BACKGROUND : The incidence of breast cancer has steadily increased through the years. The establishment of the cause of breast cancer plays an important role for the diagnosis, management and prevention of breast cancer. METHODS : We analysed 241 cases of breast cancer that were treated during the 13 years from January 1985 to December 1997 at the Department of General Surgery, Inje University Paik Hospital, Seoul. RESULTS : The peak incidence of breast cancer was in the 5th decade (100 cases, 41.5%). The most common age of menarche ranged from 14 to 20 years (89.9%). The most common age of first full-term delivery ranged from 25 to 29 years (54.5%). The normal group was the most frequent body mass index (156 cases, 65.8%). The most common chief complaint was a painless palpable breast mass (166 cases, 68.9%). Most patients (181 cases, 75.1%) visited the hospital within 6 months of developing symptoms. The upper outer quadrant was the most frequent location for breast cancer (146 cases, 60.6%). The most common type of operative technique was a modified radical mastectomy (225 cases, 93.4%). The most common size of the breast mass ranged from 2 to 5 cm (151 cases, 62.7%). A pathologically positive axillary lymph node was present in 122 cases (52.4%). The predominant type of pathological classi fication was invasive ductal carcinoma (215 cases, 90.7%). According to the TNM system, the most common stage was stage II (161 cases, 66.8%). The five-year survival rates for the patients in stages I, II, III were 96.7%, 82.2%, 68.9%, respectively. CONCLUSIONS : We conclude that women with mass or mass-related symptoms needed more careful evaluation and aggressive approaches for discovering breast cancer.
Body Mass Index ; Breast Neoplasms* ; Breast* ; Carcinoma, Ductal ; Diagnosis ; Female ; Humans ; Incidence ; Lymph Nodes ; Mastectomy, Modified Radical ; Menarche ; Seoul ; Survival Rate

Soft-tissue sarcomas account for 1% of all solid tumors. Of these, less than 15% will occur in the retroperitoneum. Late diagnosis and large tumor size make retroperitoneal sarcomas difficult to resect. Resection with wide margins in all directions is rarely possible owing to proximity to vital structures. Radiation therapy is limited in dosage and, as with chemotherapy, has only been successful in a limited number of cases. These problems result in a poor prognosis. A series of patients with retroperitoneal sarcoma was reviewed with a focus on issues of surgical management and prognostic factors. A retrospective analysis of 12 patients with retroperitoneal sarcomas who had undergone operations at the Department of Surgery, Inje University Paik Hospital, Seoul, from 1980 through 1996 was performed. The mean age of the 10 adult patients was 51 years; the male-to-female ratio was 2:1. Eighty-three percent of the patients presented with an abdominal mass. The mean diameter of the tumors was 18.3 cm. Leimyosarcomas(33%) and liposarcomas(25%) comprised the majority of the histologic types. The tumor grades were I, II, and III in 3 cases each. Resection of the tumor was possible in 75%(9/12) of the cases, although 17% of the resections were incomplete. Resection of adjacent organs was required in 66% of the cases. The resectability rose from 60% in 80s to 86% in 90s, with no statistical significance, possibly due to the small number of cases in this series. There was no postoperative morbidity or mortality. Actuarial 1-, 3-, and 5-year survival rates after resection were 75%, 60%, and 30%, respectively. Four of the 7(57%) patients who underwent complete resections had recurrence 3 to 33 months after surgery; this was notable for grade II or III tumors only. Two patients with grade I tumors are alive 65 and 102 months respectively after complete resection and show no evidence of the disease. One patient who underwent an incomplete resection of the tumor died 50 months after the operation. Only the tumor grade was a significant prognostic factor(p=0.0207). In conclusion, a wide en-bloc resection of a retroperitoneal sarcoma with a clear margin in all directions is a prerequisite for long-term survival. Aggressive follow-up for the first 3 years after a complete resection of a high-grade tumor is justified.
Adult ; Delayed Diagnosis ; Drug Therapy ; Follow-Up Studies ; Humans ; Mortality ; Prognosis ; Recurrence ; Retrospective Studies ; Sarcoma* ; Seoul ; Survival Rate

BACKGROUNDING/AIMS: It has been nearly established that liver resection for colorectal metastases is a relatively safe procedure with survival benefit to patients. This study was performed to evaluate if the liver resection for colorectal metastases is effective method and to determine the appropriate therapeutic modality. METHODS: Between January 1995 and January 1999, sixteen patients who had liver resectin for metastatic colorectal carcinoma at our hospital were analyzed retrospectively. RESULTS: Wedge resection was performed in 7 patients, segmentectomy in 3 patients, and lobectomy in 6 patients. The median survival time was 26 months and cumulative 1 and 4-year survival rate were 83.1% and 34.6%, respectively. Extent of hepatic resection had marginally influenced the survival(p=0.0514). No prognostic factor was related significantly to survival. Recurrence in remaining liver following the anatomical liver resection was significantly low compared with wedge resection( 12.5% vs. 71.5%, p=0.035). CONCLUSION: Liver resection is an effective and safe treatment for colorectal liver metastases. The anatomical liver resection decreased recurrence rate in the remnant liver. The curative resection with an adequate surgical margin will improve outcome.
Colorectal Neoplasms ; Humans ; Liver* ; Mastectomy, Segmental ; Neoplasm Metastasis* ; Recurrence ; Retrospective Studies ; Survival Rate

PURPOSE: Neovascularization has been shown to be essential for the growth of solid tumors. Vascular endothelial growth factor (VEGF) is one of the most important mediators of angiogenesis, and recent studies have demonstrated that the p53 tumor suppressor gene plays an important role in controlling tumor angiogenesis. We examined the expression of VEGF and p53 as a function of microvessel density to evaluate its clinical significance in colorectal cancer and to investigate the correlation of VEGF and p53. METHODS: The study material included 20 patients who survived more than 5 years postoperatively without distant metastasis (non-metastasis group) and 21 patients who had synchronous (10 patients) and metachronous (11 patients) metastasis (metastasis group). Immunohistochemical staining for VEGF, p53 protein and factor VIII-related antigen was done. RESULTS: The expression rate of VEGF was 20% in non-metastatic tumors and 71% in metastatic tumors (p<0.05). The VEGF expression was not correlated with microvessel density. Otherwise, the microvessel density were 32.9 9.1 in non-metastatic tumors and 40.1 12.0 in metastatic tumors (p<0.05). VEGF expression was correlated with p53 over expression. CONCLUSION: VEGF expression might be a useful prognostic factor for metastasis in colorectal cancer. Also, our findings suggest the presence of a p53-VEGF pathway in colorectal cancer.
Colorectal Neoplasms* ; Genes, Tumor Suppressor ; Humans ; Microvessels ; Neoplasm Metastasis ; Vascular Endothelial Growth Factor A* ; von Willebrand Factor

PURPOSE: Even though traumatic pancreatic injuries occur in only 0.2% to 4% of all abdominal injuries, the morbidity and the mortality rates associated with pancreatic injuries remain high. The aim of this study was to evaluate the clinical outcomes of traumatic pancreatic injuries and to identify predictors of mortality and morbidity. METHODS: We retrospectively reviewed the medical records of 26 consecutive patients with a pancreatic injury who underwent a laparotomy from January 2000 to December 2010. The data collected included demographic data, the mechanism of injury, the initial vital signs, the grade of pancreatic injury, the injury severity score (ISS), the revised trauma score (RTS), the Glasgow Coma Scale (GCS), the number of abbreviated injury scales (AIS), the number of associated injuries, the initial laboratory findings, the amount of blood transfusion, the type of operation, the mortality, the morbidity, and others. RESULTS: The overall mortality rate in our series was 23.0%, and the morbidity rate was 76.9%. Twenty patients (76.9%) had associated injuries to either intra-abdominal organs or extra-abdominal organs. Two patients (7.7%) underwent external drainage, and 18 patients (69.3%) underwent a distal pancreatectomy. Pancreaticoduodenectomies were performed in 6 patients (23.0%). Three patients underwent a re-laparotomy due to anastomosis leakage or postoperative bleeding, and all patients died. The univariate analysis revealed 11 factors (amount of transfusion, AAST grade, re-laparotomy, associated duodenal injury, base excess, APACHE II score, type of operation, operation time, RTS, associated colon injury, GCS) to be significantly associated with mortality (p<0.05). CONCLUSION: Whenever a surgeon manages a patient with traumatic pancreatic injury, the surgeon needs to consider the predictive risk factors. And, if possible, the patient should undergo a proper and meticulous, less invasive surgical procedure.
Abbreviated Injury Scale ; Abdominal Injuries ; APACHE ; Blood Transfusion ; Colon ; Drainage ; Glasgow Coma Scale ; Hemorrhage ; Humans ; Injury Severity Score ; Laparotomy ; Medical Records ; Pancreatectomy ; Pancreaticoduodenectomy ; Retrospective Studies ; Risk Factors ; Vital Signs

PURPOSE: Laparoscopic appendectomy has been recognized to have many advantages such as greater cosmetic results, less postoperative pain and shorter hospital stays. On the other hand, the cost of laparoscopic procedures is still more expensive than that of open procedures in Korea. The aim of this study is to compare clinical outcomes and hospital costs between open appendectomy and laparoscopic appendectomy. METHODS: Between January 1, 2010 and December 31, 2010, 471 patients were diagnosed with acute appendicitis. Of these, 418 patients met the inclusion criteria and were divided into two groups of open appendectomy (OA) group and laparoscopic appendectomy (LA) group. We analyzed the clinical data and hospital costs. RESULTS: The mean operation time for laparoscopic appendectomy (72.17 minutes) was significantly longer than that of open appendectomy (46.26 minutes) (P = 0.0004). The mean amounts of intravenous analgesics for OA group (2.00 times) was greater than that of LA group (1.86 times) (P < 0.0001). The complication rate was similar between the two groups (OA, 6.99% vs. LA, 10.87%; P = 0.3662). The mean length of postoperative hospital stay was shorter in LA group (OA, 4.55 days vs. LA, 3.60 days; P = 0.0002). The mean total cost covered by the National Health Insurance was more expensive in LA group (OA, 1,259,842 won [Korean monetary unit] vs. LA, 1,664,367 won; P = 0.0057). CONCLUSION: Clinical outcomes of laparoscopic appendectomy were superior to that of open appendectomy even though the cost of laparoscopic appendectomy was more expensive than that of open appendectomy. Whenever surgeons manage a patient with appendicitis, laparoscopic appendectomy should be considered as the procedure of choice.
Analgesics ; Appendectomy ; Appendicitis ; Cosmetics ; Hand ; Hospital Costs ; Humans ; Korea ; Length of Stay ; National Health Programs ; Pain, Postoperative

PURPOSE: Laparoscopic appendectomy has been recognized to have many advantages such as greater cosmetic results, less postoperative pain and shorter hospital stays. On the other hand, the cost of laparoscopic procedures is still more expensive than that of open procedures in Korea. The aim of this study is to compare clinical outcomes and hospital costs between open appendectomy and laparoscopic appendectomy. METHODS: Between January 1, 2010 and December 31, 2010, 471 patients were diagnosed with acute appendicitis. Of these, 418 patients met the inclusion criteria and were divided into two groups of open appendectomy (OA) group and laparoscopic appendectomy (LA) group. We analyzed the clinical data and hospital costs. RESULTS: The mean operation time for laparoscopic appendectomy (72.17 minutes) was significantly longer than that of open appendectomy (46.26 minutes) (P = 0.0004). The mean amounts of intravenous analgesics for OA group (2.00 times) was greater than that of LA group (1.86 times) (P < 0.0001). The complication rate was similar between the two groups (OA, 6.99% vs. LA, 10.87%; P = 0.3662). The mean length of postoperative hospital stay was shorter in LA group (OA, 4.55 days vs. LA, 3.60 days; P = 0.0002). The mean total cost covered by the National Health Insurance was more expensive in LA group (OA, 1,259,842 won [Korean monetary unit] vs. LA, 1,664,367 won; P = 0.0057). CONCLUSION: Clinical outcomes of laparoscopic appendectomy were superior to that of open appendectomy even though the cost of laparoscopic appendectomy was more expensive than that of open appendectomy. Whenever surgeons manage a patient with appendicitis, laparoscopic appendectomy should be considered as the procedure of choice.
Analgesics ; Appendectomy ; Appendicitis ; Cosmetics ; Hand ; Hospital Costs ; Humans ; Korea ; Length of Stay ; National Health Programs ; Pain, Postoperative

PURPOSE: The present study was performed to assess the outcomes in patients with colonic perforation and to determine the prognostic factors for mortality. METHODS: The cases of 42 patients who underwent surgery for colonic perforation between March 1999 and September 2008 were retrospectively reviewed. Age, sex, American Society of Anesthesiologists (ASA) classification, presence of preoperative shock, duration of symptoms, cause of perforation, location of perforation, degree of peritonitis, and the Mannheim Peritonitis Index (MPI) score were analyzed for their association with early outcome by using univariate and multivariate analyses. RESULTS: Diverticulitis (46%, 19 patients) and colorectal cancer (36%, 15 patients) were the most common causes of noniatrogenic colonic perforation, and the sigmoid colon was the most common site of perforation (60%, 25 patients). The postoperative mortality was 21.4% (9 patients). The mortality in patients with preoperative shock, with a MPI score of more than 25, and with Hinchey stage III or IV peritonitis were 70.0%, 57.1%, and 53.3%, respectively (P<0.001). No statistical difference was observed in postoperative mortality with regard to age, sex, ASA classification, duration of symptoms, cause of perforation, and location of perforation. According to the multivariate analysis, preoperative shock proved to be the only significant prognostic factor for mortality (P=0.027) (odds ratio: 19.8, 95% confidence interval: 1.4-276.9). CONCLUSION: Preoperative shock, a MPI score of more than 25, and Hinchey stage III or IV peritonitis were associated with high postoperative mortality in patients with colonic perforation. Especially, more intensive management and interest are required for patient s with preoperative shock due to colonic perforation.
Colon ; Colon, Sigmoid ; Colorectal Neoplasms ; Diverticulitis ; Humans ; Multivariate Analysis ; Peritonitis ; Retrospective Studies ; Shock

The case of sigmoid volvulus combined with a transomental hernia is reported. A 70-year-old man was admitted to our hospital with mild abdominal pain and distension. Although no signs of peritoneal irritation were apparent, a plain abdominal X-ray showed a markedly dilated loop of the sigmoid colon, and CT revealed a whirl pattern of the sigmoid mesentery. These findings suggested sigmoid volvulus. Colonoscopic reduction was attempted as an initial nonoperative treatment, and an urgent laparotomy was performed after the reduction failed. The sigmoid loop was herniated through the great omentum, with torsion in the clockwise direction. The colon was manually untwisted in the counter-clockwise direction, and the sigmoid loop was released by dividing the great omentum. During this one-stage operation, intraoperative colonic irrigation, sigmoid resection, and primary anastomosis were performed. The postoperative course was uneventful. Although sigmoid volvulus combined with a transomental hernia is rare, urgent surgical intervention is essential on failure of endoscopic reduction.
Abdominal Pain ; Aged ; Colon ; Colon, Sigmoid ; Hernia ; Humans ; Intestinal Volvulus ; Laparotomy ; Mesentery ; Omentum

We report a case of metastatic thyroid-papillary carcinoma of the breast. A 42-year-old woman was admitted to our hospital due to palpable masses on both breasts. Past history revealed that she had three individual thyroid operations due to thyroid papillary carcinoma. The first was a left lobectomy 6 years ago, the second was a subtotal thyroidectomy 2 years ago, and the third was a excision of the neck mass due to last year's recurrence. The patient underwent mass excisions on both breasts under the impression of a benign tumor. Pathologic findings of the masses showed similar histologic findings of the thyroid papillary carcinoma and immunohistochemical stainings demonstrated that the tumors originated from the thyroid.
Adult ; Breast Neoplasms ; Breast* ; Carcinoma, Papillary ; Female ; Humans ; Neck ; Recurrence ; Thyroid Gland ; Thyroidectomy