OBJECTIVE: To compare laparoscopic surgery with conventional abdominal surgery in patients with early stage endometrial cancer. METHODS: A retrospective review of 63 patients with early stage endometrial cancer managed between March 2003 and May 2005. Two groups were defined whether they had been treated by laparoscopy (case group: n=26) or by laparotomy (control group: n=37). We compared age, body mass index (BMI), hemoglobin change, operation time, number of pelvic lymph nodes, hospital stay, case with adjuvant treatment and recurrence between two groups. RESULTS: There was no statistical difference in characteristics (age, BMI, nulliparity, previous abdominal surgery, FIGO stage, histologic grade). between case and control group. In addition, there was no statistical difference in operation data and outcomes between two groups. Hemoglobin changes were 1.1 g/dL (case group) vs 1.7 g/dL (control group) (p=0.072). Operation time was 131 min vs. 115 min. The numbers of lymph nodes obtained were 8.7 vs 7.7 (right) 9.2 vs. 7.6 (left). Hospital stays were 8.4 vs. 9.2 days. Adjuvant treatment cases were 7 vs. 15. Recurrent case was one in each group. Two patients initially evaluated by laparoscopy were converted to laparotomy due to bleeding and adhesion. CONCLUSION: Laparoscopic surgery for treatment of early endometrial cancer is a safe and effective alternative to laparotomy . However, long-term survival and risk of recurrence have yet to be determined.
Body Mass Index ; Endometrial Neoplasms* ; Female ; Hemorrhage ; Humans ; Hysterectomy* ; Hysterectomy, Vaginal* ; Laparoscopy ; Laparotomy ; Length of Stay ; Lymph Nodes ; Parity ; Recurrence ; Retrospective Studies

OBJECTIVE: Lynch syndrome is a hereditary cancer syndrome that increases the risks of colorectal and gynecologic malignancies such as endometrial and ovarian cancer. Studies have shown that mutations in mismatch repair genes (MSH2, MSH6, and MLH1) are associated with Lynch syndrome. The aim of our study was to estimate the value of MSH2, MSH6, and MLH1 immunohistochemistry based on family history in a Korean sample. METHODS: Thirty six women with synchronous gynecologic tumors of endometrial and ovarian cancer were identified among patients being treated at our institution. Among them, 32 patients had tumor blocks (total 62 slides) available for analysis. According to a diagnostic algorithm, we performed immunohistochemistry analyses. Staining was scored based on intensity and proportion (negative or 0: intensity undetectable or minimal, proportion <5%; weak or 1+: intensity mild, proportion 5-30%; strong or 2+: intensity moderate to marked, proportion 30-99%). RESULTS: Among 32 eligible patients, 9 (28%) had a family history of cancer. Six patients (19%) were negative for MLH1; among them, four (4/6) were negative at both sites. Nine patients (28%) were negative for MSH2 or MSH6 at both sites or negative for both MSH2 and MSH6. Among these three patients showed negative staining for both sites. The three patients showing negative staining for MLH1, MSH2, and MSH6 at both sites with family history were considered to be the screening positive groups of Lynch syndrome. CONCLUSION: In this study, the frequency of Lynch syndrome associated immunohistochemical staining (MLH1, MSH2, and MSH6) group was estimated as 9% (3/32) among Korean women with synchronous gynecologic tumors.
Colorectal Neoplasms, Hereditary Nonpolyposis ; DNA Mismatch Repair ; Female ; Humans ; Immunohistochemistry ; Mass Screening ; Negative Staining ; Neoplastic Syndromes, Hereditary ; Ovarian Neoplasms

OBJECTIVE: This study was conducted to compare the perioperative outcomes in patients with symptomatic uterine myoma who underwent laparoscopic (LM) or laparoscopically assisted myomectomy (LAM). METHODS: A total of 207 patients with myoma underwent LM or LAM in Samsung Medical Center between October 2006 and March 2010. Of them, 121 patients with LM and 50 with LAM met the inclusion criteria and were compared for the perioperative outcomes. RESULTS: The operation time was significantly shorter in the LAM group than in the LM group (111 min versus 139 min; p<.001, respectively). Estimated blood loss was significantly higher in the LAM group (p<.001). Intraoperative, early postoperative complications, hospitalization days and postoperative analgesics use were similar between the 2 study groups. CONCLUSION: LM and LAM is comparable in the perioperative outcomes in patients with symptomatic uterine myoma.
Analgesics ; Female ; Hospitalization ; Humans ; Laparoscopy ; Lipopolysaccharides ; Myoma ; Postoperative Complications

Extra pelvic endometriosis is considered to be rare. This paper reports a case of catamenial hemoptysis accompanied by subcutaneous endometriosis in 26-year-old woman. A computed tomography scan of the chest revealed a focal ground-glass opacity lesion in the posterior segment of the right upper lobe. Histopathology confirmed the diagnosis of endometriosis of right lung and concurrent subcutaneous endometriosis. She was treated with surgical resection of the endometriosis lesions on two different sites and perioperative gonadotropin-releasing hormone agonist therapy. The 6-month follow-up after combination treatment showed no recurrence. Though long-term follow-up result is needed, aggressive treatment using combination treatment (surgery and perioperative medication) should be considered for symptomatic extra pelvic endometriosis.
Adult ; Diagnosis ; Drug Therapy ; Endometriosis* ; Female ; Follow-Up Studies ; Gonadotropin-Releasing Hormone ; Hemoptysis* ; Humans ; Lung ; Recurrence ; Thorax

In order to establish optimal management for aortoenteric fistula (AEF) the records of five patients treated for AEF (four aortoduodenal and one aortogastric fistula) were retrospectively reviewed. The arterial reconstruction procedures were selected according to the surgical findings, underlying cause, and patient status. In situ aortic reconstructions with prosthetic grafts were performed on three patients who had no gross findings of periaortic infection, whereas axillo-bifemoral bypass was carried out in the other two patients with periaortic purulence. In all patients, after retroperitoneal irrigation a pedicled omentum was used to cover the aortic graft or aortic stump. In the preoperative abdominal computed tomography (CT) scan there was a periaortic air shadow in four out of five patients. There was no surgical mortality or graft infection observed during a mean follow-up period of 40 months (range, 24-68 months). Therefore, the treatment results of an AEF can be improved using intravenous contrast-enhanced abdominal CT for rapid diagnosis and selection of an appropriate surgical procedure based on the surgical findings and underlying cause.
Aged ; Aorta, Abdominal/*pathology ; Aortic Aneurysm/surgery ; Aortic Diseases/*surgery ; Contrast Media/pharmacology ; Fistula/*surgery ; Humans ; Intestinal Fistula/*surgery ; Male ; Middle Aged ; Retrospective Studies ; Time Factors ; Tomography, X-Ray Computed/methods ; Treatment Outcome

Aorto-enteric fistula (AEF) is a rare cause of gastrointestinal (GI) bleeding but has a high mortality rate. PURPOSE: To find a better way to manage this rare vascular condition, we reviewed our series of surgical treatment for AEF. METHOD: We retrospectively reviewed the medical records of 5 patients with AEF. For the diagnosis of AEF, a contrast-enhanced abdominal CT scan was performed for all patients but conventional aortography was not performed. The surgical procedures for the AEF were determined by the operatvie findings. For 3 patients with no evidence of periaortic infection, enteric fistula closure and aortic aneurysm repair with prosthetic grafts were performed while the other 2 patients revealing periaortic infection underwent resection of infected aorta (or infected aortic graft), aortic suture closure, retroperitoneal coverage with omental pedicle and axillo-bifemoral bypass were performed. In a patient who underwent abdominal aortic resection, concomitant left colectomy was required due to colonic ischemia. RESULT: The underlying causes and features of AEF were 4 primary and 1 secondary AEF; 4 aorto-duodenal and 1 aorto-gastric fistula; 4 infrarenal and 1 type IV thoracoabdominal aneurysm, and 4 true and 1 paraanastomotic pseudoaneurysm. Episodes of herald bleeding and periaortic air bubble on CT scan was noted in 4/5 (80%) of patients. There was no operative mortality or graft infection during the follow up period (mean, 23 months, range 3~50 months). CONCLUSION: For the early diagnosis of AEF, periaortic air bubble shadow on abdominal CT scan in a patient with pulsating abdominal mass or previous history of aortic surgery was an important diagnostic clue. Prompt surgical treatment according to the operative finding resulted in good surgical outcomes.
Aneurysm ; Aneurysm, False ; Aorta ; Aortic Aneurysm ; Aortic Aneurysm, Abdominal ; Aortography ; Colectomy ; Colon ; Diagnosis ; Early Diagnosis ; Fistula* ; Follow-Up Studies ; Hemorrhage ; Humans ; Ischemia ; Medical Records ; Mortality ; Retrospective Studies ; Sutures ; Tomography, X-Ray Computed ; Transplants

OBJECTIVE: The aim of this study was to compare survival outcomes in two groups of patients with recurrent epithelial ovarian cancer (EOC) with initial recurrence detection by cancer antigen 125 (CA-125) elevation or imaging, and underwent secondary cytoreductive surgery (SCS). METHODS: A retrospective review of the medical records was performed on 99 recurrent EOC patients who underwent SCS at the Samsung Medical Center between January 2002 and December 2013. For follow-up after primary treatment, patients were routinely assessed by CA-125 levels every 3 months and computed tomography (CT) scan (or magnetic resonance imaging [MRI]) every 6 months for first 3 years, and by CA-125 every 6 months and CT scan (or MRI) every 12 months thereafter. RESULTS: The first recurrence was initially identified by either CA-125 elevation (n=41, 41.4%) or by imaging study (n=58, 58.6%). None of the patients showed the symptoms as initial sign of recurrence. There were higher percentages of extra-pelvic recurrence (87.8%) and multiple recurrences (78.0%) in the group diagnosed by CA-125 elevation. The proportion of no residual disease after SCS was comparably lower in the CA-125 group (22.0% vs. 72.4%). There were 19 cancer-associated deaths (19.2%) within a median follow-up period of 67 months. The group diagnosed by imaging had better overall survival from initial diagnosis (OS1), overall survival after SCS (OS2), progression-free survival after the initial treatment (PFS1) and progression-free survival after SCS compared to those of the CA-125 group (PFS2). CONCLUSION: EOC patients with recurrence initially detected by imaging study showed better survival outcomes than patients diagnosed by CA-125 elevation.
Adult ; Aged ; CA-125 Antigen/*blood ; Female ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Neoplasm Recurrence, Local/blood/diagnostic imaging/*mortality ; Neoplasms, Glandular and Epithelial/blood/diagnostic imaging/*mortality ; Ovarian Neoplasms/blood/diagnostic imaging/*mortality ; Retrospective Studies ; Tomography, X-Ray Computed

OBJECTIVE: Hypoxia has been established as a key factor influencing the pathophysiology of malignant growth. Hypoxia-induced changes in gene expression are coordinated primarily by hypoxia inducible factor-1 alpha (HIF-1alpha) and HIF-2alpha. The purpose of this study was to determine whether or not HIF-2alpha expression is associated with survival and response to radiation in patients with cervical cancer. METHODS: After reviewing the medical records of 119 patients treated in our institution by primary therapy for stage IIB-IVA cervical cancer, we performed a case-control study. Cases (n=12) were selected from patients with local recurrence or radiation failure after primary radiation therapy with or without concurrent chemoradiation. For each case, we selected two controls from patients who had no evidence of local recurrence. Using pre-treatment paraffin-embedded tissues, we evaluated the expression of HIF-2alpha by immunohistochemistry. Staining was scored based on intensity (intensity score [IS], 0-3) and proportion (proportion score [PS], 0-100). The results were analyzed by the Student t-test, Mann-Whitney U test, Fisher's exact test, and Cox proportional hazards regression model. RESULTS: Cytoplasmic expression of HIF-2alpha, representing the degree of hypoxia, had a relationship with poor response to radiotherapy. The hazard ratio of recurrence was 1.71 for the HIF-2alpha IS (p=0.110) and 1.04 for the HIF-2alpha PS (p<0.001), indicating that the HIF-2alpha staining area correlates weakly with the risk for recurrence. CONCLUSION: The HIF-2alpha expression area may have an important role in radioresistance in patients with locally advanced cervical cancer. We conclude that a wider area of hypoxia predicts an increased probability of radioresistance.
Anoxia ; Case-Control Studies ; Cytoplasm ; Gene Expression ; Humans ; Immunohistochemistry ; Medical Records ; Recurrence ; Uterine Cervical Neoplasms

OBJECTIVE: Mammalian target of rapamycin (mTOR) is known to promote cell proliferation, survival, and resistance to radiation. The aim of this study was to determine whether mTOR expression was associated with survival and the response to radiation in patients with cervical cancer. METHODS: After reviewing 119 patients treated by primary radiotherapy for stage IIB-IVA cervical cancer, a case-control study was performed. The cases (n=12) with local recurrence or radiation failure after primary radiation therapy were selected. For each case, two controls that had no recurrence were selected. Using pretreatment paraffin-embedded tissues, the cytoplasmic expression of phosphorylated-mTOR (p-mTOR) was evaluated by immunohistochemistry. Staining was scored based on intensity (intensity score [IS] 0-3) and proportion (proportion score [PS] 0-100). The progression free survival (PFS) was defined from the end of treatment to the day of recurrence by imaging studies or biopsy. The staining distribution and PFS were compared between the two groups. The results were analyzed by the Student t-test, Mann-Whitney U-test, Fisher's exact test, and Cox proportional hazards regression model. RESULTS: The p-mTOR cytoplasmic expression was significantly associated with a poor response to radiotherapy (p<0.01). With respect to survival, a higher cytoplasmic expression of p-mTOR was associated with a worse outcome (p=0.02). The hazard ratio for recurrence or radiation failure was 6.18 for mTOR IS and 1.04 for mTOR PS (p<0.05 for both), indicating that the degree of p-mTOR staining correlated with the recurrence risk. CONCLUSION: High expression of p-mTOR was associated with radiation resistance; therefore p-mTOR may be a prognostic marker for response to radiotherapy in patients with cervical cancer.
Biopsy ; Case-Control Studies ; Cell Proliferation ; Cytoplasm ; Disease-Free Survival ; Humans ; Immunohistochemistry ; Recurrence ; Sirolimus ; Uterine Cervical Neoplasms

OBJECTIVE: This study reports our initial experience of robotic high para-aortic lymph node dissection (PALND) with high port placement using same port for pelvic surgery in cervical and endometrial cancer patients. METHODS: Between July 2013 and January 2014, we performed robotic high PALND up to the left renal vein during staging surgeries. With high port placement and same port usage for pelvic surgery, high PALND was successfully performed without repositioning the robotic column. All data were registered consecutively and analyzed retrospectively. RESULTS: All patients successfully underwent robotic high PALND, followed by hysterectomy and pelvic lymph node dissection. Median age was 45 years (range, 39 to 51 years) and median body mass index was 22 kg/m2 (range, 19.3 to 23.1 kg/m2). Median operative time for right PALND and left PALND was 37 minutes (range, 22 to 65 minutes) and 44 minutes (range, 36 to 50 minutes), respectively. Median number of right and left para-aortic lymph node by pathologic report was 12 (range, 8 to 15) and 13 (range, 5 to 26). CONCLUSION: With high port placement and one assistant port, robotic high PALND with the same port used in pelvic surgery is feasible to non-obese patients.
Adult ; Endometrial Neoplasms/*surgery ; Feasibility Studies ; Female ; Humans ; Intraoperative Complications/etiology ; Laparoscopy/instrumentation/*methods ; Lymph Node Excision/instrumentation/*methods ; Lymphatic Metastasis ; Middle Aged ; Operative Time ; Retrospective Studies ; Robotic Surgical Procedures/instrumentation/*methods ; Surgical Instruments ; Uterine Cervical Neoplasms/*surgery