Comparison of Methylation Profiling in Cancerous and Their Corresponding Normal Tissues from Korean Patients with Breast Cancer

BACKGROUND: Aberrant DNA hypermethylation plays a pivotal role in carcinogenesis and disease progression; therefore, accurate measurement of differential gene methylation patterns among many genes is likely to reveal biomarkers for improved risk assessment. We evaluated the gene hypermethylation profiles of primary breast tumors and their corresponding normal tissues and investigated the association between major clinicopathological features and gene hypermethylation. METHODS: A single reaction using methylation-specific multiplex ligation-dependent probe amplification was used to analyze the DNA methylation status of 24 tumor suppressor genes in 60 cancerous tissues and their corresponding normal tissues from patients with primary breast cancer. RESULTS: In cancerous breast tissues, 21 of 24 genes displayed promoter methylation in one or more samples. The most frequently methylated genes included RASSF1 (43.3%), APC (31.7%), CDKN2B (25.0%), CDH13 (23.3%), GSTP1 (16.7%), and BRCA1 (10%). APC was associated with lymph node metastasis, and BRCA1 was associated with negative estrogen receptor and negative progesterone receptor expression. In normal breast tissues, 8 of 24 tumor suppressor genes displayed promoter hypermethylation; CDKN2B (28.3%) and RASSF1 (8.3%) hypermethylation were most frequently observed. CONCLUSIONS: RASSF1 and CDKN2B hypermethylation in Korean breast cancer patients were the most frequent in cancerous tissue and corresponding normal tissue, respectively. Our data indicates that methylation of specific genes is a frequent event in morphologically normal breast tissues adjacent to breast tumors as well as the corresponding breast cancers. This study also suggests that gene methylation is linked to various pathological features of breast cancer; however, this requires confirmation in a larger study.

Laparoscopic left hemihepatectomy for left intrahepatic duct stones / 대한외과학회지

PURPOSE: The feasibility of laparoscopic left hemihepatectomy for the management of intrahepatic duct (IHD) stones was evaluated. METHODS: The clinical data of 26 consecutive patients who underwent total laparoscopic left hemihepatectomy for IHD stones at Gyeongsang National University Hospital between January 2009 and June 2011 were reviewed retrospectively. RESULTS: The mean operation time was 312.1 +/- 63.4 minutes and the mean postoperative hospital stay was 11.8 +/- 5.0 days. There were 2 cases of postoperative bile leakage and 3 cases of intra-abdominal fluid collection, which were successfully managed conservatively. Remnant stones were detected in 2 patients. The initial success rate of stone clearance was 92.3% (24 of 26). The remnant stones were located in the common bile duct in both cases and were removed by endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy. Therefore, the final success rate of stone clearance was 100% (26 of 26). During a mean follow-up of 22 months (range, 7 to 36 months), there was no patient with recurrent stone. CONCLUSION: Laparoscopic surgery could be an effective treatment modality for the management of IHD stones in select patients.

Analysis of Risk Factors for Postoperative Morbidity in Perforated Peptic Ulcer

PURPOSE: Emergency operations for perforated peptic ulcer are associated with a high incidence of postoperative complications. While several studies have investigated the impact of perioperative risk factors and underlying diseases on the postoperative morbidity after abdominal surgery, only a few have analyzed their role in perforated peptic ulcer disease. The purpose of this study was to determine any possible associations between postoperative morbidity and comorbid disease or perioperative risk factors in perforated peptic ulcer. MATERIALS AND METHODS: In total, 142 consecutive patients, who underwent surgery for perforated peptic ulcer, at a single institution, between January 2005 and October 2010 were included in this study. The clinical data concerning the patient characteristics, operative methods, and complications were collected retrospectively. RESULTS: The postoperative morbidity rate associated with perforated peptic ulcer operations was 36.6% (52/142). Univariate analysis revealed that a long operating time, the open surgical method, age (> or =60), sex (female), high American Society of Anesthesiologists (ASA) score and presence of preoperative shock were significant perioperative risk factors for postoperative morbidity. Significant comorbid risk factors included hypertension, diabetes mellitus and pulmonary disease. Multivariate analysis revealed a long operating time, the open surgical method, high ASA score and the presence of preoperative shock were all independent risk factors for the postoperative morbidity in perforated peptic ulcer. CONCLUSIONS: A high ASA score, preoperative shock, open surgery and long operating time of more than 150 minutes are high risk factors for morbidity. However, there is no association between postoperative morbidity and comorbid disease in patients with a perforated peptic ulcer.

Clinical features and prognostic factors in papillary thyroid microcarcinoma depends on age / 대한외과학회지

PURPOSE: Clinical outcomes of papillary thyroid microcarcinoma (PTMC) vary. In general, age at diagnosis is an independent prognostic factor in conventional papillary thyroid carcinoma. However, it is unclear in patients of PTMC. The purpose of this study was to identify clinicopathologic features and prognostic factors of PTMC according to patients' age. METHODS: Five hundred twenty-seven patients who received thyroid surgery and diagnosed as having PTC between January 2001 and December 2009 were included. The clinical data were retrospectively analyzed. RESULTS: We divided the patients into two groups; group I who were younger than 45 years, and group II who were 45 years old or older. The mean tumor size and incidences of neck lymph nodes involvement of group I was larger than group II. In group II, however, there were more patients who had multiple cancer foci and were body mass index > or = 25 kg/m2. The overall incidence of recurrent disease was 3.2%. The incidence of recurrence was higher in group II (2.0% vs. 4.0%), without a statistical difference. In multivariate analysis, the significant risk factors of recurrence were male gender and multifocality in group I, and lymph node metastasis and multifocality in group II. In particular, the male gender and multifocality showed the highest odds ratio (OR) on each group (OR, 4.721 and 6.177). CONCLUSION: The patients with PTMCs had different clinical features and prognostic factors according to age. Hence, clinicians should consider a different strategy for therapy and plan for follow-up according to age.

Body size and thyroid nodules in healthy Korean population / 대한외과학회지

PURPOSE: Excess weight and obesity have been associated with numerous diseases including thyroid cancer, but the relationship has been weak. The objective of this study was to evaluate the relationship of body sizes on thyroid nodules in healthy Korean population. METHODS: A total of 7,763 persons who underwent a health examination in our health examination center were included in this study. The epidemiologic factors, body size and thyroid ultrasound results were reviewed. We investigated the effects of body size on the presence of thyroid nodules and malignancy. RESULTS: The incidence of thyroid nodules was 20.6%. In the group who were found to have thyroid nodules, mean height, weight and body surface area (BSA) were significantly smaller compared to the others. Especially, in the women, smaller height (less than 160 cm) and overweight (> or = 60 kg) were identified as independent risk factors for the presence of thyroid nodules. The patients with body mass index (BMI) subgroups of normal or overweight had a tendency to have thyroid nodules more frequently. The detection rate of thyroid cancer was 0.47%. The patients with thyroid cancer tended to be smaller in height and BSA than the others. CONCLUSION: A higher frequency of thyroid nodules was associated with women and, older age. In women, there were significant correlations in height, weight and BMI subgroups to the presence of thyroid nodules.

The indices of body size and aggressiveness of papillary thyroid carcinoma / 대한외과학회지

PURPOSE: The incidence of papillary thyroid carcinoma (PTC) is increasing worldwide. Positive associations between indices of body size and thyroid cancer have been reported. However, the relationships to cancer severities and/or behaviors are uncertain. METHODS: We performed a retrospective analysis of the data of patients who underwent total thyroidectomy due to PTC. The epidemiologic factor and pathologic report after operation were determined based on chart review. The relationships between indices of body size and these parameters were assessed. RESULTS: Positive association between body mass index and T stage was found, but it was not statically significant. In neck lymph node metastasis, the group with metastasis had a tendency for larger mean height and weight, but significant difference was found only in height. However, in the multivariate analysis, the age and size of nodules were only identified as independent risk factors of neck lymph node metastasis (P = 0.000 and 0.019). CONCLUSION: There was no independent association between indices of body size and stages of PTC in patients who underwent total thyroidectomy.

The Predictable Factors of Hypothyroidism Following to Thyroid Lobectomy / 대한내분비외과학회지

PURPOSE: Thyroid lobectomy is one of the common operative procedures in patients with benign thyroid nodules. The procedure is relatively feasible, but some patients who receive lobectomies have the complications, such as nerve injury, hypocalcemia, and hypothyroidism. We examined the frequency of hypothyroidism and predictable factor following thyroid lobectomy due to benign thyroid nodules. METHODS: Retrospective analysis was carried out on 212 patients who underwent thyroid lobectomy to benign nodules from January 2005 to May 2010. The risk factors, including sex, age at diagnosis, thyroid function test results, existence of thyroiditis, thyroid volume, and results of the preand post-operation thyroid ultrasounds, were analyzed between euthyroidism and hypothyroidism groups. RESULTS: The rate of hypothyroidism was 17%. In the univariate analysis, age, multiplicity of nodules, thyroiditis, preoperative levels of Tg and TSH, and thyroid volume were significantly predictable factors of hypothyroidism. In the multivariate analysis, the significant factors associated with hypothyroidism were being over 40 years old, having a preoperative TSH of more than 2 mlU/L, and having a small thyroid volume. CONCLUSION: Hypothyroidism following lobectomy is not disasterous complication. We should discuss the possibility of postoperative hypothyroidism carefully with patients before operation, especially when we plan to perform lobectomy on the patients who are over 40, have high TSH levels before surgery, or have a small thyroid volume.

Pancreatic Diabetes after Distal Pancreatectomy: Incidence Rate and Risk Factors

PURPOSE: Pancreatectomy can impair production of endocrine and exocrine hormones. In this study, we evaluated: 1) the incidence rate of diabetes in patients undergoing distal pancreatectomy; 2) the correlation between the occurrence of pancreatic diabetes and the extent of the resected pancreas; and 3) factors associated with the development of pancreatic diabetes. METHODS: We retrospectively reviewed the cases of 26 patients who could be compared in abdominal computed tomography before and after distal pancreatectomy for benign or malignant lesions between January, 1999 to June, 2010. RESULTS: The incidence of pancreatic diabetes was 19.2%. Obese patients (BMI>25.0 kg/m2) had a higher incidence (p=0.029) of pancreatic diabetes after distal pancreatectomy than non-obese patients. The diabetes group had larger volumes of resected pancreas, but the difference was not statistically significant (p=0.105). CONCLUSION: Several factors may be associated with the development of pancreatic diabetes after distal pancreatectomy. It is necessary to closely follow-up development of pancreatic diabetes regardless of the extent of resection.

Laparoscopic resection of a appendiceal mucocele / 대한외과학회지

Laparoscopic resection of appendiceal mucoceles has recently been described, but the safety and efficacy are controversial. We present two cases of laparoscopic mucocelectomies involving 14 and 15 cm cystic masses originating from the appendix. The laparoscopic mucocelectomies were performed using four ports. From the beginning of the procedure, a laparoscopic bag was used to safely contain the mucocele, prevent rupture of the mucocele, and retract the mucocele. An endoscopic stapling device was used to transect the base of the cecum. Minimal handling was achieved by gravity and with the use of laparoscopic instruments. Laparoscopic appendectomies are widely performed for acute appendicitis, but laparoscopic resection is not routinely performed for an appendiceal mucocele because of the risk of perforation and subsequent pseudomyxoma peritonei. We report two cases of laparoscopic appendiceal mucocelectomies, which were performed safely with laparoscopic instruments and minimal manipulation.

Laparoscopic Liver Resection for Hepatocellular Carcinoma

PURPOSE: With the advancement of laparoscopic instruments and accumulation of surgical technique, laparoscopic liver resection is currently performed for various benign and malignant liver diseases. However, controversies still remain over laparoscopic liver resection for malignant liver diseases including HCC and its oncologic safety is yet to be established. This study aims at determining the safety, feasibility and short-term oncologic outcomes of laparoscopic liver resection performed for HCC. METHODS: From July 2008 to March 2010, laparoscopic liver resection was performed at our hospital on a total of 45 patients with various benign and malignant liver diseases. Among these 45 patients, 16 patients diagnosed with HCC were reviewed retrospectively. RESULTS: The mean age of the patients was 59.25, comprising 11 male patients (68.8%) and 5 female patients (31.2%). The location of tumor was left lateral in 7 cases, 4 cases in segment 6, 2 cases in segment 7, 2 cases in segment 5, 1 case in segment 4 and 1 case in caudate lobe. Wedge resection was performed in 11 cases, left hemi hepatectomy in 2 cases, left lateral sectionectomy in 2 cases, caudate lobectomy in 1 case. The mean operative time was 248.75 minutes. The mean hospital stay was 13.8 days, and there were no post-operative recurrences during the post-operative follow-up period. CONCLUSION: When performed by expert surgeons in selected patients, laparoscopic liver resection for HCC is a feasible and safe procedure.

Synchronous Adenocarcinoma and Gastrointestinal Stromal Tumor of the Stomach Treated by a Combination of Laparoscopy-assisted Distal Gastrectomy and Wedge Resection

The simultaneous occurrence of a gastrointestinal stromal tumor (GIST) and a gastric adenocarcinoma is uncommon, and has rarely been reported in the literature. The present report describes the case of a 74-year-old male patient who initially presented with an adenocarcinoma that had invaded the antral mucosa. Computed tomography then revealed the presence of a suspected GIST, in the form of a 2x2 cm mass at the hilum of the spleen. In view of the advanced age of the patient, a surgical approach that would minimize risk and maximize quality of life was preferred. The patient therefore underwent simultaneous laparoscopy-assisted distal gastrectomy for the adenocarcinoma and wedge resection for the GIST. This approach was only chosen after confirming that it would be possible to preserve three or more of the short gastric arteries that supply the area below the wedge resection site. This may be considered a feasible approach to the management of the simultaneous occurrence of a mid-to-low gastric body adenocarcinoma and a high gastric body GIST.

The Risk Factors of Reflux Complication after Gastrectomy for Proximal Gastric Cancer

PURPOSE: The aim of this study was to investigate the risk factors of reflux associated complications (reflux symptoms, reflux esophagitis, and esophageal stricture) after gastrectomy for proximal gastric cancer. METHODS: 150 patients with proximal gastric cancer were included from January 2005 to December 2008. Their medical and surgical records were retrospectively analyzed concerning clinical and pathologic characteristics, operation methods, morbidity, reflux associated complications and nutritional states. RESULTS: Tumor sizes and operation methods were statistically significant in univariate analysis of risk factors for reflux associated complications (P0.05). However, reflux complications were significantly more common in proximal gastrectomy groups (72.4%) than in total gastrectomy groups (29.5%). Severe reflux esophagitis (LA classification C or D) was found in only proximal gastrectomy groups. CONCLUSION: Total gastrectomy is favorable for proximal early gastric cancer in terms of reduced esophageal reflux complications.

Up-regulation of RhoGDI2 in Human Breast Cancer and Its Prognostic Implications / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Recent research has identified many genes and proteins that play specific roles in the process of systemic metastasis in various types of cancer. Rho GDP dissociation inhibitor 2 (RhoGDI2) has been shown to inhibit metastasis in human bladder cancer, but its role in breast cancer is controversial. MATERIALS AND METHODS: We examined the regulation and clinical significance of RhoGDI2 in Korean breast cancer patients by using proteomic approaches. RESULTS: By using a proteomic approach, we observed an increased expression of RhoGDI2 in human breast cancer tissues when compared to that of the normal breast tissues, and we validated its up-regulation in an independent cohort of 8 breast cancer patients. The clinical implication of a RhoGDI2 expression was investigated in 57 breast cancer patients by performing immunohistochemistry. RhoGDI2 did not show a significant association with the tumor size, lymph node metastasis, the histologic grade or the hormone receptor status. However, the patients with RhoGDI2-expressing tumors had significantly shorter disease-free survival (p=0.043; hazard ratio, 3.87) and distant metastasis-free survival (p=0.039; hazard ratio, 5.15). CONCLUSION: Our results demonstrated a potential role of RhoGDI2 as a poor prognostic marker as well as a potential therapeutic target. The pro-metastatic nature of RhoGDI2 shown in our study may indicate its organ-specific role in cancer metastasis.

Use of Angioembolization to Replace Operative Management for Blunt Splenic Injury

PURPOSE: Over the past few decades, the treatment of traumatic splenic injuries has shifted to nonoperative management from surgical intervention. Although some nonoperative management failure have been reported, in most trauma centers, nonoperative management is now believed to be the treatment of choice in hemodynamically stable patients. Then, in this study, we have retrospectively evaluated our experience with traumatic splenic injury. METHODS: From January 2005 to July 2009, 150 patients with blunt splenic injuries were managed in our hospital. Patients' charts were retrospectively reviewed to analyze their treatment, the patients were grouped according to those who had been admitted before October 2006, defined as the "early group", and those who had been admitted after October 2006, defined as the "late group". After the patients had been divided into two group, physiologic parameters and differences between the treatments were compared. RESULTS: 150 patients were admitted to our hospital with blunt splenic trauma. In late group, both the surgical management rate and the nonoperative management failure rate were lower than they were in the early group. CONCLUSION: We expect angioembolization to effectively replace surgery for the treatment of selected patients with blunt splenic injury and to result in fewer complications.

The Feasibility of Laparoscopic Hepatectomy for the Patients with Left Intrahepatic Stones

PURPOSE: Recently, there have been several studies on the early results of hepatectomy for various intrahepatic lesions. We report the early experience of our hospital after total laparoscopic left hepatectomy in patients with intrahepatic stones in the left hemi-liver. METHODS: We retrospectively analyzed the medical records of patients who were diagnosed with left intrahepatic stones and underwent hepatectomy between January 2007 and June 2009. The patients were grouped according to operative procedure into open hepatectomy, laparoscopy-assisted hepatectomy, and total laparoscopic hepatectomy. RESULTS: There were 31 patients who underwent Lt hemihepatectomy and Lt lateral sectionectomy during this period. Hepatectomy with open method, laparoscopy-assisted method, and total laparoscopy method were performed in 10, 14, and 7 cases. There were no significant differences between the three methods for operating time and postoperative complications. But the number of fasting times and hospital days was shorter with total laparoscopic hepatectomy than with others. CONCLUSION: Total laparoscopic liver resection is a safe and useful method for treating patients with intrahepatic stones and offers the advantage of quick patient recovery. Careful selection of appropriate patients and further development in the laparoscopic surgical technique resulting from accumulated experiences will help enable the laparoscopic hepatectomy to be performed more easily and safely in patients with intrahepatic stones.

The Characteristics and Strategy of Treatment for Non-diagnostic Thyroid Fine-needle Aspiration Cytology / 대한내분비외과학회지

PURPOSE: The management of non-diagnostic fine needle aspiration biopsy of thyroid nodules has been a dilemma. The purposes of this study were to analyze the characteristics and the results of follow up of non-diagnostic aspirates and to evaluate the management strategy. METHODS: A retrospective review was conducted on the patients who underwent fine-needle aspiration of thyroid nodules that were found on a health examination. The patients' records were assessed for the demographics, the ultrasound findings and the pathologic findings. RESULTS: The initial non-diagnostic rate was 35%. The nodule size (≤10 mm) and cystic nodule were related to a high rate of non-diagnostic results. The common causes of non-diagnostic results by pathologic description were reducedcellularity (59.3%) and blood (28.2%). Among the 62 initially non-diagnosed patients, 2 patients were confirmed to have malignancy and 32 patients (51.6%) were lost from follow-up. Reaspiration was performed in 18 patients and 6 patients still resulted non-diagnostic aspirates. CONCLUSION: Nodule size and cystic nodule were associated with a high rate of non-diagnostic results. Non-diagnostic results of thyroid nodules may be associated with a relatively high frequency of follow up loss, and non-diagnostic results may be associated with a probability of malignancy. So, non-diagnostic results should not be considered just benign, and clinicians should recommend a repeat exam for such patients.

Clinical Characteristics and Prognosis of Multifocal Papillary Thyroid Carcinoma

PURPOSE: Papillary thyroid carcinomas (PTCs) often occur as multifocal tumors. The aim of this study was to investigate the clinical features and treatment of multifocal PTC. METHODS: A retrospective survey was carried out on 315 patients with PTC who underwent total thyroidectomy and central compartment neck dissection with or without lateral neck dissection from January 2007 to April 2010. The risk factors, including sex of patients, age at diagnosis, largest tumor size, extra-thyroidal extension, presence of thyroiditis, lymph node involvement, thyroid stimulating hormone and post operative follow-up results were analyzed between solitary and multifocal PTC group. RESULTS: Of those factors, the presence of central compartment and lateral neck lymph node and mean numbers of involvement lymph node were significantly related factors for the multifocality of the PTC. CONCLUSION: Multifocus is one of the clinical features of PTC. And multifocal PTCs are associated with increased risk of central and lateral neck lymph node involvement, Therefore, total thyroidectomy and central compartment neck dissection could be the standard treatments. And lateral neck node dissection should be recommended for cases with clinically positive lateral neck lymph nodes.

The Clinical Outcome of Combined Organ Resection during Radical Gastrectomy

PURPOSE: Combined organ resection is a common operation in gastric cancer surgery. The aim of this study is to investigate the risk of combined minor organ resection (GB, gynecologic organ, appendix etc) in gastric cancer surgery. METHODS: The clinical data from 673 consecutive patients who underwent gastrectomy for gastric cancer at a single center were retrospectively analyzed. We investigated clinical data between open groups (OG) and laparoscopy groups (LAG), and we divided the patients into 3 groups: no resection group, minor organ resection group and major organ (spleen, pancreas, and colon) resection group. RESULTS: There were higher complication rates in major organ resection group (59.3%, 53.8%) than no resection (32.3%, 19.1%) or minor organ resection groups (38.7%, 20%) both in OG and LAG (P<0.05). However, there were longer hospital stays in minor (22.2 days) and major resection groups (24.1) than no resection group (16.2) in OG, but stays were longer in major resection group (30.9) than minor (14.5) and no resection group (16.2) in LAG (P<0.01). Operative times were longer in minor (287 min) and major organ resection group (310) than no resection group (243) in OG (P<0.00). However, operation time was longer in major resection group (505) than minor (415) and no resection group (370) in LAG (P=0.00). CONCLUSION: Combined minor organ resection with gastrectomy does not increase morbidity, and there is no statistical difference in hospital stay and op time than no resection group in LAG.

Peutz-Jeghers Syndrome with Intussusception

Peutz-Jeghers syndrome (PJS) is a rare disease of autosomal dominant inheritance, which is characterized by multiple hamartomatous polyps and mucocutaneous pigmentations. Multiple hamartomatous polyps in the gastrointestinal tract are the hallmarks of PJS, and occur most commonly in the small intestine. Complications induced by polyps include colicky abdominal pain, bleeding, bowel obstruction; rectal prolapse of polyps, and intussusceptions. A male patient visited our emergency room with colicky abdominal pain. The patient was diagnosed small intestine intussusceptions with multiple polyps. We report this case with a review of the literature.

Clinical Experiences of Management of Bile Duct Injuries during Laparoscopic Cholecystectomy

PURPOSE: Laparoscopic cholecystectomy (LC) has become the gold standard of management of gallstone disease. LC is associated with a two-to-four times higher incidence of bile duct injury, which is a rare but more serious complication than open cholecystectomy. We reviewed our experiences with the management of bile duct injury during laparoscopic cholecystectomy. METHODS: From January 1999 to April 2009, 13 patients with bile duct injuries following LC were managed in our hospital. Patients' charts were retrospectively reviewed to analyze perioperative management. RESULTS: Among the 13 patients, 7 patients sustained their bile duct injuries at our hospital. Six patients were referred to our hospital to manage their bile duct injuries. Five patients' injuries were identified during LC. According to the Strasberg classification, there are 5 cases of type A, 2 cases of type C, 1 case of type D and 5 cases of type E injuries. Four type A bile duct injuries were treated by direct ductal ligation during LC and 1 type A bile duct injury and 1 type C bile duct injury were managed by non-surgical treatment. Type D and type E injuries were managed by Roux-en-Y hepaticojejunostomy. CONCLUSION: Bile duct injuries are a rare but serious complications that occur during laparoscopic cholecystectomy. Most minor bile duct injuries are well treatable with non-surgical management, whereas major bile duct injuries require surgical management. The combination of non-surgical management and surgical treatment results in successful outcomes in bile duct injuries.