PURPOSE: The purpose was to evaluate outcomes according to different operative strategies of type A esophageal atresia (EA). METHODS: All patients who underwent surgery for type A EA between 1980 and 2011 were included. Patients were divided into 2 groups: E-E group included patients who received esophageal end-to-end anastomosis, whereas E-G group included patients who received esophago-gastric tube anastomosis. RESULTS: Twenty-two patients were included. The median gestational age was 37.5 weeks. The median birth weight was 2.5 kg. Twenty-one patients underwent gastrostomy as initial procedures, and one patient underwent primary esophageal end-to-end anastomosis. The median gap between both esophageal ends was six vertebral distance (VD). Seven patients underwent primary anastomosis of the esophagus, and 14 patients underwent gastric replacement. Three patients (13.6%) had anastomotic leakage and 10 patients (45.5%) had anastomotic stenosis. Most of the patients (90.9%) had gastroesophageal reflux, but only two patients required antireflux surgery. The median VD was significantly shorter in E-E group than in E-G group (3 VD vs. 6 VD). Stenosis was significantly more often in E-E group, but there was no significant difference in leakage and reflux symptoms. CONCLUSION: The treatment for type A EA can include E-E anastomosis or E-G anastomosis, depending on the length of the end-to-end interval after performing gastrostomy. Appropriate tension and blood flow in the anastomosis site are essential for preventing postoperative stenosis and leakage, and esophageal replacement with gastric tube is believed to be feasible and safe in cases where excessive tension is present.
Anastomotic Leak ; Birth Weight ; Constriction, Pathologic ; Esophageal Atresia* ; Esophagus ; Gastroesophageal Reflux ; Gastrostomy ; Gestational Age ; Humans

PURPOSE: The aim of this study is to describe our initial experience and assess the feasibility and safety of robotic and laparoscopic lateral pelvic node dissection (LPND) in advanced rectal cancer. METHODS: Between November 2007 and November 2012, extended minimally invasive surgery for LPND was performed in 21 selected patients with advanced rectal cancer, including 11 patients who underwent robotic LPND and 10 who underwent laparoscopic LPND. Extended lymphadenectomy was performed when LPN metastasis was suspected on preoperative magnetic resonance imaging even after chemoradiation. RESULTS: All 21 procedures were technically successful without the need for conversion to open surgery. The median operation time was 396 minutes (range, 170-581 minutes) and estimated blood loss was 200 mL (range, 50-700 mL). The median length of stay was 10 days (range, 5-24 days) and time to removal of the urinary catheter was 3 days (range, 1-21 days). The median total number of lymph nodes harvested was 24 (range, 8-43), and total number of lateral pelvic lymph nodes was 7 (range, 2-23). Six patients (28.6%) developed postoperative complications; three with an anastomotic leakages, two with ileus and one patient with chyle leakage. Two patients (9.5%) developed urinary incontinence. There was no mortality within 30 days. During a median follow-up of 14 months, two patients developed lung metastasis and there was no local recurrence. CONCLUSION: Robotic and laparoscopic LPND is technically feasible and safe. Minimally invasive techniques for LPND in selected patients can be an acceptable alternative to an open LPND.
Anastomotic Leak ; Chyle ; Conversion to Open Surgery ; Follow-Up Studies ; Humans ; Ileus ; Laparoscopy ; Length of Stay ; Lung ; Lymph Node Excision* ; Lymph Nodes* ; Magnetic Resonance Imaging ; Mortality ; Neoplasm Metastasis ; Postoperative Complications ; Rectal Neoplasms* ; Recurrence ; Robotics ; Surgical Procedures, Minimally Invasive ; Urinary Catheters ; Urinary Incontinence

PURPOSE: Although oxaliplatin is one of the most widely used chemotherapeutic agents for the treatment of advanced stages of colorectal cancers in clinic, cancer cells often develop oxaliplatin drug resistance. Thus, overcoming oxaliplatin drug resistance is a major issue in the successful treatment for advanced stages of colorectal malignancy. In order to maximize oxaliplatin therapy, we examined whether resveratrol, a natural phytochemical known to have chemopreventive effects on cancers, can have a chemosensitizing effect upon cotreatment with oxaliplatin. Survivin, a small inhibitor of apoptosis protein (IAP), expression is examined using HCT116 colon cancer cells. METHODS: In order to examine resveratrol chemosensitizing effect upon oxaliplatin cotreatment, survivin transcripts and protein expression, cell proliferation, and apoptotic responses were evaluated using HCT116 cells. Reverse transcription polymerase chain reaction (RT-PCR), Western blot, crystal violet staining analyses were performed. For survivin specific inhibition, YM155 molecule was used. RESULTS: Although oxaliplatin significantly suppressed survivin transcripts and protein expression level in HCT116 cells, resveratrol cotreatment induced restoration of survivin expression level of both transcripts and protein. Apoptotic induction by oxaliplatin only treatment was nullified upon resveratrol cotreatment. Induction of survivin restoration upon resveratrol cotreatment also occurred when survivin specific inhibitor, YM155, was used. In addition to survivin restoration, resveratrol cotreatment also induced restoration of Bcl-2/caspase-3 expression suppressed by oxaliplatin only treatment. CONCLUSION: Resveratrol has an antichemosensitizing effect upon cotreatment with oxaliplatin in HCT colon cancer cells. This antichemosensitizing effect of resveratrol can be cell-type specific. However, clinical use of resveratrol cotreatment with oxaliplatin should be approached cautiously.
Blotting, Western ; Cell Proliferation ; Colon* ; Colonic Neoplasms* ; Colorectal Neoplasms ; Drug Resistance ; Gentian Violet ; HCT116 Cells ; Inhibitor of Apoptosis Proteins ; Polymerase Chain Reaction ; Reverse Transcription

PURPOSE: We evaluate the operative outcome and oncologic outcome of laparoscopic liver resection for hepatocellular carcinoma (HCC), and compare with open liver resection. METHODS: From January 2004 to December 2012, clinical data of 70 patients who underwent laparoscopic liver resection for HCC (laparoscopic liver resection group, lapa-group) were collected and analyzed retrospectively. Control group (open liver resection group, open-group) were retrospectively matched, and compared with lapa-group. RESULTS: Laparoscopic major liver resections were performed in 4 patients. Laparoscopic anatomical resections and nonanatomical resections were performed in 39 patients, and 31 patients, respectively. Mean operative time was shorter in lapa-group (215.5 +/- 121.84 minutes vs. 282.30 +/- 80.34 minutes, P = 0.001), mean intraoperative transfusion rate and total amount were small in lapa-group (24.28%, 148.57 +/- 3,354.98 mL vs. 40.78%, 311.71 +/- 477.01 mL). Open conversion occurred in 6 patients (8.57%) because of bleeding, inadequate resection, invisible mass on intraoperative ultrasonography, and tumor rupture. In lapa-group and open-group, 3-year disease-free survival rates were 58.3% +/- 0.08%, and 62.6% +/- 0.06%, respectively (P = 0.773). In lapa-group and open-group 3-year overall survival rates were 65.3% +/- 0.8%, and 65.7% +/- 0.6%, respectively (P = 0.610). CONCLUSION: Laparoscopic liver resection for HCC is feasible and safe in a large number of patients, with reasonable operative and oncologic results.
Carcinoma, Hepatocellular* ; Disease-Free Survival ; Hemorrhage ; Hepatectomy ; Humans ; Laparoscopy ; Liver* ; Operative Time ; Retrospective Studies ; Rupture ; Survival Rate ; Ultrasonography

PURPOSE: Current management for patients with differentiated thyroid cancer includes near total thyroidectomy and radioactive iodine therapy followed by administration of supraphysiological doses of levothyroxine (L-T4). Although hyperthyroidism is a well known risk factor for osteoporosis, the effects of L-T4 treatment on bone mineral density (BMD) in patients with thyroid cancer do not appear to be as significant as with endogenous hyperthyroidism. In this study, we evaluated the impact of long-term suppressive therapy with L-T4 on BMD and bone turn over markers in Korean female patients receiving L-T4 suppressive therapy. METHODS: We enrolled 94 female subjects (mean age, 50.84 +/- 11.43 years) receiving L-T4 after total or near total thyroidectomy and radioactive iodine therapy for thyroid cancer (mean follow-up period, 12.17 +/- 4.27 years). The subjects were divided into three groups by thyroid stimulating hormone (TSH) level (group 1 with TSH level < or =0.001 microIU/mL, group 2 with TSH level between 0.001 and 0.17 microIU/mL, group 3 with TSH level >0.17 microIU/mL) and four groups by quartile of free T4 level. L-T4 dosage, BMD (examined by dual-energy x-ray absorptiometry), and bone turnover markers were evaluated according to TSH and free T4 levels. RESULTS: No significant decrease was detected in BMD or bone turnover markers according to TSH level or free T4 level. Also, the prevalence of osteoporosis and osteopenia was not different among groups. CONCLUSION: Long-term L-T4 suppressive therapy after thyroid cancer management did not affect bone density or increase the prevalence of osteoporosis even though TSH levels were supraphysiologically suppressed.
Bone Density* ; Bone Diseases, Metabolic ; Female ; Follow-Up Studies ; Humans ; Hyperthyroidism ; Iodine ; Osteoporosis ; Prevalence ; Risk Factors ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy ; Thyrotropin ; Thyroxine*

PURPOSE: Comparative results of conventional carotid endarterectomy (cCEA) and eversion carotid endarterectomy (eCEA) have been reported in many studies. But in Korea, there have been no reports to compare the outcome of the two techniques. Thus, we investigated the results of eCEA compared to cCEA in Yeungnam University Medical Center. METHODS: A total of 120 subjects who underwent CEA were included in this study. Of them, cCEAs were performed in 63 patients and eCEAs were performed in 57 patients. We analyzed the results divided into the early (within 30 days after surgery), midterm (from 30 days up to 1 year after surgery) and late (over 1 year after surgery). RESULTS: Mean age of the patients was 65.9 +/- 7.1 years in cCEA group and 66.8 +/- 7.7 years in eCEA group (P = 0.523). Carotid shunt frequency was higher in the cCEA group (39.7% vs. 19.3%, P = 0.015). There were no statistical differences in the early complications with the exception of a significantly higher risk for new brain lesions in the cCEA group (34.9% vs. 14.0%, P = 0.008). The frequency of complication was same between cCEA group and eCEA group in the midterm. Although there was no statistical significance, the frequency of late complications was higher in the cCEA group compared to eCEA group. Mean follow-up duration was 29.4 +/- 23.5 months. CONCLUSION: These data showed that eCEA was an acceptable procedure and had some advantage compared to cCEA in the aspect of the early and late complication.
Academic Medical Centers ; Brain ; Carotid Stenosis ; Endarterectomy, Carotid* ; Follow-Up Studies ; Humans ; Korea

PURPOSE: Multiple segment 5 vein (V5) anastomoses are common and inevitable in living donor liver transplantation (LDLT) using modified right lobe (MRL) graft. Sacrifice of segment 4a vein (V4a) can simplify bench work and avoid graft congestion. But it could be harmful to some donors in previous simulation studies. This study aimed to evaluate donor safety in LDLT using caudal middle hepatic vein trunk preserved right lobe (CMPRL) graft. METHODS: LDLT using MRL grafts were performed on 33 patients (group A) and LDLT using CMPRL grafts were performed on 37 patients (group B). Group B was classified into 2 subgroups by venous drainage pattern of segment 4: V4a dominant drainage group (group B1) and the other group (group B2). Parameters compared between group A donors and group B donors included operation time, bench work time, number and diameter of V5, remnant liver volume and postoperative course. Those were also investigated in group B1 compared with group B2. And, we reviewed postoperative course of the recipients in groups A and B. RESULTS: Operation time and bench work time in group B were significantly shorter. There were no significant differences in most postoperative parameters between groups B1 and B2. As a result of recipient, V5 patency rates after LDLT were significantly higher in group B. CONCLUSION: LDLT using CMPRL graft is a safe procedure for living donors. Donors with any type of V4 could be proper candidates for CMPRL graft if remnant liver volume is greater than 30% with minimal fatty change.
Drainage ; Estrogens, Conjugated (USP) ; Hepatectomy ; Hepatic Veins* ; Humans ; Liver ; Liver Transplantation* ; Living Donors* ; Tissue Donors ; Transplants* ; Veins

PURPOSE: The evaluation and extent of lymph node (LN) retrieval is clinically relevant for staging because lymphatic invasion is the most common mechanism leading to up-staging of carcinoma. However, the optimal number of LN retrievals for early gastric cancer (EGC) is unclear. With the aim of clarification, we analyzed our database to investigate the optimal number of retrieved LNs in EGC. METHODS: Three hundred twenty-six gastric cancer patients who underwent curative gastrectomy with D2 LN dissection at Ewha Womans University Hospital (Dongdaemun and Mokdong) were analyzed according to sex, age, tumor location, size of tumor, macroscopic type, histological classification, depth of invasion, LNs metastasis, TNM stage and type of surgery. RESULTS: In LN negative cases, patients with 15-25 retrieved LNs had a 5- and 10-year survival rate of 88% and 54%, respectively, whereas retrieval of > or =26 LNs was associated with 5- and 10-year survival rate of 90% and 75%, respectively (P = 0.105). In LN positive cases, the 5- and 10-year survival rate was 50% and 30% for the 15-25 group, and 77% and 67% for the > or =26 group, respectively (P = 0.044). CONCLUSION: LN metastasis is an independent factor of survival and the number of retrieved LNs significantly relate to the long-term survival benefit in node metastatic EGC. Also, our data suggest that the retrieval of at least 15 LNs may not be sufficient to warrant recommendation for more curative surgery, and that qualified LN dissection should be considered if LN metastasis is in doubt, even in EGC.
Classification ; Female ; Gastrectomy ; Humans ; Lymph Nodes* ; Neoplasm Metastasis ; Stomach Neoplasms* ; Survival Rate

PURPOSE: The primary aim of the present study was to analyze the association between high-risk clinicopathologic characteristics and the BRAFV600E mutation. METHODS: From March 2010 to September 2012, we performed analysis of the BRAF mutation (assessing V600E point mutation of BRAF gene, exon 15, on chromosome 7q34 by real-time polymerase chain reaction kit) from 499 papillary thyroid carcinoma (PTC) patients who underwent thyroidectomy. We analyzed the relation between the mutation and known clinicopathologic risk factors of PTC. RESULTS: BRAF mutations were found in 353 of 499 patients (70.7%). On univariate analysis, BRAF mutations were more frequently detected in patients with central lymph node metastasis (78.5% vs. 66.7%, P = 0.007) and classic PTC type (71.3% vs. 16.7%, P = 0.011). Patients with one or more aggressive pathologic feature such as lymph node metastasis, multifocality, and extrathyroidal extension showed higher BRAF mutation rate (73.5% vs. 62.3%, P = 0.022). BRAF mutation group showed more aggressive pathologic features, which is considered as higher necessity of radioactive iodine ablation (relative risk, 1.617; P = 0.035). CONCLUSION: This study found that BRAF mutation is associated with classic PTC and central lymph node metastasis and higher necessity of radioactive iodine ablation.
Exons ; Humans ; Iodine* ; Lymph Nodes ; Mutation Rate ; Neoplasm Metastasis ; Point Mutation ; Real-Time Polymerase Chain Reaction ; Risk Factors ; Thyroid Neoplasms* ; Thyroidectomy

PURPOSE: The aim of this study is to know whether silibinin has an anticancer effect on triple negative breast cancer xenograft model using MDA-MB-468 cells. METHODS: To establish the xenograft model, we injected the MDA-MB-468 cells into female Balb/c-nude mice. After establishing a xenograft model, oral silibinin was administered to the tested mice in the way of 200 mg/kg for 45 days. The difference of mean tumor volume between silibinin fed mice and control mice was analyzed. The epidermal growth factor receptor (EGFR) phosphorylation in MDA-MB-468 cells was analyzed by Western blotting. The expression of VEGF, COX-2, and MMP-9 genes in tumor tissue was analyzed by real-time polymerase chain reaction (PCR). RESULTS: In the xenograft model using MDA-MB-468 cells, we found that oral administration of silibinin significantly suppressed the tumor volume (silibinin treated mice vs. control mice; 230.3 +/- 61.6 mm3 vs. 435.7 +/- 93.5 mm3, P < 0.001). The phosphorylation of EGFR in MDA-MB-468 cells was inhibited by treatment with 50 microg/mL of silibinin. In real time-PCR analysis of tumor tissue obtained from sacrificed mice, the gene expression of MMP-9, VEGF, and COX-2 was 51.8%-80% smaller in silibinin group than that of control group and we can also verify the similar result using Western blotting analysis. CONCLUSION: We verified that silibinin had anticancer effect on xenograft model of MDA-MB-468 cells in the way of preventing the phosphorylation of EGFR and eventually suppressed the production of COX-2, VEGF, and MMP-9 expression. Finally, the tumor volume of xenograft models was decreased after administration of Silibinin.
Administration, Oral ; Animals ; Blotting, Western ; Breast Neoplasms* ; Female ; Gene Expression ; Heterografts* ; Humans ; Mice ; Phosphorylation ; Real-Time Polymerase Chain Reaction ; Receptor, Epidermal Growth Factor ; Triple Negative Breast Neoplasms ; Tumor Burden ; Vascular Endothelial Growth Factor A