Purpose: Although increasing body mass index (BMI) is regarded as a potential risk factor for breast cancer (BC) in postmenopausal women, research on premenopausal women has produced conflicting results. We investigated the association between BMI and BC according to menopausal status in Korean. Methods: We analyzed clinical data from 186,835 women aged 20 years or older between 2003 and 2008 using a sample cohort from the national database in Korea. We identified women newly diagnosed with BC and estimated the risk of BC according to BMI (kg/m2). Subjects were categorized into five groups according to World Health Organization recommendations for Asians: underweight, <18.5 kg/m2; normal weight, 18.5–22.9 kg/m2; overweight, 23.0–24.9 kg/m2; obese class I, 25.0–29.9 kg/m2; and obese class II, ≥30.0 kg/m2. Results: 1,372 women in the cohort were newly diagnosed with BC. A positive relationship between BMI and BC was detected and the hazard ratio in each group compared with the normal weight group was 0.57 (95% CI, 0.42–0.78), 1.27 (1.11–1.45), 1.25 (1.09–1.44), and 1.28 (0.95–1.73), respectively. BMI was determined to be an important risk factor for BC in postmenopausal women (p for trend was 0.015). We failed to find a significant correlation between BMI and BC in premenopausal women. Conclusion BMI is positively associated with BC in postmenopausal Korean women.

PURPOSE: Intraoperative peritoneal washing cytology (PWC) is used to determine treatment strategies for gastric cancer with suspected serosal invasion. However, a standard staining method for intraoperative PWC remains to be established. We evaluated the feasibility of a rapid and simple staining method using Shorr's stain for intraoperative PWC in advanced gastric cancer. MATERIALS AND METHODS: Between November 2012 and December 2014, 77 patients with clinical T3 or higher gastric cancer were enrolled. The sensitivity, specificity, and concordance between the Shorr staining method and conventional Papanicolaou (Pap) staining with carcinoembryonic antigen (CEA) immunohistochemistry (IHC) were analyzed. RESULTS: Intraoperative PWC was performed laparoscopically in 69 patients (89.6%). The average time of the procedure was 8.3 minutes, and the average amount of aspirated fluids was 83.3 mL. The average time for Shorr staining and pathologic review was 21.0 minutes. Of the 77 patients, 16 (20.7%) had positive cytology and 7 (9.1%) showed atypical findings; sensitivity and specificity were 73.6% and 98.2% for the Shorr method, and 78.9% and 98.2% for the Pap method with CEA IHC, respectively. Concordance of diagnosis between the 2 methods was observed in 90.9% of cases (weighted κ statistic=0.875) and most disagreements in diagnoses occurred in atypical findings (6/7). In overall survival, there was no significant difference in C-index between the 2 methods (0.459 in Shorr method vs. 0.458 in Pap with CEA IHC method, P=0.987). CONCLUSIONS: Shorr staining could be a rapid and reliable method for intraoperative PWC in advanced gastric cancer.
Carcinoembryonic Antigen ; Diagnosis ; Humans ; Immunohistochemistry ; Laparoscopy ; Methods ; Pilot Projects ; Sensitivity and Specificity ; Stomach Neoplasms

PURPOSE: Obesity is associated with morbidity following gastric cancer surgery, but whether obesity influences morbidity after laparoscopic gastrectomy (LG) remains controversial. The present study evaluated whether body mass index (BMI) and visceral fat area (VFA) predict postoperative complications. MATERIALS AND METHODS: A total of 217 consecutive patients who had undergone LG for gastric cancer between May 2003 and December 2005 were included in the present study. We divided the patients into two groups ('before learning curve' and 'after learning curve') based on the learning curve effect of the surgeon. Each of these groups was sub-classified according to BMI (<25 kg/m2 and > or =25 kg/m2) and VFA (<100 cm2 and > or =100 cm2). Surgical outcomes, including operative time, quantity of blood loss, and postoperative complications, were compared between BMI and VFA subgroups. RESULTS: The mean operative time, length of hospital stay, and complication rate were significantly higher in the before learning curve group than in the after learning curve group. In the subgroup analysis, complication rate and length of hospital stay did not differ according to BMI or VFA; however, for the before learning curve group, mean operative time and blood loss were significantly higher in the high VFA subgroup than in the low VFA subgroup (P=0.047 and P=0.028, respectively). CONCLUSIONS: VFA may be a better predictive marker than BMI for selecting candidates for LG, which may help to get a better surgical outcome for inexperienced surgeons.
Body Mass Index ; Gastrectomy* ; Humans ; Intra-Abdominal Fat* ; Learning ; Learning Curve ; Length of Stay ; Obesity ; Operative Time ; Postoperative Complications ; Stomach Neoplasms* ; Surgeons

PURPOSE: Adrenocortical carcinoma (ACC) is a rare malignant tumor. Early detection is difficult and prognosis is poor. We report on 20 years of ACC surgical experience at our institution. METHODS: This study included 32 ACC patients who underwent surgical resection at the Department of Surgery of the Yonsei University Health System in South Korea between January 1990 and February 2012. We reviewed these 32 patients and retrospectively analyzed long-term clinical outcomes and prognosis after radical surgery for ACC. RESULTS: The median age of the 32 patients at diagnosis was 42.25 years (range 3~81 years). There were 16 (50%) female and 16 (50%) male patients. Mean tumor size was 12.36 cm (range 1.8~20 cm). Twenty-five patients (78.12%) had nonfunctioning tumors while the other seven patients (21.87%) had functioning tumors. Seventeen patients (53.12%) were classified as stage II, two (6.25%) as stage III, and 13 (40.62%) as stage IV. Fourteen patients underwent radical surgical resection, while 14 patients received adjuvant chemotherapy, two received adjuvant radiotherapy, and two received adjuvant chemoradiation. Four patients were lost to follow-up. Among the remaining 28 patients, 15 patients survived. The 5- and 10-year overall survival was 60.6% and 37.8%, respectively (median survival=85+/-24.3 months). Seventeen patients (53%) experienced disease recurrence. Five- and 10-year recurrence-free survival was 41.5% and 29.7%, respectively (median survival=18+/-5.5 months). CONCLUSION: Early stage at diagnosis and surgical resection were the most important prognostic factors associated with prolonged survival. The role of additional therapy remains controversial and new agents should continually be evaluated for efficacy.
Adrenocortical Carcinoma* ; Chemotherapy, Adjuvant ; Diagnosis ; Female ; Humans ; Korea ; Lost to Follow-Up ; Male ; Prognosis ; Radiotherapy, Adjuvant ; Recurrence ; Retrospective Studies

PURPOSE: During the past decade, various endoscopic thyroid surgeries have been conducted, each with its own benefits. The incorporation of robotic systems to endoscopic thyroid surgery has improved the visualization and precision of endoscopic techniques. We previously reported our initial experience with robotic modified radical neck dissection (MRND) of papillary thyroid carcinoma (PTC) with lateral neck node metastasis (LNM). The aim of this study was to compare surgical outcomes of robotic vs. conventional open MRND of PTC with LNM using propensity score matching. METHODS: From January 2008 to February 2011, 515 patients with PTC with LNM were enrolled. One hundred patients underwent robotic MRND, and 415 patients underwent conventional open MRND. These two groups were retrospectively compared with respect to their clinicopathological characteristics, surgical outcomes, and surgical completeness. Furthermore, to avoid selection bias, propensity score matching analysis was used to compare surgical outcomes of each group without any compounding factors. RESULTS: The operative time for the robotic MRND was longer than for the open MRND (297.9±60.2 min vs. 212.1±55.6 min, P=0.089). However, the mean numbers of retrieved lymph nodes and mean hospital stay after surgery were similar in the two groups (36.0±12.9 vs. 40.8±13.3, P=0.235), (6.1±1.6 days vs. 6.1±2.1 days, P=0.577). The complication rates were similar between the two groups, and there was no statistical difference in postoperative thyroglobulin levels between groups (0.51±0.83 ng/ml vs. 0.89±2.46 ng/ml, P=0.593). CONCLUSION: According to our study, robotic MRND shows similar surgical outcomes to conventional open MRND after case-matched analyses. We suggest that robotic MRND is an acceptable alternative as an operative method for PTC with LNM, resulting in excellent cosmesis and patient satisfaction.
Humans ; Length of Stay ; Lymph Nodes ; Methods ; Neck Dissection ; Neck* ; Neoplasm Metastasis* ; Operative Time ; Patient Satisfaction ; Propensity Score* ; Retrospective Studies ; Selection Bias ; Thyroglobulin ; Thyroid Gland* ; Thyroid Neoplasms*

Hiatal hernia is a very rare disease in the pediatric population. However information from our esophageal atresia postoperative follow-up program has hypotheses; "Hiatal hernia may more frequently occur in postoperative esophageal atresia patients (EA group) than in the general pediatric population (GP group)" and "The tension on the esophagus after esophageal anastomosis may be an important etiologic factor of hiatal hernia in EA group". To prove the first hypotheses, we compared the incidence of hiatal hernia in the GP group with the incidence in the EA group. The Incidence in the GP group was obtained from national statistic data from Statistics Korea and Health Insurance Review and Assessment Service of Korea. The incidence in the EA group was obtained from the medical record and the imaging studies of our esophageal atresia postoperative follow-up program. To prove the second hypothesis, the presumptive risk factors for the development of hiatal hernia in EA group, such as the type of esophageal atresia, degree of esophageal gap, the stage operation and the redo-operation with resection and re-anastomosis of esophagus were analyzed statistically. The total number of patients in the EA group was ninety-nine and there were 5 hiatus hernias. The incidence of EA group (5 %) is significantly higher than incidence of GP group (0.024 %). (p=0.0001) The statistical analysis of the presumptive risk factors for hiatal hernia development in EA group failed to show any evidence of correlation between postoperative esophageal tension and the hiatal hernia. This study shows that the postoperative patients with esophageal atresia have high occurrence of hiatal hernia and should be followed up carefully to detect hiatal hernia.
Esophageal Atresia ; Esophagus ; Follow-Up Studies ; Hernia ; Hernia, Hiatal ; Humans ; Incidence ; Insurance, Health ; Korea ; Medical Records ; Rare Diseases ; Risk Factors

In 2002, breast became the most common cancer site in Korean women. Using national breast cancer incidence data during 1993-2002, crude, age-standardized, and age-specific rates for incidence and mortality were calculated. Survival was examined for cases diagnosed during 1993-2002 and followed up to 2004. Observed survival was calculated using the life table method and relative survival using the Ederer II method. Age-standardized incidence rates in female increased from 14.5 in 1993 to 26.2 per 100,000 in 2002. Age-specific incidences showed peaks in women in their forties. Mortality rates increased from 3.7 in 1993 to 4.6 per 100,000 in 2002 and showed peaks in women in their fifties. Five-year relative survival for female breast cancer diagnosed during 1993-2002 was 82.2%. When we examined the secular trends using cases diagnosed 1993-1999 for complete 5-yr follow-up, the 5-yr relative survival increased from 75.2% in 1993 to 83.5% in 1999. The data from this study will provide valuable information to plan and evaluate actions against breast cancer including national breast cancer screening.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Breast Neoplasms/*epidemiology/mortality ; Breast Neoplasms, Male/epidemiology/mortality ; Epidemiologic Factors ; Female ; Humans ; Korea/epidemiology ; Male ; Middle Aged ; Survival Rate ; Time Factors

Small cell neuroendocrine carcinoma is a type of undifferentiated, malignant neuroendocrine tumor. Most of neuroendocrine tumors exhibit well-differentiated features and are classified as carcinoid tumors. However, carcinomas of the liver with anaplastic characters, which are classified as small-cell carcinomas are extremely rare and only few cases have been reported in the literature. We report an unusual case of primary small cell neuroendocrine carcinoma of the liver in a 67-year-old man. The patient was found to have a palpable mass on right upper quadrant of abdomen on physical examination. The diagnosis was made by immunohistochemical stains of biopsied specimen from the liver. Other possible primary site was excluded by radiologic and endoscopic evaluations. The tumor was composed of small monotonous and hyperchromatic poorly differentiated cells with higher nuclear to cytoplasmic ratio, and were positive for neuroendocrine tissue markers such as synaptophysin, c-kit, and CD56.
Aged ; Carcinoma, Neuroendocrine/*diagnosis/pathology ; Carcinoma, Small Cell/*diagnosis/pathology ; Humans ; Liver Neoplasms/*diagnosis/pathology ; Male

Meckel's diverticulum is an embryonic derivative of the omphalomesenteric duct and the most commonly encountered congenital anomaly of the gastrointestinal tract. Its incidence records about 2%. Among them, only 5% are symptomatic with complications-bleeding, intestinal obstruction, inflammation, and perforation. In particular, bleeding is a common complication and has always been caused by an ulceration of the ileal mucosa adjacent to the acid-producing ectopic mucosa in a Meckel's diverticulum. Wireless capsule endoscopy is a new method enabling non-invasive diagnostic endoscopy of the entire small intestine. We experienced a case of Meckel's diverticulum detected by wireless capsule endoscopy in a 34 year-old man who presented with chronic obscure gastrointestinal bleeding.
Adult ; Chronic Disease ; *Endoscopy, Gastrointestinal ; English Abstract ; Gastrointestinal Hemorrhage/*diagnosis/*etiology ; Humans ; Male ; Meckel Diverticulum/*complications/diagnosis

Ulcerative colitis is a chronic inflammatory bowel disease and may have many intestinal and extraintestinal complications. Compared with general population, patients with longstanding ulcerative colitis have an increased risk of colorectal cancer. Patients with ulcerative colitis have an increased frequency of thromboembolism too. However, hepatic vein thrombosis is a very rare extraintestinal complication. This is the first reported case of a young patient with ulcerative colitis who developed synchronous colonic neoplasm and chronic Budd-Chiari syndrome manifested as esophageal variceal bleeding. We report a case of ulcerative colitis complicated by Budd-Chiari syndrome and colon cancer in a 28-year-old female.
Adult ; Budd-Chiari Syndrome* ; Colitis, Ulcerative* ; Colon* ; Colonic Neoplasms* ; Colorectal Neoplasms ; Esophageal and Gastric Varices ; Female ; Humans ; Inflammatory Bowel Diseases ; Thromboembolism ; Ulcer*