Axillary Lymph-Node Metastases in Patients with T1 Breast Cancer

PURPOSE: In T1 tumors, the reported incidence of lymph-node metastases ranges from 21% to 35%. We analyzed the pathological parameters of T1 tumors for their association with the likelihood of axillary lymph-node metastases. Our objectives were to determine if standard pathologic factors can predict lymph-node metastases in T1 tumors and to provide a basis for patient selection for nonradical surgery. METHODS: Sixty-five patients with T1 unilateral invasive breast cancer were studied. All patients underwent axillary dissection from 1990 to 1999 at Masan Samsung Hospital, and the pathologic status of the nodes was reviewed. The associations between the incidence of axillary lymph-node metastases and pathologic factors, including age, size, histologic subtype, nuclear grade, hormone receptor status, and lymphatic/vascular invasion, were analyzed. RESULTS: Of the 65 patients, 21 (32.3%) had nodes that were positive for metastases. The independent predictor of lymph-node metastases in the multivariate logistic regression analyses was a tumor size larger than 1 cm (p<0.05). However, other predictors showed nonspecific findings. CONCLUSION: These results suggest that the characteristics of the primary tumor can help assess the risk for axillary lymph-node metastases. Axillary lymph-node dissection should be performed routinely for all patients with lesions with a tumor more than 1 cm in size. Although a routine axillary dissection or radiation therapy to the axilla might be spared in selected patients who are assessed to be at minimal risk, new prognostic factors for providing reliable assurance of the absences of axillary lymph-node metastases must be investigated.

A Clinical Study of Periappendiceal Abscess

This is a clinical analysis and review of one-hundred ninety-four patients with periappendiceal abscesses who were treated at the Departmeat of Surgery, Masan Samsung Hospital over a ten year period from January 1985 to December 1994. The following results were obtained. The incidence of periappendiceal abscesses was 7.24% of the total cases of appendicitis operated on during the same period, and most of the patients(43.8%) were over fifty years old. The male to female ratio was 1:1.02. 41.2% of the patients had operations within four days after their symptoms occurred. On admission, the most common physical finding was tenderness on the right lower quadrant of the abdomen (92.9%) and leukocytosis(> OR = 10,000/mm3) was noted on CBC in 82% of the patients. Abdominal sonograms revealed periappendiceal abscesses in 88% of the patients, 83% were revealed with barium enema and 88% with abdominal CT scan. Many patients(75.5%) visited the local clinic and were treated under the diagnosis of gastritis or enteritis instead of appendicitis. One-hundred eighty-three patients(94.3%) had appendectomies with drainages(94.3%), two patients had drainages of abscesses without appendectomy, six patients had ileocecal resections and three patients had right hemicolectomies. Microbiologically, E. coli was the most frequently cultured species(63%) from abscess, and Klebsiella, Enterococcus and Proteus were isolated in some cases. Postoperative complication occurred in seventy-five patients(38.6%) and the most frequent complication was wound infection(28.8%). There was no mortality and the mean hospital stay was fifteen days.

A Case of Congenital Hemangiopericytoma of Small Bowel Associated with Intestinal Obstruction

Hemangiopericytoma was first described by Stout & Murray in 1942 and was an uncommon soft tissue tumor thought to be derived from vascular pericytes. Approximately 10-15% of the cases occur in children have a propensity to develop in the region of head, neck and lower extremities. We experienced a case of congenital hemangiopericytoma of small bowel in a male neonate who showed vomiting and abdorninal distension. We reported a case of congenital hemangiopericytoma of small bowel with brief review of related literature.

En-Bloc Resection of Extended Total Gastrectomy VS. Total Gastrectomy for Proximal Gastric Cancer

It is very important to select the appropriate operative method in cancer surgery. For proximal gastric cancer, a total gastrectomy (TG) has usually had less morbidity and mortality than an extended total gastrectomy (ETG). To compare and evaluate the results of a TG with those of an ETG, the authors analyzed 50 cases treated by a TG and 50 cases treated by an ETG during the last 12 years. The results were as follows: The post operative complication rates were 34% for a TG and 54% for an ETG, the average operation time was 3 hours 53 minutes for a TG and 3 hours 42 minutes for an ETG, the postoperative fasting period was 7.1 days for a TG and 6.5 days for an ETG, and the mean length of hospital stay was 21.4 days for a TG and 22.6 days for an ETG. the ETG had a higher complication rate than the TG, but there was no statistical difference between the operation times, the postoperative fasting periods, and the length of stay in the hospital. from our experience, it is suggested that the ETG is easier, or almost the same, to carry out than the TG procedure. Therefore, we recommend an ETG for proximal gastric cancer to achieve better curative results.