Long-Term Resultof Surgical Treatmentfor Esophageal Cancer / 대한흉부외과학회지

BACKGROUND: From 1987 to 1997, a total of 500 patients underwent surgery for esophageal cancer in our department. To determine the lon g-term results, recurrence patterns and prognostic factors, we reviewed the 11 y ears experiences. MATERIAL AND METHOD: Double pr imary tumors, cancers of the pharyngoesophageal and esophagogastric junction, pa lliative bypass surgery or esophageal prosthesis and exploration only were exclu ded in this study. Resection was usually performed through right thoracotomy(Ivo r Lewis operation) and anastomosis was made with staplers. Extended lymph node d issection was performed from August 1994 but not before. The stomach was used as a substitute for the esophagus in 96.8%. All reconstruction was done through po steromediastinal route except cervical reconstruction. RESULT: 474(94.8%) had confirm ed squamous cell carcinoma. Most(58.2%) of the tumors were located in the middle third of the esophagus, 47.4% of patients had operative pathologic stage III di sease, and 25% had stage IIA disease. Of the resections, 392 were classified as curative and 74 palliative, blunt dissection(transhiatal esophagectomy) and jeju nal free graft(34) were excluded in these classifications. The overall morbidity rate was 38.4%. The operative mortality rate was 5.8%, mainly due to respirator y complications and anastomosis leakages. The follow-up rate of these patients w as 99.8%. Overall actuarial 1, 2, and 5-year survival rates were 63.5%, 38.9%, a nd 19.4% including operative mortality. In standard lymph node dissection group, the actuarial 1, 2, and 5-year survival rates were 60.7%, 35.9%, and 16.9%(oper ative mortality rate: 4.3%), but in extended lymph node dissection group, the ac tuarial 1, 2, and 4-year survival rates were 70.2%, 46.5% and 30.9%(operative mo rtality rate: 6.5%), respectively. In curative resection group, the actuarial 1, 2, and 5-year survival rates were 69.4%, 43.9%, and 21.9%, but in palliative re section group, these were 37.8%, 17.6%, and 7.3%, respectively. The 4-year survi val rate was 35.6% in curative resection with extended lymph node dissection gro up. Postoperative recurrence was found in 226 patients. Site of recurrence were mainly lymph nodes(69%; neck, paratracheal and abdominal) and other systemic rec urrence was detected at liver, lung, bone, brain etc. CONCLUSION: We think that cura tive resection with extensive lymph node dissection is necessary for long term s urvival, but adequate postoperative care is a prerequisite. In advanced esophage al cancer, more effective multimodal adjuvant regimens remain to be established.

Treatment of Stomach Cancer Involving Esophagogastric Junction / 대한흉부외과학회지

BACKGROUND: The origin site of carcinoma invading esophagogastric junction is variable. It may arise from squamous cell carcinoma of low esophagus, adenocarcinoma arising from Barrett's esophagus, adenocarcinoma of gastric cardia, or extension from proximal stomach cancer. In Korea, the majority of adenocarcinoma invading esophago-gastric junction seems to arise from proximal gastric carcinoma. MATERIAL AND METHOD: We reviewed the data of surgically-resected gastric adenocarcinoma involving esophagogastric junction in KCCH between 1988 and 1999. RESULT: There were 212 cases. Male to female ratio was 156 to 56. Age distribution was between 22 and 78. Variable surgical approaches including median laparotomy, laparotomy with left or right thoracotomy, left thoracotomy, and thoracoabdominal approach were used. Postoperative pathologic stages were : Stage IA-7, IB-11, II-25, IIIA-73, IIIB-34, and IV-57. Curative resection was performed in 199 patients, and total gastrectomy was performed in 200 patients. There were 77.4%(164 cases) with esophageal involvement, 74.1%(157 cases) with tumor involvement in the abdominal LN, and 8%(17 cases) with mediastinal LN metastasis. Operative mortality was 3.3%, and over-all 5 year survival rate was 35%. CONCLUSION: There are various surgical approaches and many things to consider for surgical resection, thoracic and abdominal approach may need for obtain proper resection margin and adequate lymph node dissection in stomach cancer invading esophagogastric junction.

Result of Complete Resection of T3 Non-Small Cell Lung Cancer Invading the Chest Wall / 대한흉부외과학회지

BACKGROUND: The long-term survival after operation of patients with lung cancer invading the chest wall is known to be related to regional nodal involvement, completeness of resection and depth of chest wall involvement. In this study results of complete resection are reviewed to determine survival charateristics. MATERIAL AND METHOD: Of 680 consecutive patients who were operated on for primary non-small cell carcinoma between 1988 and 1998, we retrospectively reviewed 55 patients(8.0%) who had complete resection for lung cancer invading the chest wall or parietal pleura. RESULT: Resection of the chest wall was en bloc in 29 patients(47.3%), and extrapleural in 26(52.7%). In the patients undergoing extrapleural resection, the depth of chest wall invasion was confined to the parietal pleura in all patients(100%). In the patients underging en bloc resection, the pathologic depth of invasion was into the parietal pleura alone in 9(31.0%) and into the chest wall in 20(69.0%). The follow-up rate of these patients was 100%. Hospital mortality was 5.4%(n=3). The actuarial 5-year survival rate was 26% for all hospital survivors(n=52). The actuarial 5-year survival rate of patients with T3N0M0 disease(29%) was better than that of T3N2M0 disease(18%), however, there was no significant(p=0.30) difference. The depth of chest wall invasion had no statistically significant effect on survival in our series, neither for patients with involved lymphatic metastasis nor for those without(p=0.99). CONCLUSION: These observations indicate that the good five year survival in patients with T3 NSCLC invading the chest wall resulted from complete resection. Survival of patients with lung cancer invading the chest wall after complete resection is dependent on the extent of nodal involvement and much less so on the depth of chest wall invasion.

A Case Report of Endobronchial Lipoma / 대한흉부외과학회지

Endobronchial lipomas are rare lesions that usually obstruct a major bronchus and cause irreversible pulmonary damage distally. They are histologically benign tumors. But they can produce pulmonary damage or irreversible bronchiectasis if dignoses or treatments are delayed. Whenever possible, the treatment of choice is resection by means of bronchoscopy. If endoscopic removal is not possible or if the nature of the tumor is unclear, surgery is necessary, with lobectomy or pneumonectomy being required in most cases due to the extensively damaged pulmonary parenchyma. We present a case of endobronchial lipoma causing bronchial obstruction and peripheral organizing pneumonia with its clinical features, diagnosis and treatment methods.

A Case of Intrapulmonary Neurilemmoma / 대한흉부외과학회지

In this paper, we present an extremely rare case of a primary intrapulmonary neurogenic tumor, in which localization of S-100 protein was investigated using immunohistochemical staining. The patient, who was a 47 year old man, experienced no symptoms, however, a routine chest X-ray revealed a round tumor like shadow in the hilar area of left lung. To confirm and cure the mass, surgery was performed. Histopathological examination of the excised tumor revealed it to be a primary intrapulmonary neurilemmoma. Immunohistochemical staining demonstrated the presence of S-100 protein in the tumor cells.

Measurement of Hemothorax Amount in Patients with Non-penetrating Chest Trauma by Supine Chest AP Radiograph

PURPOSE: To evaluate the predictability of amount of hemothorax in the patients with blunt chest trauma, supine chest AP radiographs of 66 patients were reviewed and statistically analyzed. MATERIALS AND METHODS: In 66 patients, rib fractures were present in 53 patients, hemothorax in 46 patients, pneumothorax in 25 patients, and pulmonary contusions in 18 patients. Width and length of hemothorax were measured on supine chest AP radiograph, and were correlated with known drained amount of hemothorax. The presence and number of rib fracture, pulmonary contusion, subcutaneous emphysema, fracture of scapula and clavicle, and total opacification of hemithorax were also correlated with the drained amount of hemothorax. RESULTS: In multiple logistic regression analysis, width of hemothorax had the highest correlation with drained amount of hemothorax(regression coefficient 0.718, p value 0.00005). The presence and number of rib fracture, scapular fracture, subcutaneous emphysema were also correlated with drained amount of hemothorax. But length of hemothorax, pulmonary contusion, clavicular fracture, total opacification of hemithorax were not correlated with drained amount of hemothorax. CONCLUSION: Measured width of hemothorax in supine chest AP radiograph is the most reliable predictor for estimation of the amount of hemothorax, and may also be used as an indication for the application of closed thoracostomy in the treatment of hemothorax.

Experience with Rastelli procedure in the repair of congenital heart diseases / 대한흉부외과학회지

No abstract available.

Surgical treatment of the acute subclavian artery thromboembolism due to thoracic outlet syndrome: a case report / 대한흉부외과학회지

No abstract available.

Surgical correction of anomalous right superior vena cava into the left artium as an isolated anomaly: report of a case / 대한흉부외과학회지

No abstract available.

Surgical treatment of isolated primary tricuspid insufficiency except Ebstein's anomaly: report of 2 cases / 대한흉부외과학회지

No abstract available.

Posterior thoracotomy under the prone position in children / 대한흉부외과학회지

No abstract available.