PURPOSE: Many studies have shown that the completion of adjuvant chemotherapy improves the survival rate. Recently, laparoscopic surgery has been used to treat patients with colon cancer. We analyzed the relationship between the completion of adjuvant chemotherapy and the operation method. METHODS: We retrospectively analyzed the medical records of 147 patients diagnosed with colon cancer from January 1, 2009, to May 31, 2012. The numbers of patients who underwent laparoscopic and open surgery were 91 and 56, respectively. We analyzed the relationship between the operation method and various factors such as the completion rate of chemotherapy, the patient's age, gender, and physical activity, the postoperative hospital stay, the start time of chemotherapy, and the patient's body mass index (BMI), TNM stage, and type of health insurance. RESULTS: In the laparoscopic surgery group, the postoperative hospital stay (13.5 +/- 14.82 days vs. 19.6 +/- 11.38 days, P = 0.001) and start time of chemotherapy (17.7 +/- 17.48 days vs. 23.0 +/- 15.00 days, P = 0.044) were shorter, but the percent complete of chemotherapy (71/91 [78.0%] vs. 38/56 [67.8%], P = 0.121), and survival rate (88/91 [96.7%], 47/56 [83.9%], P = 0.007) were higher than they were in the open surgery group. Patients who were elderly, had a low BMI, and a high American Society of Anesthesiologists score were less likely to complete adjuvant chemotherapy than other patients were. CONCLUSION: Laparoscopic surgery shows a shorter postoperative hospital stay, a shorter start time of chemotherapy, and a higher survival rate. Laparoscopic surgery may be expected to increase compliance of chemotherapy and to improve survival rate.
Aged ; Body Mass Index ; Chemotherapy, Adjuvant* ; Colonic Neoplasms* ; Compliance* ; Drug Therapy ; Humans ; Insurance, Health ; Laparoscopy ; Length of Stay ; Medical Records ; Motor Activity ; Retrospective Studies ; Survival Rate

Fundoplication is a common surgical procedure for gastroesophageal reflux Disease (GERD). Recently the procedure has been performed with increased frequency laparoscopically. The aim of this study is to compare laparoscopic Nissen fundoplication (LNF) and open Nissen fundoplication (ONF) for GERD in children. We studied retrospectively the 88 pediatric patients who underwent the Nissen fundoplication for GERD as primary antireflux surgery from 1994 and 2009. ONF was performed in 34 cases and LNF was in 54 cases. 58 patients have neurologic impairment. Time to initial food intake after the surgery were reduced in the LNF group (p = 0.032).Recurrent GERD symptom occurred in one patient in LNF group and four patients in ONF group within 1 year after the surgery (p = 0.012). There were no statistically significant differences in post operative morbidity and mortality between both groups. In conclusion, our practice of Nissen fundoplication indicates that LNF takes priority in most pediatric patients.
Child ; Eating ; Fundoplication ; Gastroesophageal Reflux ; Humans ; Laparoscopy ; Retrospective Studies

PURPOSE: For the treatment of acute appendicitis, a conventional laparoscopic appendectomy (LA) has been widely performed. Recently, the use of single incision laparoscopic surgery (SILS) is increasing because it is believed to have advantages over conventional laparoscopic surgery. In this study, we compared SILS and a conventional LA. METHODS: We analyzed the 217 patients who received laparoscopy-assisted appendectomies between August 2010 and April 2012 at Inje University Sanggye Paik Hospital. One hundred-twelve patients underwent SILS, and 105 patients underwent LA. For the two groups, we compared the operation times, postoperative laboratory results, postoperative pain, hospital stay, and postoperative complications. RESULTS: The patients' demographics, including body mass index, were not significantly different between the two groups. There were 6 perforated appendicitis cases in the SILS group and 5 cases in the LA group. The mean operative time in the SILS group was 65.88 +/- 22.74 minutes whereas that in the LA group was 61.70 +/- 22.27 minutes (P = 0.276). There were no significant differences in the mean hospital stays, use of nonsteroidal antiinflammatory drugs, and wound infections between the two groups. CONCLUSION: Postoperative pain, complications and hospital stay showed no statistically significant differences between the SILS and the LA groups. However, our SILS method uses a single trocar and two latex tubes, so cost savings and reduced interference during surgery are expected.
Appendectomy ; Appendicitis ; Body Mass Index ; Cost Savings ; Demography ; Humans ; Laparoscopes ; Laparoscopy ; Latex ; Length of Stay ; Operative Time ; Pain, Postoperative ; Surgical Instruments ; Wound Infection

PURPOSE: There is still debate regarding the suitability of extension of laparoscopic gastrectomy to advanced gastric cancer. Due to the development of new instruments and techniques, several studies are being conducted to extend the range of laparoscopic gastrectomy. This study was conducted to investigate the appropriateness of laparoscopic D2 lymph node dissection for the treatment of gastric cancer from an oncology perspective. METHODS: A total of 109 patients, 50 of whom had undergone laparoscopy assisted distal gastrectomy (LADG) and 59 patients who underwent open distal gastrectomy (ODG), that were operated on by a single surgeon in the surgery department of Sanggye Paik Hospital from April 2009 to May 2011 were analyzed. All patients underwent D2 lymph node dissection. The clinical characteristics of patients, surgical outcomes and clinicopathologic findings were then compared and analyzed. RESULTS: There was no significant difference in the operation time between the two groups (252.70+/-40.81 vs. 252.20+/-45.22, p=0.698). The day 1 post operation hemoglobin was higher in the LADG group than the ODG group (12.52+/-1.53 vs. 10.54+/-1.57, p=0.011). There were nosignificant differences in resection margin (6.89+/-2.25 vs. 7.20+/-3.42, p=0.254, 4.05+/-2.57 vs. 3.68+/-2.74, p=0.254) or total number of harvested lymph nodes (30.36+/-10.67 vs. 35.44+/-12.56, p=0.508) between groups. CONCLUSION: In stomach cancer surgery, both ODG and LADG can be used to conduct lymph node dissection. Therefore, if the stability and feasibility of LADG is confirmed by prospective studies at multiple centers, laparoscopic gastrectomy may be extended to advanced gastric cancer as well.
Gastrectomy ; Hemoglobins ; Humans ; Laparoscopy ; Lymph Node Excision ; Lymph Nodes ; Stomach Neoplasms

PURPOSE: This study analyzed factors affecting local recurrences in AGES low risk papillary thyroid carcinomas (PTCs). METHODS: The clinical records of 89 patients who underwent thyroidectomy because of PTC were reviewed. Seventy patients had belonged to low risk PTC according to the AGES classification scheme. The clinical data of these patients concerning disease recurrence was analyzed considering age, gender, operative methods, tumor size, lymph node (LN) metastasis, postoperative radioactive iodine scan (RI scan ¹³¹I), and Synthyroid® intake. RESULTS: Of the 70 patients, 56 were female (80%). Thirtyseven patients underwent total thyroidectomy with central neck LN dissection and 33 patients underwent partial thyroidectomy with ipsilateral central neck LN dissection. Mean tumor size was 2 cm (0.4~6 cm) and 31 patients had LN metastasis. Levels were <1µg/L in all patients who underwent total thyroidectomy but were 1~10µg/L in patients who received partial thyroidectomy thyroglobulin. Local recurrencein AGES low risk papillary carcinomas was significantly associated with tumor size >2 cm (P=0.030) and partial thyroidectomy (P=0.045). There was no significant association between local recurrence and age, gender, extrathyroidal extension, LN metastasis, RI scan ¹³¹I, or Synthyroid® intake. CONCLUSION: Partial thyroidectomy and tumor size >2 cm are significantly associated with local recurrence in AGES low risk papillary thyroid carcinomas.
Carcinoma, Papillary ; Classification ; Female ; Humans ; Iodine ; Lymph Nodes ; Neck ; Neoplasm Metastasis ; Recurrence* ; Thyroglobulin ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

PURPOSE: Human epidermal growth factor receptor-2 (HER-2)/neu amplification affects the cell proliferation through the modulation of multiple G1 cell cycle regulators in breast tumor cells. We performed this study to investigate whether retinoblastoma protein (pRB) and p27Kip1 were differently expressed according to the HER2 amplification status in human breast cancer. METHODS: HER2 amplification was assayed by fluorescence in situ hybridization and the expression of cell cycle regulators were assayed by immunohistochemistry on 153 consecutive invasive breast cancers. The proliferative activity of breast cancer was analyzed according to the HER2 amplification and cell cycle protein expression status. RESULTS: HER2 amplification was observed in 39 (25.5%) of 153 breast cancers. In the HER2 amplified breast cancers, the pRB expression was significantly increased (p=0.011) whereas there was no significant relationship between HER2 amplification and p27Kip1 expression. There was an inverse correlation between pRB expression and Ki-67 labeling index in the HER2 amplified breast cancers (p=0.036). In contrast, Ki67 labeling index was significantly decreased as p27Kip1 expression increased in HER2 non-amplified breast cancers (p=0.028). In HER2 non-amplified breast cancers, we could not observe any association between the pRB expression and Ki67 labeling index. CONCLUSION: The proliferation of the breast cancers was associated with pRB expression in HER2 amplified tumors whereas it was associated with p27Kip1 expression in HER2 non-amplified tumors. The results of the current study indicate that the cell proliferative activity of the breast cancer is under different growth signal pathways according to HER2 amplification status.
Breast ; Breast Neoplasms ; Cell Cycle ; Cell Proliferation ; Epidermal Growth Factor ; Fluorescence ; Humans ; Immunohistochemistry ; In Situ Hybridization ; Retinoblastoma ; Retinoblastoma Protein ; Signal Transduction

Necrotizing enterocolitis (NEC) is the most common gastrointestinal emergency in the neonatal population. The aim of this study is to evaluate surgical indication and prognostic factors of NEC. Clinical data of seventy patients, diagnosed as NEC between January 2000 & January 2007, were reviewed retrospectively. Fifty-seven patients had medical treatment and 7 of them died. Thirteen patients who presented with pneumoperitoneum on plain abdominal film or were refractory to medical treatment received surgical treatment, and 5 of them died. All the expired 12 patients weighed less than 2500g. Twenty out of seventy patients showed thrombocytopenia, and 11 patients of them died. The finding of pneumoperitoneum and thrombocytopenia could be the most important surgical indication. Prematurity, low birth weight and thrombocytopenia were related to a bad prognosis. NEC patients who presents with these findings must be considered for close observation and intensive care.
Emergencies ; Enterocolitis, Necrotizing ; Humans ; Infant, Low Birth Weight ; Infant, Newborn ; Pneumoperitoneum ; Prognosis ; Retrospective Studies ; Thrombocytopenia

Isaacs' syndrome consists of spontaneously occurring muscle activity of peripheral nerve origins. This syndrome arises in association with/without polyneuropathy and rarely with malignancy. A 63-year-old man was admitted to our hospital due to generalized painful muscle stiffness. He complained of difficulty with standing and with finger exten-sion after grasping. Chvostek's and Trousseau's signs were noticed. Electrolytes, calcium, CK, and LDH were in the normal range. Small cell lung cancer was diagnosed by a needle biopsy. Electrophysiological testing revealed normal nerve conduction studies with the exception of a grossly abnormal EMG. Continuous neuromyotonic discharges with firing rates of 120-200 Hz were seen at rest. The amplitude of the response typically waned with 0.5-1.5 seconds of duration. The discharges persisted throughout sleep, after diazepam injection, and with brachial plexus blockage.Muscle stiffness improved with the administration of oral phenytoin. Under chemotherapy and radiotherapy, tumor remission was partially achieved and neurological symptoms markedly improved.
Biopsy, Needle ; Brachial Plexus ; Calcium ; Diazepam ; Drug Therapy ; Electrolytes ; Fingers ; Fires ; Hand Strength ; Humans ; Isaacs Syndrome* ; Middle Aged ; Neural Conduction ; Peripheral Nerves ; Phenytoin ; Polyneuropathies ; Radiotherapy ; Reference Values ; Small Cell Lung Carcinoma*

PURPOSE: Advancements in technology and surgical skill have extended the applications of minimally invasive surgery, and various studies have suggested that laparoscopic adrenalectomy (LA) might lead to better clinical outcomes compared to open surgery. We reviewed our experience in order to evaluate the clinical outcomes of laparoscopic and open adrenalectomy (OA). METHODS: We retrospectively analyzed the clinical records of 41 patients who underwent surgery for adrenal lesions between 1998 and 2006. Outcome measurements included gender, age, diagnosis, lesion size, operative time, intraoperative blood loss, procedure-related complications, time to first oral intake, and postoperative hospital stay. RESULTS: There were 19 LAs and 22 OAs. There were no significant differences in gender, age, lesion location (right or left), comorbidity, complications, or postoperative hospital stay. The mean operative time was longer in the LA group than in the OA group (OA 215, LA 273 min, P=0.048). Resumption of oral intake occurred at 3.4 days in the OA group and at 1.9 days in the LA group (P<0.001), and the incidence of bleeding that required transfusion was 58% in the OA group and 21% in the LA group (P=0.018). We divided the LA group into 14 pure LAs (pLA) and 5 conversions from laparoscopic procedures to open adrenalectomy (CA). Significant postoperative complications occurred in the OA, pLA, and CA groups at rates of 18%, 14%, and 80%, respectively (OA vs pLA, P=0.569 pLA vs CA, P=0.017 OA vs CA, P=0.017), and postoperative hospital stays were 11.1, 5.7, and 19.6 days for each group, respectively (OA vs pLA, P=0.005 pLA vs CA, P<0.001 OA vs CA, P=0.025). CONCLUSION: Patients who underwent pLA had similar postoperative complications, but shorter hospital stays and shorter times to first oral intake compared to OA. Patients in the CA group had longer operative times, longer postoperative hospital stays, and significantly higher rates of variable complications compared to the pLA and OA groups. Careful preoperative selection of patients for LA is important to avoid unnecessary CA.
Adrenalectomy* ; Comorbidity ; Diagnosis ; Hemorrhage ; Humans ; Incidence ; Length of Stay ; Minimally Invasive Surgical Procedures ; Operative Time ; Postoperative Complications ; Retrospective Studies

PURPOSE: Perforations are rare but serious complications in colorectal cancer. Controversy exists over whether to perform a radical operation because colorectal cancer perforation is considered as an advanced stage disease, and septic complications of peritonitis have been identified as being responsible for a poor prognosis. The aim of this study was to assess the correlation between the survival rate and the clinicopathological parameters that might be used as predictive factors of the prognosis for perforated colorectal cancer. METHODS: The analysis was based on 24 cases of perforated colorectal cancer (the case group), 48 cases of matching uncomplicated colorectal cancer (the control group), and 72 cases of the case and the control groups combined together (the combined group), all of which were identified during a 10-yr period in a single institution. RESULTS: The five-year survival rates of the perforated colorectal cancer patients and their matching controls were similar (P=0.484). No significant differences in the locations of the cancer, the pre-operative carcinoembryonic antigen (CEA) levels, the tumor sizes, the resection margins, or the numbers of the lymph nodes harvested were found between the two groups. A univariate analysis of the prognostic factors that influenced the case group revealed that adjuvant chemotherapy (P=0.004) was significantly correlated to a better five-year survival rate. A univariate analysis of the prognostic factors that influenced the five-year survival rate of the combined group revealed that the stage (P<0.001), the pre-op CEA level (P=0.018), the angio invasion (P=0.019), the perineural invasion (P=0.019), the number of harvested lymph nodes (P=0.004), and adjuvant chemotherapy (P=0.001) were significantly correlated to the five-year survival rate. The identified independent prognostic factors in the combined group were the stage (hazard ratio, 5.20), angio-invasion (hazard ratio, 2.81), and adjuvant chemotherapy (hazard ratio, 0.17). CONCLUSION: The clinical pathway of perforated colorectal cancer is similar to that of uncomplicated colorectal cancer. Therefore, perforated colorectal cancer patients should be recommended for treatment with the appropriate radical operation and adjuvant chemotherapy based on oncologic principles.
Carcinoembryonic Antigen ; Case-Control Studies ; Chemotherapy, Adjuvant ; Colorectal Neoplasms ; Critical Pathways ; Humans ; Lymph Nodes ; Peritonitis ; Prognosis ; Survival Rate