Although high-risk gastrointestinal stromal tumors (GISTs) frequently recur, even after a complet... more Although high-risk gastrointestinal stromal tumors (GISTs) frequently recur, even after a complete resection and imatinib therapy, local recurrence at the suture line after complete resection is rare. The present case was an 88-year-old woman who was initially diagnosed with high-risk GIST without a distant metastasis. She underwent a complete surgical resection of the lesion and received adjuvant imatinib therapy for 18 months, which was discontinued due to severe drug-induced anemia. During the follow-up, an endoscopic examination performed 40 months after the initial surgery revealed local recurrence at the anastomosis site. Although a complete surgical resection was performed, repeated local recurrence was detected 18 months later, which progressed rapidly to metastatic disease. This paper reports a case of a completely resected gastric GIST with repeated local recurrence, despite the complete surgical resections and adjuvant imatinib therapy.
Purpose: Quality of life (QOL) has become important in the trend of emphasizing patient satisfact... more Purpose: Quality of life (QOL) has become important in the trend of emphasizing patient satisfaction. This study aimed to evaluate the QOL in patients who underwent laparoscopic or robotic gastrectomy for gastric cancer. Methods: A prospective trial was performed involving patients who underwent laparoscopic or robotic gastrectomy for primary gastric cancer at 11 hospitals in Korea. Within this comparative trial, QOL, postoperative pain, and long-term complications were exanimated. The quality-of-life questionnaire (QLQ)-C30 and QLQ-STO22 developed by the European Organization for Research and Treatment of Cancer were used for the QOL survey. We compared the data after dividing it into several types of characteristics as follows; device (robotic or laparoscopic), operation type, pathological stage, and sex. Biased components were extracted by logistic regression analysis. Propensity score matching was applied to the data set with the biased components. Results: In total, 434 patients (211 for laparoscopic surgery and 223 for robotic surgery) were enrolled, out of which 321 patients who responded to both preoperative and postoperative surveys were selected for analysis. Robotic gastrectomy was not different from laparoscopic gastrectomy with respect to postoperative QOL. Distal gastrectomy showed better scores than total gastrectomy in terms of role functioning, social functioning, fatigue, nausea/vomiting, pain, dyspnea, constipation, financial difficulties, dysphagia, eating restrictions, anxiety, taste, and body image. Male patients showed better scores on the 19 scales compared to female patients. Conclusion: Robotic and laparoscopic approaches for gastric cancer surgery did not differ from each other with respect to QOL. Distal gastrectomy resulted in better QOL than total gastrectomy.
4025Background: Robotic gastrectomy for gastric cancer has been proven to be a feasible and safe ... more 4025Background: Robotic gastrectomy for gastric cancer has been proven to be a feasible and safe minimally invasive procedure. However, our previous multicenter prospective study indicated that robotic gastrectomy is not superior to laparoscopic gastrectomy. This study aimed to identify which subgroups of patients would benefit from robotic gastrectomy over conventional laparoscopic gastrectomy. Methods: A prospective multicenter comparative study was conducted. Surgical outcomes were compared between the robotic and laparoscopic groups. The analysis was conducted in each subgroup according to the patients’ obesity status, the type of gastrectomy, and the extent of lymph node dissection. Results: A total of 434 patients were enrolled for the robotic (n = 223) and laparoscopic (n = 211) groups. According to obesity and gastrectomy type, there was no difference in the estimated blood loss (EBL), number of retrieved lymph nodes (RLN), complication rate, open conversion rate, and the length of hospital stay b...
Long-term results following bariatric surgery compared to conventional treatments has never been ... more Long-term results following bariatric surgery compared to conventional treatments has never been reported in morbidly obese Korean patients. This study aimed to evaluate the long-term efficacy of bariatric surgery in morbidly obese Korean patients compared to conventional medical treatments. Methods: In this multicenter retrospective cohort study, we reviewed 137 obese subjects between January 2008 and February 2011 with a body mass index (BMI) > 30 kg/m 2 who had more than 5 years of follow-up clinical data after bariatric surgery (surgery group, n = 49) or conventional treatment (conventional treatment group, n = 88). Anthropometric data and the status of comorbidities were compared between the 2 groups. Results: The median follow-up period was 72.1 months (range 19.3-109.7 months). At the last follow-up, the surgery group showed a greater amount of total weight loss than the conventional treatment group (24.9% vs. 2.8%, P < 0.001). The prevalence of diabetes and hypertension significantly decreased in the surgery group, while the conventional treatment group showed a marked increase in these comorbidities. In the surgery group, Roux-en-Y gastric bypass and sleeve gastrectomy achieved comparable long-term weight loss (26.5% vs. 22.4%, respectively; P = 0.087). Conclusion: In the long-term, bariatric surgery achieved and maintained significantly greater weight reduction, as well as a decrease in obesity-related comorbidities, than did conventional medical therapy in morbidly obese Korean patients.
To investigate the current status of adjuvant chemotherapy (AC) regimens in Korea and the differe... more To investigate the current status of adjuvant chemotherapy (AC) regimens in Korea and the difference in efficacy of AC administered by surgical and medical oncologists in patients with stage II or III gastric cancers. We performed a retrospective observational study among 1,049 patients who underwent curative resection and received AC for stage II and III gastric cancers between February 2012 and December 2013 at 29 tertiary referral university hospitals in Korea. To minimize the influence of potential confounders on selection bias, propensity score matching (PSM) was used based on binary logistic regression analysis. The 3-year disease-free survival (DFS) rates were compared between patients who received AC administered by medical oncologists or surgical oncologists. Between February 2012 and December 2013 in Korea, the most commonly prescribed AC by medical oncologists was tegafur/gimeracil/oteracil (S-1, 47.72%), followed by capecitabine with oxaliplatin (XELOX, 16.33%). After pe...
Laparoscopic total fundoplication is the standard surgery for gastroesophageal reflux disease. Ho... more Laparoscopic total fundoplication is the standard surgery for gastroesophageal reflux disease. However, partial fundoplication may be a viable alternative. Here, we conducted a nationwide survey of partial fundoplication in Korea. The Korean Anti-Reflux Surgery study group recorded 32 cases of partial fundoplication at eight hospitals between September 2009 and January 2016. The surgical outcomes and postoperative adverse symptoms in these cases were evaluated and compared with 86 cases of total fundoplication. Anterior partial fundoplication was performed in 20 cases (62.5%) and posterior in 12 (37.5%). In most cases, partial fundoplication was a secondary procedure after operations for other conditions. Half of patients who underwent partial fundoplication had typical symptoms at the time of initial diagnosis, and most of them showed excellent (68.8%), good (25.0%), or fair (6.3%) symptom resolution at discharge. Compared to total fundoplication, partial fundoplication showed no d...
Background: Pre-emptive intravenous lidocaine infusion is known to improve postoperative pain in ... more Background: Pre-emptive intravenous lidocaine infusion is known to improve postoperative pain in abdominal surgery. We assessed the effect of intravenous lidocaine infusion in patients who underwent subtotal gastrectomy. Methods: We conducted a double-blind, placebo-controlled study with patients undergoing subtotal gastrectomy for early gastric cancer divided into 2 groups: 1 group received intravenous lidocaine infusion preoperatively and throughout surgery, and the other received normal saline infusion (placebo). We assessed postoperative outcomes, including pain scores on a visual analogue scale (VAS), administration frequency of patient-controlled analgesia (PCA) and the amount of consumed fentanyl. Postoperative nausea and vomiting, length of hospital stay (LOS), time to return to regular diet and patient satisfaction at discharge were evaluated. Results: There were 36 patients in our study. Demographic characteristics were similar between the groups. The VAS pain scores and administration frequency of PCA were significantly lower in the lidocaine group until 24 hours after surgery, and fentanyl consumption was significantly lower in this group until 12 hours postoperatively compared with the placebo group. The total amount of consumed fentanyl and the total administration frequency of PCA were significantly lower in the lidocaine than the control group. No significant differences were detected in terms of nausea and vomiting, return to regular diet, LOS and patient satisfaction, and there were no reported side-effects of lidocaine. Conclusion: Intravenous lidocaine infusion reduces pain during the postoperative period after subtotal gastrectomy. Contexte : Administrée à titre préventif, la perfusion intraveineuse de lidocaïne améliorerait la douleur postopératoire dans la chirurgie abdominale. Nous avons mesuré l'effet d'une perfusion intraveineuse de lidocaïne chez des patients soumis à une gastrectomie subtotale. Méthodes : Nous avons réalisé une étude à double insu avec témoins sous placebo auprès de patients soumis à une gastrectomie subtotale pour un cancer de l'estomac au premier stade. Les patients ont été répartis en 2 groupes : l'un a reçu une perfusion intraveineuse de lidocaïne en préopératoire et tout au long de la chirurgie, tandis que l'autre a reçu une perfusion de solution physiologique (placebo). Nous avons évalué les résultats postopératoires, y compris les scores de douleur sur une échelle analogique visuelle, la fréquence d'administration d'analgésie contrôlée par les patients (ACP) et la quantité de fentanyl utilisée. Les nausées et vomissements postopératoires, la durée du séjour hospitalier, l'intervalle avant la reprise d'une alimentation régulière et la satisfaction du patient au moment de son congé ont aussi été consignés. Résultats : Notre étude a regroupé 36 patients. Les caractéristiques démographiques étaient similaires entre les groupes. Les scores de douleur à l'échelle analogique visuelle et la fréquence d'administration de l'ACP ont été significativement moindres dans le groupe sous lidocaïne jusqu'à 24 heures après la chirurgie et la prise de fentanyl a aussi été significativement moindre dans ce groupe jusqu'à 12 heures après la chirurgie, comparativement au groupe témoin. La quantité totale de fentanyl utilisée et la fréquence totale d'administration de l'ACP ont été significativement plus faibles dans le groupe sous lidocaïne que dans le groupe témoin. Aucune différence significative n'a été observée pour ce qui est des nausées et vomissements, du retour à une alimentation régulière, de la durée du séjour hospitalier et de la satisfaction des patients et on n'a rapporté aucun effet secondaire associé à la lidocaïne. Conclusion : La perfusion de lidocaïne intraveineuse atténue la douleur durant la période postopératoire après une gastrectomie subtotale.
Abstract For a class of nonlinear systems which perform a given task repetitively, an extended ty... more Abstract For a class of nonlinear systems which perform a given task repetitively, an extended type of a direct learning control (DLC) is proposed using the information on the (vector) relative degree of the a multi-input multi-output system. DLC method can generate the desired control input directly from prestored control input profiles with different time scales without any repetitive learning process. It is shown that existing DLC methods can be applied only to a certain limited class of nonlinear systems and the information on the relative degree of a nonlinear system is essential to find the desired control input if the system has higher relative degree.
Korean Journal of Hepato-Biliary-Pancreatic Surgery, 2012
The annular pancreas in adults is a rare congenital anomaly that is detected after development of... more The annular pancreas in adults is a rare congenital anomaly that is detected after development of complications, such as gastric outlet obstruction, recurrent pancreatitis, and peptic ulcer. Duodenal bypass is the procedure of choice for treating duodenal obstruction caused by the annular pancreas in both children and adults. Duodenoduodenostomy is routinely performed in neonates and children. In adults, duodenojejunostomy or gastrojejunostomy are recommended, because the duodenum is less mobile. We report a case of annular pancreas in a 33-year-old male that was successfully treated with laparoscopic gastrojejunostomy.
To compare short-term surgical outcomes including financial cost of robotic and laparoscopic gast... more To compare short-term surgical outcomes including financial cost of robotic and laparoscopic gastrectomy. Despite a lack of supporting evidence, robotic surgery has been increasingly adopted as a minimally invasive modality for the treatment of gastric cancer because of its assumed technical superiority over conventional laparoscopy. A prospective, multicenter comparative study was conducted. Patients were matched according to the surgeon, extent of gastric resection, and sex. The primary endpoint was morbidity and mortality. Outcomes were analyzed on an intention-to-treat and per-protocol basis. A total of 434 patients were enrolled for treatment with either robotic (n = 223) or laparoscopic (n = 211) gastrectomy for intention-to-treat analysis, and a total of 370 patients (n = 185 per treatment) were compared in per-protocol analysis. Results were similar between both analyses. In per-protocol analysis, both groups showed similar overall complication rates (robotic = 11.9% vs lapa...
To investigate the weight loss effects with higher sensitivity, disease specific quality of life ... more To investigate the weight loss effects with higher sensitivity, disease specific quality of life (QoL) instruments were important. The Moorehead-Ardelt quality of life questionnaire II (MA-II) is widely used, because it was simple and validated the several languages. The aims of present study was performed the translation of MA-II Korean version and the validation compared with EuroQol-5 dimension (EQ-5D), obesity-related problems scale (OP-scale), and impact of weight quality of life-lite (IWQoL-Lite). The study design was a multicenter, cross-sectional survey and this study was included the postoperative patients. The validation procedure is translation-back translation procedure, pilot study, and field study. The instruments of measuring QoL included the MA-II, EQ-5D, OP-scale, and IWQoL-lite. The reliability was checked through internal consistency using Cronbach alpha coefficients. The construct validity was assessed the Spearman rank correlation between 6 domains of MA-II and ...
This study was designed to evaluate the bacteriological characteristics and antibiotics sensitivi... more This study was designed to evaluate the bacteriological characteristics and antibiotics sensitivity in acute appendicitis. Methods: The microbiologic culture and antibiotics sensitivity tests were done on 165 patients who underwent laparoscopic appendectomy under the diagnosis of acute appendicitis. The postoperative complications were also checked. The microbiologic and clinical results were compared between perforated and non-perforated groups. Results: The most common organism cultured from the periappendiceal fluid was Escherichia coli (51.2%), followed by Enterobacter (16.2%) and Pseudomonas (8.9%). In the antibiotics sensitivity test, ciprofloxacin and levofloxacin were highly susceptible. Ceftriaxone and cefotaxime were also highly susceptible. Piperacillin/tazobactam, imipenem and meropenem were very highly susceptible. The complication rate of perforated appendicitis group (17.9%) was higher than that of the non-perforated appendicitis group (7.1%) (P＜0.001). A surgical drain was used more frequently in perforated group (23% vs 84.6%, P＜0.001). The mean in-patient days were longer in the perforated group (5.7 vs 7.2 days, P＜0.001). In the patients with infectious wound complication, antibiotic resistance was more prominent in the non-perforated group than in the perforated group. Conclusion: In the perforated appendicitis group, more precise and careful procedure was required. In the non-perforated appendicitis group, more prudent use of the available antibiotics to conserve valuable therapeutic resources and improved infection control to limit the spread of resistant organisms was required.
Medical oncology (Northwood, London, England), 2010
Bone morphogenetic protein-2 (BMP-2) was reported to enhance migration, invasion, and metastasis ... more Bone morphogenetic protein-2 (BMP-2) was reported to enhance migration, invasion, and metastasis at the various types of cancer cells. The purpose of this study is to identify the role of BMP-2 in progression of gastric cancer. Forty-four patients with operable gastric cancer were enrolled. Also, twenty healthy volunteers were enrolled as control group. All patients received gastrectomy with D2 lymphadenectomy, and surgical staging was performed. Whole blood was obtained preoperatively in all patients, and serum BMP-2 levels were quantified by commercially available ELISA kit. Immunohistochemical stain for BMP-2 in all gastric cancer tissues was performed using tissue microarray. All patients showed increased serum BMP-2 levels compared with control group, when upper normal limit was defined as the mean of control serum level+2×standard deviation. The mean serum BMP-2 level of lymph node positive group was significantly elevated than that of lymph node-negative group (382.7 pg/ml, 9...
Purpose: Advanced gastric cancer patients have a poorer prognosis as compared to the patients wit... more Purpose: Advanced gastric cancer patients have a poorer prognosis as compared to the patients with early gastric cancer. This study was conducted to define the prognostic factors for advanced gastric cancer. Materials and Methods: 606 patients with advanced gastric cancer who underwent curative gastric resection at our hospital were retrospectively examined. The patients were divided into two groups: group 1 was comprised of patients with a survival time ＜5 years, and group 2 patients had a survival time ≥5 years. We compared clinicopathological characteristics of the two groups by performing univariate and multivariate analysis. We also investigated the prognostic factors according to the stage. Results: On univariate analysis, 7 factors (age, tumor size, Borrmann type, resection type, distal resection margin, depth of invasion and lymph node status) were found to be different, and multivariate analysis revealed that patient age, depth of invasion and lymph node metas-tasis were the only significantly differences between the two groups. On the other hand, age and the Borrmann type for stage I b patients, age and the number of retrieved lymph nodes for stage II patients, tumor size for stage III patients, and the type of resection for stage IV patients were found to be the independent prognostic factors. Conclusion: The age of patients had prognostic value in the early stages of advanced gastric cancers such as stage I b or II. The number greater than 20 retrieved lymph nodes affected the survival, particularly for the patients with stage II disease, and the tumor size was a significant prognostic factor for patients with stage III disease. Therefore, physicians are advised to pay special attention to lymph node dissection for those patients with stage II or III disease.
The aim of this study was to assess clinical correlations with postoperative alteration of p16 DN... more The aim of this study was to assess clinical correlations with postoperative alteration of p16 DNA methylation, and to clarify whether postoperative changes in the serum DNA methylation status of p16 could be used as a reliable prognostic factor for gastric cancer. Materials and Methods: Fifty-three consecutive gastric adenocarcinoma patients who underwent gastric resection (Chung-Ang University Hospital, Seoul, Korea) were included. DNA methylation of p16 was evaluated by methylation-specific polymerase chain reaction using serum DNA preoperatively and at the 10th postoperative day. The correlation between changes in methylation status and patients' prognosis was analyzed. Results: p16 was methylated in 79.2% of preoperative serum DNA and in 54.7% of postoperative serum DNA, respectively. Methylation in p16 disappeared more frequently in patients who underwent standard D2 lymphadenectomy compared to those who underwent modified D1+ lymphadenectomy (P=0.016). Whereas methylation of preoperative serum DNA was not correlated with survival, patients with postoperative disappearance of p16 methylation showed longer survival than those without postoperative disappearance of p16 methylation in the patients who had gastric cancer with lymph node metastasis (P=0.042). Conclusions: Postoperative disappearance of p16 methylation could be an available prognostic factor for node-positive gastric cancer.
Reversal of Hartmann's procedure is a major surgical procedure associated with significant morbid... more Reversal of Hartmann's procedure is a major surgical procedure associated with significant morbidity and mortality. Because of the difficulty of the procedure, laparoscopic reversal of Hartmann's procedure is not well established. We describe our experience with this laparoscopic procedure to assess its difficulty and safety. Five patients (4 men and 1 woman) underwent laparoscopic reversal of Hartmann's procedure (LRHP). The initial surgeries were performed to manage obstructive colorectal cancer for 4 patients, and rectovesical fistula for one patient. The procedure was laparoscopically completed for 4 patients. Conversion to open laparotomy was required for one patient, secondary to massive adhesion in lower abdomen. Transient ileostomies were made in 2 cases. Operative time ranged from 240 to 545 minutes. There was no operative mortality. LRHP can be performed safely by an experienced surgeon. However, it is still technically challenging and time consuming.
Background: Gastric outlet obstruction (GOO) caused by unresectable gastric cancer is a challengi... more Background: Gastric outlet obstruction (GOO) caused by unresectable gastric cancer is a challenging aspect of patient care. There have been no reports involving patients with obstructing gastric cancer and several incurable factors curatively treated by multimodal treatments. Case presentation: We report a case of 55-year-old man who was diagnosed with a poorly differentiated adenocarcinoma in the pre-pyloric antrum with GOO by gastroscopy. An abdominal computed tomography (CT) scan revealed thickening of the gastric wall and adjacent fat infiltration, and a large amount of food in the stomach suggesting a passage disturbance, enlarged lymph nodes along the common hepatic and left gastric arteries, and multiple hepatic metastases. The serum carcinoembryonic antigen (CEA) level was 343 ng/ml and the carbohydrate antigen (CA) 19-9 level was within normal limits. The patient underwent a laparoscopic gastrojejunostomy for palliation of the GOO. On the 3 rd and 12 th days after surgery, he received intraperitoneal chemotherapy with 40 mg of docetaxel and 150 mg of carboplatin. Simultaneously, combined chemotherapy with 85 mg/m 2 of oxaliplatin for the 1 st day and 600 mg/m 2 of 5-FU for 2 days (FOLFOX regimen) was administered from the 8 th post-operative day. After completion of nine courses of FOLFOX, the patient achieved a complete response (CR) with complete disappearance of the primary tumor and the metastatic foci. He underwent a radical subtotal gastrectomy with D3 lymph node dissection 4 months after the initial palliative surgery. The pathologic results revealed no residual primary tumor and no lymph node metastasis in 43 dissected lymph nodes. He has maintained a CR for 18 months since the last operation. Conclusion: Combination chemotherapy with systemic and intraperitoneal chemotherapy following laparoscopic bypass surgery showed marked efficacy in the treatment for unresectable advanced gastric cancer with GOO.
Although high-risk gastrointestinal stromal tumors (GISTs) frequently recur, even after a complet... more Although high-risk gastrointestinal stromal tumors (GISTs) frequently recur, even after a complete resection and imatinib therapy, local recurrence at the suture line after complete resection is rare. The present case was an 88-year-old woman who was initially diagnosed with high-risk GIST without a distant metastasis. She underwent a complete surgical resection of the lesion and received adjuvant imatinib therapy for 18 months, which was discontinued due to severe drug-induced anemia. During the follow-up, an endoscopic examination performed 40 months after the initial surgery revealed local recurrence at the anastomosis site. Although a complete surgical resection was performed, repeated local recurrence was detected 18 months later, which progressed rapidly to metastatic disease. This paper reports a case of a completely resected gastric GIST with repeated local recurrence, despite the complete surgical resections and adjuvant imatinib therapy.
Purpose: Quality of life (QOL) has become important in the trend of emphasizing patient satisfact... more Purpose: Quality of life (QOL) has become important in the trend of emphasizing patient satisfaction. This study aimed to evaluate the QOL in patients who underwent laparoscopic or robotic gastrectomy for gastric cancer. Methods: A prospective trial was performed involving patients who underwent laparoscopic or robotic gastrectomy for primary gastric cancer at 11 hospitals in Korea. Within this comparative trial, QOL, postoperative pain, and long-term complications were exanimated. The quality-of-life questionnaire (QLQ)-C30 and QLQ-STO22 developed by the European Organization for Research and Treatment of Cancer were used for the QOL survey. We compared the data after dividing it into several types of characteristics as follows; device (robotic or laparoscopic), operation type, pathological stage, and sex. Biased components were extracted by logistic regression analysis. Propensity score matching was applied to the data set with the biased components. Results: In total, 434 patients (211 for laparoscopic surgery and 223 for robotic surgery) were enrolled, out of which 321 patients who responded to both preoperative and postoperative surveys were selected for analysis. Robotic gastrectomy was not different from laparoscopic gastrectomy with respect to postoperative QOL. Distal gastrectomy showed better scores than total gastrectomy in terms of role functioning, social functioning, fatigue, nausea/vomiting, pain, dyspnea, constipation, financial difficulties, dysphagia, eating restrictions, anxiety, taste, and body image. Male patients showed better scores on the 19 scales compared to female patients. Conclusion: Robotic and laparoscopic approaches for gastric cancer surgery did not differ from each other with respect to QOL. Distal gastrectomy resulted in better QOL than total gastrectomy.
4025Background: Robotic gastrectomy for gastric cancer has been proven to be a feasible and safe ... more 4025Background: Robotic gastrectomy for gastric cancer has been proven to be a feasible and safe minimally invasive procedure. However, our previous multicenter prospective study indicated that robotic gastrectomy is not superior to laparoscopic gastrectomy. This study aimed to identify which subgroups of patients would benefit from robotic gastrectomy over conventional laparoscopic gastrectomy. Methods: A prospective multicenter comparative study was conducted. Surgical outcomes were compared between the robotic and laparoscopic groups. The analysis was conducted in each subgroup according to the patients’ obesity status, the type of gastrectomy, and the extent of lymph node dissection. Results: A total of 434 patients were enrolled for the robotic (n = 223) and laparoscopic (n = 211) groups. According to obesity and gastrectomy type, there was no difference in the estimated blood loss (EBL), number of retrieved lymph nodes (RLN), complication rate, open conversion rate, and the length of hospital stay b...
Long-term results following bariatric surgery compared to conventional treatments has never been ... more Long-term results following bariatric surgery compared to conventional treatments has never been reported in morbidly obese Korean patients. This study aimed to evaluate the long-term efficacy of bariatric surgery in morbidly obese Korean patients compared to conventional medical treatments. Methods: In this multicenter retrospective cohort study, we reviewed 137 obese subjects between January 2008 and February 2011 with a body mass index (BMI) > 30 kg/m 2 who had more than 5 years of follow-up clinical data after bariatric surgery (surgery group, n = 49) or conventional treatment (conventional treatment group, n = 88). Anthropometric data and the status of comorbidities were compared between the 2 groups. Results: The median follow-up period was 72.1 months (range 19.3-109.7 months). At the last follow-up, the surgery group showed a greater amount of total weight loss than the conventional treatment group (24.9% vs. 2.8%, P < 0.001). The prevalence of diabetes and hypertension significantly decreased in the surgery group, while the conventional treatment group showed a marked increase in these comorbidities. In the surgery group, Roux-en-Y gastric bypass and sleeve gastrectomy achieved comparable long-term weight loss (26.5% vs. 22.4%, respectively; P = 0.087). Conclusion: In the long-term, bariatric surgery achieved and maintained significantly greater weight reduction, as well as a decrease in obesity-related comorbidities, than did conventional medical therapy in morbidly obese Korean patients.
To investigate the current status of adjuvant chemotherapy (AC) regimens in Korea and the differe... more To investigate the current status of adjuvant chemotherapy (AC) regimens in Korea and the difference in efficacy of AC administered by surgical and medical oncologists in patients with stage II or III gastric cancers. We performed a retrospective observational study among 1,049 patients who underwent curative resection and received AC for stage II and III gastric cancers between February 2012 and December 2013 at 29 tertiary referral university hospitals in Korea. To minimize the influence of potential confounders on selection bias, propensity score matching (PSM) was used based on binary logistic regression analysis. The 3-year disease-free survival (DFS) rates were compared between patients who received AC administered by medical oncologists or surgical oncologists. Between February 2012 and December 2013 in Korea, the most commonly prescribed AC by medical oncologists was tegafur/gimeracil/oteracil (S-1, 47.72%), followed by capecitabine with oxaliplatin (XELOX, 16.33%). After pe...
Laparoscopic total fundoplication is the standard surgery for gastroesophageal reflux disease. Ho... more Laparoscopic total fundoplication is the standard surgery for gastroesophageal reflux disease. However, partial fundoplication may be a viable alternative. Here, we conducted a nationwide survey of partial fundoplication in Korea. The Korean Anti-Reflux Surgery study group recorded 32 cases of partial fundoplication at eight hospitals between September 2009 and January 2016. The surgical outcomes and postoperative adverse symptoms in these cases were evaluated and compared with 86 cases of total fundoplication. Anterior partial fundoplication was performed in 20 cases (62.5%) and posterior in 12 (37.5%). In most cases, partial fundoplication was a secondary procedure after operations for other conditions. Half of patients who underwent partial fundoplication had typical symptoms at the time of initial diagnosis, and most of them showed excellent (68.8%), good (25.0%), or fair (6.3%) symptom resolution at discharge. Compared to total fundoplication, partial fundoplication showed no d...
Background: Pre-emptive intravenous lidocaine infusion is known to improve postoperative pain in ... more Background: Pre-emptive intravenous lidocaine infusion is known to improve postoperative pain in abdominal surgery. We assessed the effect of intravenous lidocaine infusion in patients who underwent subtotal gastrectomy. Methods: We conducted a double-blind, placebo-controlled study with patients undergoing subtotal gastrectomy for early gastric cancer divided into 2 groups: 1 group received intravenous lidocaine infusion preoperatively and throughout surgery, and the other received normal saline infusion (placebo). We assessed postoperative outcomes, including pain scores on a visual analogue scale (VAS), administration frequency of patient-controlled analgesia (PCA) and the amount of consumed fentanyl. Postoperative nausea and vomiting, length of hospital stay (LOS), time to return to regular diet and patient satisfaction at discharge were evaluated. Results: There were 36 patients in our study. Demographic characteristics were similar between the groups. The VAS pain scores and administration frequency of PCA were significantly lower in the lidocaine group until 24 hours after surgery, and fentanyl consumption was significantly lower in this group until 12 hours postoperatively compared with the placebo group. The total amount of consumed fentanyl and the total administration frequency of PCA were significantly lower in the lidocaine than the control group. No significant differences were detected in terms of nausea and vomiting, return to regular diet, LOS and patient satisfaction, and there were no reported side-effects of lidocaine. Conclusion: Intravenous lidocaine infusion reduces pain during the postoperative period after subtotal gastrectomy. Contexte : Administrée à titre préventif, la perfusion intraveineuse de lidocaïne améliorerait la douleur postopératoire dans la chirurgie abdominale. Nous avons mesuré l'effet d'une perfusion intraveineuse de lidocaïne chez des patients soumis à une gastrectomie subtotale. Méthodes : Nous avons réalisé une étude à double insu avec témoins sous placebo auprès de patients soumis à une gastrectomie subtotale pour un cancer de l'estomac au premier stade. Les patients ont été répartis en 2 groupes : l'un a reçu une perfusion intraveineuse de lidocaïne en préopératoire et tout au long de la chirurgie, tandis que l'autre a reçu une perfusion de solution physiologique (placebo). Nous avons évalué les résultats postopératoires, y compris les scores de douleur sur une échelle analogique visuelle, la fréquence d'administration d'analgésie contrôlée par les patients (ACP) et la quantité de fentanyl utilisée. Les nausées et vomissements postopératoires, la durée du séjour hospitalier, l'intervalle avant la reprise d'une alimentation régulière et la satisfaction du patient au moment de son congé ont aussi été consignés. Résultats : Notre étude a regroupé 36 patients. Les caractéristiques démographiques étaient similaires entre les groupes. Les scores de douleur à l'échelle analogique visuelle et la fréquence d'administration de l'ACP ont été significativement moindres dans le groupe sous lidocaïne jusqu'à 24 heures après la chirurgie et la prise de fentanyl a aussi été significativement moindre dans ce groupe jusqu'à 12 heures après la chirurgie, comparativement au groupe témoin. La quantité totale de fentanyl utilisée et la fréquence totale d'administration de l'ACP ont été significativement plus faibles dans le groupe sous lidocaïne que dans le groupe témoin. Aucune différence significative n'a été observée pour ce qui est des nausées et vomissements, du retour à une alimentation régulière, de la durée du séjour hospitalier et de la satisfaction des patients et on n'a rapporté aucun effet secondaire associé à la lidocaïne. Conclusion : La perfusion de lidocaïne intraveineuse atténue la douleur durant la période postopératoire après une gastrectomie subtotale.
Abstract For a class of nonlinear systems which perform a given task repetitively, an extended ty... more Abstract For a class of nonlinear systems which perform a given task repetitively, an extended type of a direct learning control (DLC) is proposed using the information on the (vector) relative degree of the a multi-input multi-output system. DLC method can generate the desired control input directly from prestored control input profiles with different time scales without any repetitive learning process. It is shown that existing DLC methods can be applied only to a certain limited class of nonlinear systems and the information on the relative degree of a nonlinear system is essential to find the desired control input if the system has higher relative degree.
Korean Journal of Hepato-Biliary-Pancreatic Surgery, 2012
The annular pancreas in adults is a rare congenital anomaly that is detected after development of... more The annular pancreas in adults is a rare congenital anomaly that is detected after development of complications, such as gastric outlet obstruction, recurrent pancreatitis, and peptic ulcer. Duodenal bypass is the procedure of choice for treating duodenal obstruction caused by the annular pancreas in both children and adults. Duodenoduodenostomy is routinely performed in neonates and children. In adults, duodenojejunostomy or gastrojejunostomy are recommended, because the duodenum is less mobile. We report a case of annular pancreas in a 33-year-old male that was successfully treated with laparoscopic gastrojejunostomy.
To compare short-term surgical outcomes including financial cost of robotic and laparoscopic gast... more To compare short-term surgical outcomes including financial cost of robotic and laparoscopic gastrectomy. Despite a lack of supporting evidence, robotic surgery has been increasingly adopted as a minimally invasive modality for the treatment of gastric cancer because of its assumed technical superiority over conventional laparoscopy. A prospective, multicenter comparative study was conducted. Patients were matched according to the surgeon, extent of gastric resection, and sex. The primary endpoint was morbidity and mortality. Outcomes were analyzed on an intention-to-treat and per-protocol basis. A total of 434 patients were enrolled for treatment with either robotic (n = 223) or laparoscopic (n = 211) gastrectomy for intention-to-treat analysis, and a total of 370 patients (n = 185 per treatment) were compared in per-protocol analysis. Results were similar between both analyses. In per-protocol analysis, both groups showed similar overall complication rates (robotic = 11.9% vs lapa...
To investigate the weight loss effects with higher sensitivity, disease specific quality of life ... more To investigate the weight loss effects with higher sensitivity, disease specific quality of life (QoL) instruments were important. The Moorehead-Ardelt quality of life questionnaire II (MA-II) is widely used, because it was simple and validated the several languages. The aims of present study was performed the translation of MA-II Korean version and the validation compared with EuroQol-5 dimension (EQ-5D), obesity-related problems scale (OP-scale), and impact of weight quality of life-lite (IWQoL-Lite). The study design was a multicenter, cross-sectional survey and this study was included the postoperative patients. The validation procedure is translation-back translation procedure, pilot study, and field study. The instruments of measuring QoL included the MA-II, EQ-5D, OP-scale, and IWQoL-lite. The reliability was checked through internal consistency using Cronbach alpha coefficients. The construct validity was assessed the Spearman rank correlation between 6 domains of MA-II and ...
This study was designed to evaluate the bacteriological characteristics and antibiotics sensitivi... more This study was designed to evaluate the bacteriological characteristics and antibiotics sensitivity in acute appendicitis. Methods: The microbiologic culture and antibiotics sensitivity tests were done on 165 patients who underwent laparoscopic appendectomy under the diagnosis of acute appendicitis. The postoperative complications were also checked. The microbiologic and clinical results were compared between perforated and non-perforated groups. Results: The most common organism cultured from the periappendiceal fluid was Escherichia coli (51.2%), followed by Enterobacter (16.2%) and Pseudomonas (8.9%). In the antibiotics sensitivity test, ciprofloxacin and levofloxacin were highly susceptible. Ceftriaxone and cefotaxime were also highly susceptible. Piperacillin/tazobactam, imipenem and meropenem were very highly susceptible. The complication rate of perforated appendicitis group (17.9%) was higher than that of the non-perforated appendicitis group (7.1%) (P＜0.001). A surgical drain was used more frequently in perforated group (23% vs 84.6%, P＜0.001). The mean in-patient days were longer in the perforated group (5.7 vs 7.2 days, P＜0.001). In the patients with infectious wound complication, antibiotic resistance was more prominent in the non-perforated group than in the perforated group. Conclusion: In the perforated appendicitis group, more precise and careful procedure was required. In the non-perforated appendicitis group, more prudent use of the available antibiotics to conserve valuable therapeutic resources and improved infection control to limit the spread of resistant organisms was required.
Medical oncology (Northwood, London, England), 2010
Bone morphogenetic protein-2 (BMP-2) was reported to enhance migration, invasion, and metastasis ... more Bone morphogenetic protein-2 (BMP-2) was reported to enhance migration, invasion, and metastasis at the various types of cancer cells. The purpose of this study is to identify the role of BMP-2 in progression of gastric cancer. Forty-four patients with operable gastric cancer were enrolled. Also, twenty healthy volunteers were enrolled as control group. All patients received gastrectomy with D2 lymphadenectomy, and surgical staging was performed. Whole blood was obtained preoperatively in all patients, and serum BMP-2 levels were quantified by commercially available ELISA kit. Immunohistochemical stain for BMP-2 in all gastric cancer tissues was performed using tissue microarray. All patients showed increased serum BMP-2 levels compared with control group, when upper normal limit was defined as the mean of control serum level+2×standard deviation. The mean serum BMP-2 level of lymph node positive group was significantly elevated than that of lymph node-negative group (382.7 pg/ml, 9...
Purpose: Advanced gastric cancer patients have a poorer prognosis as compared to the patients wit... more Purpose: Advanced gastric cancer patients have a poorer prognosis as compared to the patients with early gastric cancer. This study was conducted to define the prognostic factors for advanced gastric cancer. Materials and Methods: 606 patients with advanced gastric cancer who underwent curative gastric resection at our hospital were retrospectively examined. The patients were divided into two groups: group 1 was comprised of patients with a survival time ＜5 years, and group 2 patients had a survival time ≥5 years. We compared clinicopathological characteristics of the two groups by performing univariate and multivariate analysis. We also investigated the prognostic factors according to the stage. Results: On univariate analysis, 7 factors (age, tumor size, Borrmann type, resection type, distal resection margin, depth of invasion and lymph node status) were found to be different, and multivariate analysis revealed that patient age, depth of invasion and lymph node metas-tasis were the only significantly differences between the two groups. On the other hand, age and the Borrmann type for stage I b patients, age and the number of retrieved lymph nodes for stage II patients, tumor size for stage III patients, and the type of resection for stage IV patients were found to be the independent prognostic factors. Conclusion: The age of patients had prognostic value in the early stages of advanced gastric cancers such as stage I b or II. The number greater than 20 retrieved lymph nodes affected the survival, particularly for the patients with stage II disease, and the tumor size was a significant prognostic factor for patients with stage III disease. Therefore, physicians are advised to pay special attention to lymph node dissection for those patients with stage II or III disease.
The aim of this study was to assess clinical correlations with postoperative alteration of p16 DN... more The aim of this study was to assess clinical correlations with postoperative alteration of p16 DNA methylation, and to clarify whether postoperative changes in the serum DNA methylation status of p16 could be used as a reliable prognostic factor for gastric cancer. Materials and Methods: Fifty-three consecutive gastric adenocarcinoma patients who underwent gastric resection (Chung-Ang University Hospital, Seoul, Korea) were included. DNA methylation of p16 was evaluated by methylation-specific polymerase chain reaction using serum DNA preoperatively and at the 10th postoperative day. The correlation between changes in methylation status and patients' prognosis was analyzed. Results: p16 was methylated in 79.2% of preoperative serum DNA and in 54.7% of postoperative serum DNA, respectively. Methylation in p16 disappeared more frequently in patients who underwent standard D2 lymphadenectomy compared to those who underwent modified D1+ lymphadenectomy (P=0.016). Whereas methylation of preoperative serum DNA was not correlated with survival, patients with postoperative disappearance of p16 methylation showed longer survival than those without postoperative disappearance of p16 methylation in the patients who had gastric cancer with lymph node metastasis (P=0.042). Conclusions: Postoperative disappearance of p16 methylation could be an available prognostic factor for node-positive gastric cancer.
Reversal of Hartmann's procedure is a major surgical procedure associated with significant morbid... more Reversal of Hartmann's procedure is a major surgical procedure associated with significant morbidity and mortality. Because of the difficulty of the procedure, laparoscopic reversal of Hartmann's procedure is not well established. We describe our experience with this laparoscopic procedure to assess its difficulty and safety. Five patients (4 men and 1 woman) underwent laparoscopic reversal of Hartmann's procedure (LRHP). The initial surgeries were performed to manage obstructive colorectal cancer for 4 patients, and rectovesical fistula for one patient. The procedure was laparoscopically completed for 4 patients. Conversion to open laparotomy was required for one patient, secondary to massive adhesion in lower abdomen. Transient ileostomies were made in 2 cases. Operative time ranged from 240 to 545 minutes. There was no operative mortality. LRHP can be performed safely by an experienced surgeon. However, it is still technically challenging and time consuming.
Background: Gastric outlet obstruction (GOO) caused by unresectable gastric cancer is a challengi... more Background: Gastric outlet obstruction (GOO) caused by unresectable gastric cancer is a challenging aspect of patient care. There have been no reports involving patients with obstructing gastric cancer and several incurable factors curatively treated by multimodal treatments. Case presentation: We report a case of 55-year-old man who was diagnosed with a poorly differentiated adenocarcinoma in the pre-pyloric antrum with GOO by gastroscopy. An abdominal computed tomography (CT) scan revealed thickening of the gastric wall and adjacent fat infiltration, and a large amount of food in the stomach suggesting a passage disturbance, enlarged lymph nodes along the common hepatic and left gastric arteries, and multiple hepatic metastases. The serum carcinoembryonic antigen (CEA) level was 343 ng/ml and the carbohydrate antigen (CA) 19-9 level was within normal limits. The patient underwent a laparoscopic gastrojejunostomy for palliation of the GOO. On the 3 rd and 12 th days after surgery, he received intraperitoneal chemotherapy with 40 mg of docetaxel and 150 mg of carboplatin. Simultaneously, combined chemotherapy with 85 mg/m 2 of oxaliplatin for the 1 st day and 600 mg/m 2 of 5-FU for 2 days (FOLFOX regimen) was administered from the 8 th post-operative day. After completion of nine courses of FOLFOX, the patient achieved a complete response (CR) with complete disappearance of the primary tumor and the metastatic foci. He underwent a radical subtotal gastrectomy with D3 lymph node dissection 4 months after the initial palliative surgery. The pathologic results revealed no residual primary tumor and no lymph node metastasis in 43 dissected lymph nodes. He has maintained a CR for 18 months since the last operation. Conclusion: Combination chemotherapy with systemic and intraperitoneal chemotherapy following laparoscopic bypass surgery showed marked efficacy in the treatment for unresectable advanced gastric cancer with GOO.
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Papers by Joong-Min Park