft rejection in renal transplantation. METHODS: Retrospective review was performed on clinical courses of 592 recipients of renal transplantation treated with cyclosporine, azathioprine or mycophenolate mofetile and prednisone from January, 1985 to December, 2000 in Hanyang University Hospital. Of 592 cases, chronic rejection was occurred in 51 cases, we analysed this group. The control group was demographically matched using the parameters of age, gender, date of transplantation, and immunosuppressive protocol, the numbers of control group was 98 cases in same period. We compared with two groups for risk factors, such as donor age, HLA mismatching, acute rejection episode and frequency, and proteinuria at 1 month after transplantation. We identified statistical analysis using univariate logistic regression analysis with SPSS program. The data comparison was performed through chi-square test. RESULTS: The average age of recipient is 33.8 years and that of donor is 45.5 years in chronic rejection group. Acute rejection episode was 51% (26/51) compared with control group 10.2% (10/98). Univariate analysis of risk factors revealed that acute rejection episode (P=0.000), HLA-DR mismatching (P=0.000), and donor age (P=0.000) were significant independent risk factors. CONCLUSION: We suggested that acute rejection episode, over 50 years of donor age and the degree of HLA-DR mismatching were the risk factors of chronic rejection. And so, in selecting donor for living donor renal transplantation, we should concern donor age, HLA-DR mismatching, and aggressive treatment in occurring acute rejection episode after transplantation.

A Clinical Review of Initial 20 Cases of a Laparoscopic Adrenalectomy / 대한내분비외과학회지

PURPOSE: The laparoscopic adrenalectomy (LA) has become the preferred procedure for adrenal tumors since it has many advantages; a more rapid and comfortable recovery, shorted hospitalization, and fewer complications. The purpose of this study was to report the initial 4 years experiences of LA and describe the unusual findings encountered during the operations. METHODS: From February 1997 to November 2000, a total of 20 LA were performed. Several techniques of LA have been described already. We prefer the transabdominal approach in the lateral decubitus position using 3 or 4 trocars. RESULTS: 20 patients had all unilateral tumor. The pathological findings were 11 aldosteronomas, 6 Cushing adenomas, 2 pheochromocytomas and 1 cortical carcinoma. 18 cases of 20 patients were successfully operated by laparoscopic procedure and 2 cases were converted to open adrenalectomy. The reasons of conversion were sudden cardiac arrest due to unknown origin and intraoperative bleeding due to periadrenal massive fat. During the laparoscopic operation, 2 patients showed abnormal EKG findings. The pathologies of those patients were non-catecholamine-secreting cortical adenomas. After operation, they have been completely normal in EKG. The average operating time for the complete laparoscopic adrenalectomies was 186 minutes in the first 9 cases and 132 minutes in the next 9 cases. The first oral intake was started within 24 hours in all cases. There was no postoperative complication and no operative morbidity or mortality. The average hospital stay was 6.2 days in the first 9 cases and 4.2 days in the next 9 cases. CONCLUSION: The LA is relatively fast and safe method and is accepted as the preferred procedure for the adrenal tumors but it should be well prepared perioperatively. Surgeons and anesthesiologists should be aware of those possible cardiovascular complications and of the problems inherent in the manipulation of the adrenal gland during LA.

Immediate Free TRAM Flap Reconstruction after Mastectomy in Breast Cancer Patients / 한국유방암학회지

PURPOSE: Despite the advocation of a breast conserving approach to the treatment of breast cancer, many women continue to surgically require or choose mastectomy for the treatment of breast cancer. In many cases, breast reconstruction after mastectomy is being performed using tissue expander, implants or a myocutaneous flap. In recent years, immediate free transverse rectus abdominis musculocutaneous (TRAM) flap reconstruction has become an cosmetically and economically attractive alternative, compared to other types of reconstruction, although the technique is not easy. The author's experience with 25 successful immediate free TRAM flap reconstructions is reviewed. METHODS: We analyzed 25 cases of immediate free TRAM reconstruction that were performed at the Department of Surgery, Hanyang University Hospital, from August 1995 to June 2000, for age, histologic type, stage and estimated degree of patient satisfaction. RESULTS: The patient age distribution ranged from 26 to 58 years old, the mean age was 38.3, and the majority of tumors were invasive ductal carcinoma (13 cases) and intraductal carcinoma (8 cases). All tumor sizes were less than 3 cm (Tis: 8 cases, T1: 8 cases, T2: 7 cases) with the exception of the phyllodes tumors (8 cm and 6 cm). The stage was from 0 to IIB (0: 7 cases, I: 7 cases, IIA: 8 cases, IIB: 1 case, phyllodes tumor: 2 cases). Immediate posto-perative complications included 3 cases of bleeding and 1 case of wound infection at the donor site. According to the patients' expressed opinions, almost all patients were pleased with the result. There was no local recurrence during the follow-up period except for one case of bone metastasis that developed. CONCLUSION:This technique undoubtedly can play a major role in the so called "onco-plastic" surgical management of breast cancer.

Immediate Free TRAM Flap Reconstruction after Mastectomy in Breast Cancer Patients

PURPOSE: Despite the advocation of a breast conserving approach to the treatment of breast cancer, many women continue to surgically require or choose mastectomy for the treatment of breast cancer. In many cases, breast reconstruction after mastectomy is being performed using tissue expander, implants or a myocutaneous flap. In recent years, immediate free transverse rectus abdominis musculocutaneous (TRAM) flap reconstruction has become an cosmetically and economically attractive alternative, compared to other types of reconstruction, although the technique is not easy. The author's experience with 25 successful immediate free TRAM flap reconstructions is reviewed. METHODS: We analyzed 25 cases of immediate free TRAM reconstruction that were performed at the Department of Surgery, Hanyang University Hospital, from August 1995 to June 2000, for age, histologic type, stage and estimated degree of patient satisfaction. RESULTS: The patient age distribution ranged from 26 to 58 years old, the mean age was 38.3, and the majority of tumors were invasive ductal carcinoma (13 cases) and intraductal carcinoma (8 cases). All tumor sizes were less than 3 cm (Tis: 8 cases, T1: 8 cases, T2: 7 cases) with the exception of the phyllodes tumors (8 cm and 6 cm). The stage was from 0 to IIB (0: 7 cases, I: 7 cases, IIA: 8 cases, IIB: 1 case, phyllodes tumor: 2 cases). Immediate postoperative complications included 3 cases of bleeding and 1 case of wound infection at the donor site. According to the patients' expressed opinions, almost all patients werepleased with the result. There was no local recurrence during the follow-up period except for one case of bone metastasis that developed. CONCLUSION: This technique undoubtedly can play a major role in the so called "onco-plastic" surgical management of breast cancer.

A Clinical Review of 20 Initial Cases of Laparoscopic Adrenalectomy

PURPOSE: The laparoscopic adrenalectomy (LA) has become the preferred procedure for adrenal tumors due to many advantages; a more rapid and comfortable recovery, shortened hospitalization period, and fewer complications. This study reports on an initial 4 year period of experience with LA and describes various unusual findings encountered during the treatment. METHODS: From February 1997 to November 2000, a total of 20 LA were performed. Of the several LA techniques previously described we prefer the transabdominal approach in the lateral decubitus position utilizing 3 or 4 trocars, and this method was employed in all the cases presented here. RESULTS: All 20 patients had a unilateral tumor. The pathological findings consisted of 11 aldosteronomas, 6 Cushing adenomas, 2 pheochromocytomas and 1 cortical carcinoma. Of the 20 patients, 18 were successfully operated with the laparoscopic procedure and the remaining 2 cases were converted to open adrenalectomy. The reasons for conversion were sudden cardiac arrest of unknown origin in one and intraoperative bleeding due to periadrenal massive fat in the other. During LA, 2 patients with non-catecholamine-secreting cortical adenomas pathologies displayed abnormal EKG findings, which reverted to normal after the operation. The average complete LA operation times was 186 minutes in the first 9 cases and 132 minutes in the next 9 cases. The first oral intake was started within 24 hours in all cases. There were no postoperative complications, operative morbidity or mortality. The average hospital stay was 6.2 days in the first 9 cases and 4.2 days in the next 9 cases. CONCLUSION: LA is a relatively fast and safe method and has become is accepted as the preferred procedure for adrenal tumors but it requires good perioperative preparation. Surgeons and anesthesiologists need to be aware of the possible cardiovascular complications and of the problems inherent in the manipulation of the adrenal gland during LA.

Pulmonary Metastasis of Gastric Cancer

BACKGROUND: Gastric cancer is still the leading cause of death in Korea. Pulmonary metastasis(PM) is the second most frequent form of organ metastasis from gastric cancer followed by liver metastasis. However, there have been few reports in Korea dealing with the clinicopathological characteristics of pulmonary metastasis from gastric cancer (PMGC). METHODS: Six hundread sixty seven surgeries for gastric cancer were performed during the period from June 1992 to August 1997 in our department. Fourteen cases of PMGC were included in this study. The diagnostic methods for PMGC were chest X-ray, chest CT, and CT-guided fine-needle aspiration biopsy or bronchoscopic biopsy (in doubtful cases). RESULTS: The most common symptoms in PMGC were cough and dyspnea; 4 cases (28.6%) had no symptoms related to PM. There were four types of PM: lymphangitic carcinomatosa (LC), 6 cases; nodular, 5 cases; pleuritis carcinomatosa (PC), 2 cases; and mediastinal lymphadenopathy (ML), 1 case. The mean survival duration after PM was 13.2 months for the nodular type, 2.3 months for the LC type, 2 months for the ML type, and 1.5 months for the PC type. The mean survival time after PM was 12.4 months when the disease- free interval after gastric surgery was longer than 12 months and was 2.1 months when it was less than 12 months. The mean survival durations after PM were 23 months and 6 months (still alive) for the 2 patients operated on for PM lesions and 4.7 months for the 12 not receiving operations. In summary, when the disease free interval was longer, the mean survival duration after PM was also longer. The survival duration in cases with nodular type PM was longer than that for other types of PM. CONCLUSION: On the basis of this study, we can assume that a pulmonary resection can be carried out in the case of a single metastatic nodule in order to extend the length of survival.

Clinicopathological Analysis of Krukenberg Tumor Arising from Stomach Cancer

BACKGROUND: The Krukenberg tumor (KT) is a metastatic or primary ovarian tumor of the signet-ring cell type. The incidence of this tumor is higher in Korea than in Western countries due to the higher incidence of gastric cancer in Korea. This tumor arises more commonly in the relatively young age group, especially women in the prememopausal period. We tried to find the clinicopathological (CP) characteristics of this tumor and also tried to confirm the appropriateness of the classification by the Japanese Research Society for Gastric Cancer which classifies a KT as P2. METHODS: We observed 23 cases of KT which were diagnosed from July 1984 to December 1997 at the Department of General Surgery, Hanyang University Hospital and analyzed their CP factors. RESULT: The age distribution ranged from 30 to 67 years old, and the mean age was 43.3 years old. The most common symptom was lower abdominal pain. The tumor occurred at the bilateral ovaries in 17 cases (74%). Two patients who manifested a KT without other metastatic findings during gastric cancer surgery survived 20 months and 8 months (still alive), whereas 21 cases with peritoneal seeding (PS)(P2) and 6 cases which manifested a KT combined with PS had mean survival durations (MSD) of 7.4 months and 7.2 months, respectively. The MSDs for three patterns of recurrence were 21.4 months for KT cases (8 cases), 21.4 months for PS cases (47 cases), and 5.0 months for KT combined with PS cases (7 cases). In patients under the age of 50 years old who showed signet-ring cell type gastric cancer, the incidence of a KT as a coincidental finding or as a form of recurrence was 24.1% when the tumor showed serosal invasion. CONCLUSIONS: The prognosis for a patient with a KT was relatively better than that for patient with other forms of PS, which is due to the difference in the resectability of these two forms of P2 cancer.This indicates a need to reconsider the P2 classification. If the gastric cancer with a signet-ring cell type and more than T3 in women under the age of 50 years old, we have to consider the necessity for a preventive oophorectomy because of the high incidence of KTs under such conditions.