Publications by authors named "Duk Hwan Moon"

23 Publications

  • Page 1 of 1

Huge Pulmonary Sclerosing Pneumocytoma with Endobronchial Invasion: A Case Report with a Literature Review.

J Chest Surg 2021 May 27. Epub 2021 May 27.

Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

Pulmonary sclerosing pneumocytoma (PSP) is a tumor of pneumocytic origin that is classified as a benign neoplasm. To date, aggressive behavior of this tumor has rarely been reported. Here, we describe a case of a 56-year-old woman with a huge, 19-cm PSP that resulted in mediastinal shift and showed microscopic endobronchial invasion and necrosis. The differential diagnosis included malignant mesenchymal tumors, such as solitary fibrous tumor; however, PSP was confirmed based on the characteristic thyroid transcription factor 1 positivity and membranous expression of Ki-67 on immunohistochemical staining of tumor cells.
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http://dx.doi.org/10.5090/jcs.21.016DOI Listing
May 2021

Comparison of EQ-5D-3L and metabolic components between patients with hyperhidrosis and the general population: a propensity score matching analysis.

Qual Life Res 2021 Sep 11;30(9):2591-2599. Epub 2021 May 11.

Department of Family Medicine, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, Korea.

Purpose: It is important to understand the characteristics of patients with hyperhidrosis, which are different from the general population, for treating hyperhidrosis. Sympathetic overactivity, which might play an important role in hyperhidrosis, can contribute to metabolic diseases and the decreased quality of life (QoL). We compared the metabolic components and health-related QoL between patients with hyperhidrosis and the general population.

Methods: We conducted a case-control study and compared the characteristics of the patients (N = 196) with hyperhidrosis and propensity score-matched controls (N = 196) selected from the Korean National Health and Nutrition Examination Survey. Metabolic components and EQ-5D-3L (EQ-5D) index were compared using a two-way mixed analysis of covariance after adjusting for confounders.

Results: Patients with hyperhidrosis had significantly higher waist circumference (estimated mean values ± SD for patients and the control group, 85.5  ±  10.8 cm vs 81.3  ±  10.3 cm, p < 0.001), blood pressure (SBP, 121.1  ±  16.9 vs 111.7  ±  10.3, p < 0.001 AND DBP, 77.5  ±  12.8 vs 73.6  ±  8.6, p < 0.001, respectively), fasting glucose (97.1  ±  11.3 vs 91.5  ±  9.2, p < 0.001), and the number of components of metabolic syndrome (1.4  ±  1.3 vs 1.0  ±  1.2, p = 0.002), and significantly lower estimated glomerular filtration rate (144.3  ±  53.2 vs 158.3  ±  55.7, p = 0.002) and EQ-5D values (estimated mean values (standard error) for patients and the control group, 0.92 (0.01) vs 0.97 (0.01), p < 0.001) compared to the control group after adjustment.

Conclusion: The patients with hyperhidrosis had more central obesity and unfavorable metabolic parameters and a lower EQ-5D index compared with the general population, emphasizing clinical importance of hyperhidrosis to be cured in aspect of metabolic components as well as patients' QOL.
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http://dx.doi.org/10.1007/s11136-021-02856-8DOI Listing
September 2021

Surgical outcomes of pulmonary metastasectomy in hepatocellular carcinoma patients according to approach method: thoracoscopic versus open approach.

World J Surg Oncol 2021 Jan 30;19(1):33. Epub 2021 Jan 30.

Department of Thoracic & Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

Background: The role of surgical intervention as a treatment for pulmonary metastasis (PM) from hepatocellular carcinoma (HCC) has not been established. In this study, we investigated the clinical outcomes of pulmonary metastasectomy. Using propensity score matching (PSM) analysis, we compared the results according to the surgical approach: video-assisted thoracic surgery (VATS) versus the open method.

Methods: A total of 134 patients (115 men) underwent pulmonary metastasectomy for isolated PM of HCC between January 1998 and December 2010 at Seoul Asan Medical Center. Of these, 84 underwent VATS (VATS group) and 50 underwent thoracotomy or sternotomy (open group). PSM analysis between the groups was used to match them based on the baseline characteristics of the patients.

Results: During the median follow-up period of 33.4 months (range, 1.8-112.0), 113 patients (84.3%) experienced recurrence, and 100 patients (74.6%) died of disease progression. There were no overall survival rate, disease-free survival rate, and pulmonary-specific disease-free survival rate differences between the VATS and the open groups (p = 0.521, 0.702, and 0.668, respectively). Multivariate analysis revealed local recurrence of HCC, history of liver cirrhosis, and preoperative alpha-fetoprotein level as independent prognostic factors for overall survival (hazard ratio, 1.729/2.495/2.632, 95% confidence interval 1.142-2.619/1.571-3.963/1.554-4.456; p = 0.010/< 0.001/< 0.001, respectively).

Conclusions: Metastasectomy can be considered a potential alternative for selected patients. VATS metastasectomy had outcomes comparable to those of open metastasectomy.
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http://dx.doi.org/10.1186/s12957-021-02138-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7847567PMC
January 2021

Size and extranodal extension of metastatic lymph nodes in lung adenocarcinoma.

J Thorac Dis 2020 Nov;12(11):6514-6522

Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.

Background: This study assessed the prognostic significance of metastatic lymph node size (MLNS) and extranodal extension (EN) in patients with node-positive lung adenocarcinoma (ADC).

Methods: Prognostic factors influencing survival were analyzed, including age, sex, extent of operation, T- and N-stage, size of tumor, postoperative chemotherapy, presence of EN, and MLNS (>7.0 ≤7.0 mm).

Results: Three hundred seventy-five patients met the inclusion criteria were enrolled (mean age: 59.8±10.5 years). Increasing MLNS was significantly correlated with large tumor size (P=0.015), advanced N status (P<0.001), and presence of EN (P<0.001). In multivariable analysis, large tumor size [hazard ratio (HR) 1.135, 95% confidence interval (CI): 1.050 to 1.228, P<0.001], adjuvant chemotherapy (HR 0.582, 95% CI: 0.430 to 0.787, P<0.001), EN (HR 1.454, 95% CI: 1.029 to 2.055, P=0.034), and MLNS greater than 7 mm (HR 1.741, 95% CI: 1.238 to 2.447, P<0.001) were significant prognostic factors for survival. Patients were classified into 3 groups: Group A, MLNS ≤7.0 mm/EN (-); Group B, MLNS ≤7.0 mm/EN (+) or MLNS >7.0 mm/EN (-); and Group C, MLNS >7.0 mm/EN (+). The 5-year overall survival (OS) was 72.2%, 59.0%, and 38.5% in Groups A, B and C, respectively (P<0.001).

Conclusions: The MLNS and presence of EN could provide an important prognostic implication for patients with node-positive lung ADC.
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http://dx.doi.org/10.21037/jtd-20-2039DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7711416PMC
November 2020

Percutaneous Cryoablation of Multiple Pulmonary Endometriosis.

J Chest Surg 2021 Feb;54(1):75-78

Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

Minimally invasive cryoablation is often considered for lung tumor patients with high surgical risk or inoperable metastatic lung tumors. Cryoablation is a type of thermal percutaneous ablation in which argon and helium gases are delivered via a cryoprobe to induce tissue freezing and necrosis. We report the case of a 23-year-old woman who had suffered from multiple pulmonary endometriosis with frequent intermittent hemoptysis during menstruation for 6 years prior to her visit. She was treated with cryoablation at our hospital, and since her treatment, she has been doing well with no hemoptysis for at least 6 months. Although endometriosis is a benign lung disease, cryoablation is an ideal and effective treatment option for patients with multiple endometriosis.
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http://dx.doi.org/10.5090/kjtcs.20.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7946532PMC
February 2021

The effectiveness of double-bar correction for pectus excavatum: A comparison between the parallel bar and cross-bar techniques.

PLoS One 2020 17;15(9):e0238539. Epub 2020 Sep 17.

Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.

Purpose: To compare the effectiveness between parallel bar and cross-bar techniques for treating pectus excavatum.

Methods: A total of 80 patients who underwent parallel bar insertion (group 1) or cross-bar insertion (group 2) were evaluated retrospectively. From the pre- and post-operative chest CT images, vertebral-level-specific pectus indices were defined as the ratio of the maximum transverse diameter to the anteroposterior diameter of the thoracic cavity at a specific vertebral level and measured at 3 levels up (3Up-PI, 2Up-PI, 1Up-PI) and 1 vertebral level down (1Down-PI) from the narrowest point. The effectiveness of double-bar correction was compared between the 2 groups using postoperative vertebral level-specific pectus index changes.

Results: A total of 44 patients were enrolled in group 1, and 36 patients were enrolled in group 2. Preoperative pectus index values were not different between the 2 groups (4.5 ± 1.0 vs. 4.9 ± 1.5, P = 0.135). After double-bar correction, pectus index significantly decreased in both groups. There were no differences in postoperative pectus indices between the 2 groups (2.7 ± 0.4 vs. 2.6 ± 0.3, P = 0.197). Postoperative changes in 3Up-PI, 2Up-PI, and 1Up-PI were not significantly different between the 2 groups (P > 0.05). However, postoperative changes at the narrowest level and at 1Down-PI were significantly greater in group 2 than in group 1 (1.78 ± 0.85 vs. 2.32 ± 1.44, P = 0.009; 1.21 ± 0.70 vs. 1.70 ± 1.20, P = 0.009, respectively).

Conclusions: Double-bar correction appears to be effective for treating pectus excavatum. The cross-bar insertion technique might be superior to the parallel bar insertion technique for correcting a wider range of deformities, especially at the lower part of the depression.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0238539PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7498055PMC
October 2020

Usefulness of 3-Dimensional Body Surface Scanning in the Evaluation of Patients with Pectus Carinatum.

Korean J Thorac Cardiovasc Surg 2020 Oct;53(5):301-305

Department of Thoracic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

Background: Radiographic modalities have been commonly used to evaluate pectus carinatum (PC), and compressive orthotic bracing is the most widely accepted treatment method. The aim of this study was to determine the efficacy of 3-dimensional (3D) body surface scanning as an alternative modality for the evaluation of PC.

Methods: The medical records of 63 patients with PC who were treated with compressive orthotic bracing therapy between July 2017 and February 2019 were retrospectively analyzed. Using both 2-view chest radiography (posteroanterior and lateral view) and 3D body scanning, the height of maximal protrusion of the chest wall was measured both before and after 2 weeks of bracing therapy. The difference between the pre- and post-treatment measurements was calculated for both modalities, and these differences were compared and analyzed.

Results: Based on the comparison between the pre- and post-treatment radiographs, bracing therapy produced favorable outcomes in all patients (p<0.001). The measurements obtained via 3D scanning were strongly correlated with those obtained via chest radiography (r=0.60).

Conclusion: Based on the findings of this study, 3D body surface scanning appears to be an effective, radiation-free, and simple method for the post-treatment follow-up evaluation of PC, and thus can be considered an alternative to radiography.
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http://dx.doi.org/10.5090/kjtcs.20.042DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7553828PMC
October 2020

To avoid compensatory hyperhidrosis after sympathetic surgery for craniofacial hyperhidrosis.

J Thorac Dis 2020 May;12(5):2529-2535

Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.

Background: Endoscopic thoracic sympathectomy (ETS) has not been widely adopted for treating craniofacial hyperhidrosis (CFH) due to its known postoperative complication, compensatory hyperhidrosis (CH). In this study, we evaluated whether the autonomic nerve analysis data via pre-ETS heart rate variability (HRV) test can predict post-ETS CH in patients with CFH.

Methods: From October 2017 to March 2019, we consecutively included CFH patients who underwent ETS and received preoperative HRV. In this prospective observational study, we evaluated those who developed CH 3 months postoperatively. The CH grades were categorized into none, mild, moderate, and severe.

Results: A total of 53 patients were included; the mean age was 42.5±13.2 years, and there were 41 males (77.4%). Twenty-six (49.1%) patients had a post-ETS CH grade of greater than moderate (moderate and severe). We further classified the group into trivial and serious compensation, based on the CH grade for comparison. Among the various HRV values, low frequency/high frequency (LF/HF) value was the only one that achieved statistical significance (P=0.025). Moreover, among those in the trivial compensatory group, 23 (85.2%) patients had an LF/HF value between 0.66 and 2.60, and therefore, were included in the autonomic balanced group. On the other hand, among those in the serious compensatory group, 24 patients (92.3%) had an LF/HF value of less than 0.66 and greater than 2.60, and thus, in the autonomic dysfunction group.

Conclusions: According to the present study, HRV test, especially the HF/LF value, appears to be a useful test in predicting post-ETS serious CH.
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http://dx.doi.org/10.21037/jtd.2020.03.28DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7330312PMC
May 2020

Efficacy and Cost-Effectiveness of Portable Small-Bore Chest Tube (Thoracic Egg Catheter) in Spontaneous Pneumothorax.

Korean J Thorac Cardiovasc Surg 2020 Apr;53(2):49-52

Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

Background: Primary spontaneous pneumothorax is commonly treated with chest tube insertion, which requires hospitalization. In this study, we evaluated the efficacy, costs, and benefits of a portable small-bore chest tube (Thoracic Egg; Sumitomo Bakelite Co. Ltd., Tokyo, Japan) compared with a conventional chest tube.

Methods: We retrospectively analyzed all primary spontaneous pneumothorax patients who underwent treatment at Gangnam Severance Hospital between August 2014 and May 2018.

Results: A total of 279 patients were divided into 2 groups: the conventional group (n=236) and the Thoracic Egg group (n=43). Of the 236 patients in the conventional group, 100 were excluded because they underwent surgery during the study period. The efficacy and cost were compared between the 2 groups. There was no statistically significant difference between the groups regarding recurrence (conventional group, 36 patients [26.5%]; Thoracic Egg group, 15 patients [29.4%]; p=0.287). However, the Egg group had statistically significantly lower mean medical expenses than the conventional group (433,413 Korean won and 522,146 Korean won, respectively; p<0.001).

Conclusion: Although portable small-bore chest tubes may not be significantly more efficacious than conventional chest tubes, their use is significantly less expensive. We believe that the Thoracic Egg catheter could be a less costly alternative to conventional chest tube insertion.
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http://dx.doi.org/10.5090/kjtcs.2020.53.2.49DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7155180PMC
April 2020

Significance of the lobe-specific emphysema index to predict prolonged air leak after anatomical segmentectomy.

PLoS One 2019 5;14(11):e0224519. Epub 2019 Nov 5.

Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.

Prolonged air leak (PAL) is a major complication of pulmonary resection. Emphysema quantification with computed tomography is regarded as an important predictor of PAL for patients undergoing lobectomy. Therefore, we investigated whether this predictor might be applicable for segmentectomy. Herein, we characterized the factors that influence PAL in early stage lung cancer patients undergoing anatomical segmentectomy. Forty-one patients who underwent anatomical segmentectomy for early lung cancer between January 2014 and July 2017 were included for analysis. Several baseline and surgical variables were evaluated. In particular, the emphysema index (EI, %) and lobe-specific emphysema index (LEI, %) were assessed by using three-dimensional volumetric CT scan. PAL was observed in 13 patients (31.7%). There were statistically significant differences in DLCO (97.3% ± 18.3% vs. 111.7% ± 15.9%, p = 0.014), EI (4.61% ± 4.66% vs. 1.17% ± 1.76%, p = 0.023), and LEI (5.81% ± 5.78% vs. 0.76% ± 1.17%, p = 0.009) between patients with and without PAL. According to logistic regression analysis, both EI and LEI were significantly associated with PAL (p = 0.028 and p < 0.001, respectively). We found that EI and LEI significantly influenced the development of PAL after pulmonary resection. In particular, LEI showed stronger association with PAL, compared with EI, suggesting the importance of LEI in the prediction of PAL after anatomical segmentectomy.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0224519PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6830768PMC
April 2020

Hyperhidrosis, Endoscopic Thoracic Sympathectomy, and Cardiovascular Outcomes: A Cohort Study Based on the Korean Health Insurance Review and Assessment Service Database.

Int J Environ Res Public Health 2019 10 15;16(20). Epub 2019 Oct 15.

Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Korea.

Sympathetic overactivity is associated with hyperhidrosis and cardiovascular diseases. Endoscopic thoracic sympathectomy (ETS) is a treatment for hyperhidrosis. We aimed to compare the risk for cardiovascular events between individuals with and without hyperhidrosis and investigate the effects of ETS on cardiovascular outcomes. We conducted a nationwide population-based cohort study using data acquired from the Korean Health Insurance Review and Assessment Service. Subjects newly diagnosed with hyperhidrosis in 2010 were identified and divided into two groups according to whether or not they underwent ETS. Propensity scores were calculated using a logistic regression model to match hyperhidrosis patients with control subjects. Combined cardiovascular events were defined as stroke and ischemic heart diseases. Subjects were followed up until the first cardiovascular event or 31 December 2017. The risk for cardiovascular events with hyperhidrosis and ETS was analyzed using Cox proportional hazards regression analysis. The risk for stroke was significantly higher in the hyperhidrosis group than in the control group (hazard ratio (HR), 1.28; 95% confidence interval (CI), 1.08-1.51); nonetheless, no significant difference in the risk for ischemic heart diseases was observed between the hyperhidrosis group and the control group (HR, 1.17; 95% CI, 0.99-1.31). Hyperhidrosis patients who did not undergo ETS were at significantly higher risk for cardiovascular events than the control group (HR, 1.28; 95% CI, 1.13-1.45). However, no significant difference in the risk for cardiovascular events was observed between hyperhidrosis patients who underwent ETS and the control group. Hyperhidrosis increases the risk for cardiovascular events. ETS could reduce this risk and needs to be considered for high-risk patients with cardiovascular diseases.
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http://dx.doi.org/10.3390/ijerph16203925DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6843684PMC
October 2019

Intramuscular stimulation as a novel alternative method of pain management after thoracic surgery.

J Thorac Dis 2019 Apr;11(4):1528-1535

Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.

Background: The purpose of this study was to determine whether electrical twitch-obtaining intramuscular stimulation (ETOIMS) can be an alternative to intravenous patient-controlled analgesia (IV-PCA) for postoperative pain management in pneumothorax patients undergoing single-port video-assisted thoracoscopic surgery (VATS).

Methods: This preliminary prospective randomized study was conducted between March 2017 and July 2017. A total of 26 patients undergoing single-port VATS were randomly assigned to two groups: the ETOIMS group (n=12), which received intramuscular stimulation prior to chest tube insertion toward the end of procedure, and the IV-PCA group (n=14), which received continuous infusion of fentanyl with a basal rate of 10 µg/mL/h. To measure postoperative pain, visual analogue scale (VAS; range, 0-10) was used as the primary endpoint.

Results: Baseline characteristics were not different between the two groups. According to the linear mixed model, there was statistical difference in the serial VAS score between the two groups (P=0.007). The ETOIMS group showed a significantly lower VAS score compared with the IV-PCA group, especially at postoperatively hour 8, day 1, and day 2.

Conclusions: We showed that ETOIMS may be a safe, effective, and simple alternative for pain management after single-port VATS.
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http://dx.doi.org/10.21037/jtd.2019.03.24DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6531751PMC
April 2019

Hydrogen gas inhalation ameliorates lung injury after hemorrhagic shock and resuscitation.

J Thorac Dis 2019 Apr;11(4):1519-1527

Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.

Background: Hemorrhagic shock and resuscitation (HSR) is known to cause inflammatory reactions in the lung parenchyma and acute lung injury, increasing the risk of complications that can lead to death. Hydrogen gas has shown to inhibit the formation and eliminate reactive oxygen species (ROS), which are known to cause reperfusion injury. Hence, the purpose of this study was to investigate the protective effect of 2% inhaled hydrogen gas on post-HSR lung injury.

Methods: Rats weighing 300-500 g were divided into three groups: sham, HSR, and hydrogen (H)/HSR groups. In the latter two groups, HSR was induced via femoral vein cannulation. Gas containing 2% hydrogen gas was inhaled only by those in the H/HSR group. Lung tissue and abdominal aorta blood were obtained for histologic examination and arterial blood gas analyses, respectively. Neutrophil infiltration and proinflammatory mediators were also measured.

Results: PO was lower in the HSR and H/HSR groups than in the sham group. Blood lactate level was not significantly different between the sham and H/HSR groups, but it was significantly higher in the HSR group. Infiltration of inflammatory cells into the lung tissues was more frequent in the HSR group. Myeloperoxidase (MPO) activity was significantly different among the three groups (highest in the HSR group). All proinflammatory mediators, except IL-6, showed a significant difference among the three groups (highest in the HSR group).

Conclusions: Inhalation of 2% hydrogen gas after HSR minimized the extent of lung injury by decreasing MPO activity and reducing infiltration of inflammatory cells into lung tissue.
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http://dx.doi.org/10.21037/jtd.2019.03.23DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6531717PMC
April 2019

Correlation between maximal tumor diameter of fresh pathology specimens and computed tomography images in lung adenocarcinoma.

PLoS One 2019 25;14(1):e0211141. Epub 2019 Jan 25.

Department of Pathology, Ewha Womans University Mokdong Hospital, Seoul, Korea.

The authors compared maximal tumor diameters between fresh lung tissue and axial and multiplanar reformatted chest computed-tomography (CT) images in lung adenocarcinoma and investigated the factors affecting tumor-size discrepancies. This study included 135 surgically resected lung adenocarcinomas. An experienced pulmonary pathologist aimed to cut the largest tumor section and measured pathological tumor size (PTS) in fresh specimens. Radiological maximal tumor sizes (RTS) were retrospectively measured on axial (RTSax) and multiplanar reformatted (RTSre) chest CT images. Mean PTS, RTSax, and RTSre were 19.13 mm, 18.63 mm, and 20.80 mm, respectively. RTSre was significantly larger than PTS (mean difference, 1.68 mm; p<0.001). RTSax was also greater than PTS for 6-10-mm and 11-20-mm tumors. PTS and RTS were strongly positively correlated (RTSax, r2 = 0.719, p<0.001; RTSre, r2 = 0.833, p<0.001). The intraclass correlation coefficient was 0.915 between PTS and RTSax and 0.954 between PTS and RTSre. Postoperative down-staging occurred in 11.0% and 27.4% of tumors on performing radiological staging using RTSax and RTSre, respectively. Postoperative up-staging occurred in 12.3% and 1.4% of tumors on performing radiological staging using RTSax and RTSre, respectively. Multiple linear regression revealed that pleural dimpling (p = 0.024) was an independent factor affecting differences between PTS and RTSax. Specimen type (p = 0.012) and tumor location (p = 0.020) were independent factors affecting differences between PTS and RTSre. In conclusion, RTSre was significantly larger than PTS and caused postoperative down-staging in 27.4% of the tumors. Reliability analysis revealed that RTSre was more strongly correlated with PTS than RTSax. Specimen type and anatomical tumor location influenced the measured size differences between PTS and RTSre.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0211141PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6347433PMC
October 2019

Effect of inferior pulmonary ligament division on residual lung volume and function after a right upper lobectomy.

Interact Cardiovasc Thorac Surg 2019 05;28(5):760-766

Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Objectives: The requirement to divide an inferior pulmonary ligament (IPL) during an upper lobectomy has not been standardized. We evaluated the influence of the division of an IPL after a lobectomy of the right upper lobe.

Methods: We evaluated 52 patients with lung cancer who underwent a video-assisted thoracoscopic lobectomy of the right upper lobe at Asan Medical Center between January 2011 and April 2014. These cases were stratified by division of the IPL or not, i.e. a preservation group (group P, n = 21) and a division group (group D, n = 31). The angle between the bronchus intermedius and the right middle lobe bronchus and the lung volume were measured using computed tomography. The results of the pulmonary function tests and the prevalence of complications were also reviewed.

Results: The prevalences of atelectasis (P = 0.538), dead space (P = 0.084) and pleural effusion (P = 0.538) were not statistically different. The postoperative volumetric change of the right middle lobe (group P, -27 ± 97 ml; group D, -29 ± 111 ml; P = 0.950) and of the right lower lobe (group P, 397 ± 293 ml; group D, 335 ± 294 ml; P = 0.459) did not show statistical differences. The change in the bronchial angle was not statistically different between the groups (group P, -26.3 ± 13.7°; group D, -26.7 ± 13.6°; P = 0.930). The patients in group D experienced a greater loss in forced vital capacity than those in group P (group P, -0.16 ± 0.26 l; group D, -0.42 ± 0.33 l; P = 0.007), but the loss in the forced expiratory volume in 1 s was not significant (P = 0.328).

Conclusions: An IPL division does not produce significant differences in lung volume, bronchial angle change or prevalence of complications other than loss of forced vital capacity.
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http://dx.doi.org/10.1093/icvts/ivy344DOI Listing
May 2019

Long-Term Results of Compressive Brace Therapy for Pectus Carinatum.

Thorac Cardiovasc Surg 2019 01 14;67(1):67-72. Epub 2018 Sep 14.

Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Seoul, the Republic of Korea.

Background: Pectus carinatum (PC) is one of the most common types of congenital chest wall deformity. Recently, noninvasive compressive brace therapy has been more frequently used than invasive surgical correction to treat PC. Hence, the purpose of this study was to determine the long-term outcome of compressive brace therapy.

Methods: We retrospectively reviewed patients with PC who underwent compressive brace therapy between January 2014 and December 2016. All patients underwent a 2-week compression period, in which braces were worn for 20 hours per day, followed by a 6-month maintenance period, in which braces were worn for 12 hours per day. Patient satisfaction was investigated via telephone survey.

Results: A total of 320 patients were included in this study. The average age was 13 years, and 280 were males (87.5%). The median follow-up period was 42 months (13-68). Good compliance was observed in 286 patients (89.4%; compliance group). In this group, the initial Haller index significantly increased from 2.20 ± 0.31 to 2.59 ± 0.38 after the 6-month therapy period ( = 0.001). After the 6-month period, 255 patients (89.1%) and 31 patients (12.1%) in the compliance group were very satisfied and satisfied, respectively. Satisfaction at the last follow-up via telephone survey was very satisfied in 250 patients (87.4%) and satisfied in 36 (12.6%). In the compliance group, no patient needed compressive braces again after the therapy period.

Conclusion: Given the findings presented in this study, compressive brace therapy appears to be a relatively simple and safe method with good long-term outcome in treating patients with PC.
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http://dx.doi.org/10.1055/s-0038-1669927DOI Listing
January 2019

Early results of new endoscopic thoracic sympathectomy for craniofacial hyperhidrosis.

J Thorac Dis 2018 Jun;10(6):3627-3631

Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

Background: Endoscopic thoracic sympathectomy (ETS) has been considered as a definitive treatment for hyperhidrosis. However, despite its well-established success rate, surgical treatment for craniofacial hyperhidrosis (CFH) is rarely performed due to the possibility of fatal complications and compensatory sweating. The aim of this study was to evaluate the safety and efficacy of our newly developed method of ETS for CFH, based on early results.

Methods: Between June 2016 and October 2017, a total of 70 patients underwent ETS with our new technique for CFH. All patients were placed under double-lumen intubation anesthesia with CO2 gas installation. We utilized two ports, one for 2-mm endoscope and another for 3-mm instrument. Our technique involved R2 and R4-R7 sympathectomy with R4-R7 truncal ablation.

Results: There were 55 males and 15 females, with a mean age of 48 years (range, 22-75 years). The median operation time was 38 minutes (range, 28-75 minutes). There was no operative mortality and morbidity. During the short follow-up period (average 7 months; range, 1-17 months), symptoms were improved in all patients and compensatory hyperhidrosis was observed 68 patients: mild in 50 patients (71.4%), moderate in 13 patients (18.6%), and severe in 5 patients (7.1%).

Conclusions: In select patients, our technique of ETS appears to be a safe and effective treatment method for treating CFH. However, a study with long-term follow-up is still necessary to confirm our findings.
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http://dx.doi.org/10.21037/jtd.2018.05.190DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6051804PMC
June 2018

Intramural Metastasis as a Risk Factor for Recurrence in Esophageal Squamous Cell Carcinoma.

Ann Thorac Surg 2018 07 11;106(1):249-256. Epub 2018 Mar 11.

Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Korea.

Background: The purpose of this study was to assess the clinicopathologic implications of intramural metastasis (IM) in patients with esophageal squamous cell carcinoma (ESCC).

Methods: We retrospectively analyzed 743 patients who underwent esophagectomy. Among these patients, IM was detected in 41 patients (5.5%). The clinicopathologic features of IM and its influence on postoperative recurrence were investigated.

Results: In total, 710 male patients and 33 female patients with a mean age of 64.4 ± 7.7 years were included. The median follow-up period was 98.5 months. IM was associated with large tumor size (p < 0.001), advanced T stage (p < 0.001), advanced N stage (p < 0.001), and advanced histologic grade (p < 0.023). IM was detected preoperatively in 51.2% of patients, and the median size of the metastasis was 2.0 cm (range: 0.1 to 6.4 cm). The median distance from the primary tumor to the metastasis was 2.5 cm (range: 0.5 to 21.0 cm); multiple metastases were observed in 46.3% of patients. Multivariable analyses revealed that advanced T stage (p < 0.001), advanced N stage (p < 0.001), and IM presence (p = 0.002) were independent risk factors for recurrence. The 5-year recurrence-free survival was 6.1% for patients with IM and 43.5% for patients without IM (p < 0.001).

Conclusions: IM could be an important prognostic factor, along with anatomic determinants such as the TNM staging system, in patients with ESCC. Effective preoperative evaluation and postoperative surveillance may help improve the outcome of patients with ESCC, particularly when accompanied by IM.
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http://dx.doi.org/10.1016/j.athoracsur.2018.02.018DOI Listing
July 2018

Clinical outcomes of video-assisted thoracoscopic surgery esophagectomy for esophageal cancer: a propensity score-matched analysis.

J Thorac Dis 2017 Sep;9(9):3005-3012

Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, South Korea.

Background: Minimally invasive esophagectomy theoretically offers advantages compared with open esophagectomy (OE). The aim of this study was to compare the early- and mid-term outcomes between video-assisted thoracoscopic surgery (VATS) esophagectomy (VE) and OE in patients with esophageal cancer.

Methods: Between November 2011 and July 2015, a total of 172 patients were divided into two groups depending on the method of esophagectomy: the VE group (n=42) and the OE group (n=130). A propensity analysis that incorporated perioperative variables, such as age, sex, preoperative pulmonary function, Charlson comorbidity index, tumor location, histologic grade of the tumor, pathologic stage and operative procedure (Ivor Lewis or McKeown) was performed, and postoperative outcomes were compared.

Results: Matching based on propensity scores produced 42 patients in each group for the analysis. After propensity matching, there were only two operative mortalities in the OE group, and both died of postoperative pneumonia. The overall incidence of postoperative complications was 38.1% (16 of 42) and 57.1% (24 of 42) in the VE group and in the OE group, respectively (P=0.088). The incidence of pulmonary complications was lower in the VE group than in the OE group (9.5% 40.5%, P=0.004). The 2-year overall survival and disease-free survival were not different between the two groups (74.4% and 69.5% in the VE group, 69.5% and 69.8% in the OE group, P=0.865 and P=0.513, respectively).

Conclusions: In select patients, superior short-term surgical results and equal oncological outcomes were achieved with VE compared with OE.
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http://dx.doi.org/10.21037/jtd.2017.08.71DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5708494PMC
September 2017

Prognostic Differences in Subgroups of Patients With Surgically Resected T3 Non-Small Cell Lung Cancer.

Ann Thorac Surg 2016 Nov 17;102(5):1630-1637. Epub 2016 Sep 17.

Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Korea.

Background: This study determined the characteristics and prognosis of each descriptor of T3 non-small cell lung cancer (NSCLC).

Methods: A total of 3,241 patients underwent an operation for NSCLC between 2001 and 2013, and this study included 461 patients who received complete anatomic resection of T3 NSCLC. The T3 descriptors were coded as follows: tumor invading main bronchus within 2 cm of the carina (T3-cent), tumor invading beyond visceral pleura (T3-inv), tumor larger than 7 cm (T3-size), separate tumor nodules (T3-sep), or tumor with combined T3 descriptors (T3-comb).

Results: The T3 distribution was as follows: T3-cent, 75 patients (16.3%); T3-inv, 157 patients (34.1%); T3-size, 132 patients (28.6%); T3-sep, 34 patients (7.4%); and T3-comb, 63 patients (13.7%). Subgroup analyses revealed a significant survival benefit in the T3-cent group compared with the other groups (all p < 0.05). The 5-year disease-free survival (DFS) values were 55.4%, 36.7%, 40.9%, 30.3%, and 32.0% in the T3-cent, T3-inv, T3-size, T3-sep, and T3-comb subgroups, respectively. Multivariable analyses revealed that age (p = 0.019), N status (p = 0.001), adjuvant chemotherapy (p < 0.001), and T3 descriptors (T3-cent versus others, p < 0.001) were the most important independent prognostic factors for DFS. Additional analyses were performed to evaluate prognostic factors for DFS in the T3-cent group. Multivariable analysis revealed that bronchoplastic procedures (p = 0.004) was an independent prognostic factor for DFS.

Conclusions: Survival for centrally located T3 NSCLC is better than other types of T3 NSCLC. Lung-preserving operations such as bronchoplastic procedures might result in improved survival of these patients.
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http://dx.doi.org/10.1016/j.athoracsur.2016.04.096DOI Listing
November 2016

A comparison of the proposed classifications for the revision of N descriptors for non-small-cell lung cancer.

Eur J Cardiothorac Surg 2016 Feb 18;49(2):580-8. Epub 2015 Apr 18.

Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

Objectives: Several new classifications have been proposed for revision of the N descriptors for non-small-cell lung cancer (NSCLC), but external validation is required. The aim of this study was to validate various newly proposed nodal classifications and to compare the discrimination abilities of these classifications.

Methods: A retrospective analysis was conducted of 1487 patients who underwent complete resection with systematic lymph node dissection for NSCLC between 2000 and 2008. Four nodal classifications based on the following categories were analysed: zone-based classification (single-zone N1, multiple-zone N1, single-zone N2 and multiple-zone N2), number-based classification (the number of metastatic lymph nodes; 1-2, 3-6 and ≥7), rate-based classification (ratio of the number of metastatic lymph nodes to the total number of resected lymph nodes; ≤15, 15-40 and >40%) and the combination of location- and number-based classification (N1: 1-3, N1: ≥4, N2: 1-3 and N2: ≥4). Concordance (C)-index and net reclassification improvement (NRI) index were used to assess the discrimination abilities of the models.

Results: In multivariate analysis, all of the newly proposed classifications were independent predictors (P < 0.001) of overall survival (OS) after adjustment for significant variables (age, tumour histology and pathological T status). The C-indices of the classifications based on the nodal zone, nodal number, rate and location alongside the number of metastatic lymph nodes were 0.6179, 0.6280, 0.6203 and 0.6221, respectively; however, the differences in the C-indices were statistically insignificant. Compared with the zone-based classification, the NRI for OS of classifications based on the nodal number, rate and location with number were 0.1101, 0.0972 and 0.0416, respectively.

Conclusions: All four proposed classifications based on the nodal zone, nodal number, rate and the combination of location and number are prognostically valid and could serve as future N descriptors after complete resection of NSCLC. The discrimination ability was not significantly different among the four proposed classifications, although the number-based classification tended to have a higher predictive ability compared with the zone-based classification. Future studies with an in-depth discussion are needed to clarify optimal future N descriptors for NSCLC.
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http://dx.doi.org/10.1093/ejcts/ezv134DOI Listing
February 2016

Total arch repair versus hemiarch repair in the management of acute DeBakey type I aortic dissection.

Eur J Cardiothorac Surg 2011 Oct 18;40(4):881-7. Epub 2011 Feb 18.

Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.

Objective: In acute DeBakey type I aortic dissection, it is still controversial whether to perform extended aortic replacement to improve long-term outcome or to use a conservative strategy with ascending aortic and hemiarch replacement to palliate a life-threatening condition.

Methods: Between 1999 and 2009, 188 consecutive patients (93 women; mean age, 57.4±11.7 years) with acute DeBakey type I aortic dissection underwent hemiarch (Hemiarch group; n=144) or total arch replacement (Total arch group; n=44) in conjunction with ascending aorta replacement. Clinical outcomes were compared after adjustment for baseline characteristics using inverse-probability-of-treatment weighting.

Results: Median follow-up was 47.5 months (range 0-130.4 months) and was 92.0% (n=173) complete. Five-year unadjusted survival and permanent-neurologic-injury-free survival rates were 65.8±8.3% and 43.1±9.7% in the Total arch group, and 83.2±3.3% and 75.2±4.0% in the Hemiarch group, respectively (P=0.013 and <0.001). After adjustment, the Total arch group patients were at greater risks of death (hazard ratio (HR) 2.38, 95% confidence interval (CI) 1.21-4.67; P=0.012), and permanent neurologic injury (HR 3.25, 95% CI 1.31-8.04; P=0.011) compared to the Hemiarch group patients. The risks of the re-operation for aortic pathology or distal aortic dilatation (>55 mm) were similar for both groups (HR 0.33, 95% CI 0.08-1.43; P=0.14).

Conclusions: Total arch repair was associated with greater morbidity and mortality compared with hemiarch repair in acute DeBakey type I aortic dissection. Rates of aortic re-operation or aortic dilatation were not significantly different between the two surgical strategies. These findings support a conservative surgical approach to circumvent this life-threatening situation.
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http://dx.doi.org/10.1016/j.ejcts.2010.12.035DOI Listing
October 2011

Long-term outcomes after surgery for rheumatic mitral valve disease: valve repair versus mechanical valve replacement.

Eur J Cardiothorac Surg 2010 May 24;37(5):1039-46. Epub 2009 Dec 24.

Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-dong Songpa-gu, Seoul 138-736, South Korea.

Objectives: Although mitral valve (MV) repair is known to be superior to replacement in overall clinical outcomes, the appropriateness of valve repair for rheumatic MV disease remains controversial because of the risks of recurrent mitral dysfunction and the need for re-operation.

Methods: From 1997 to 2007, 540 patients underwent either isolated MV repair (n=122) or replacement with a mechanical prosthesis (n=418) in treatment of rheumatic MV disease. Survival and morbidity were evaluated using Kaplan-Meier analysis and Cox regression, including propensity score analysis.

Results: Follow-up was complete in 96.1% of patients (mean, 71.8+/-39.1 months). Patients undergoing repair were younger; more likely to have predominant mitral regurgitation; and less likely to show atrial fibrillation (AF), significant tricuspid regurgitation or pulmonary hypertension, than those undergoing replacement. The 10-year freedom from cardiac death rate was 92.0+/-4.2% following repair and 86.8+/-2.3% following replacement (P=0.042). After adjustment for baseline differences, repair and replacement were found to be similar in terms of cardiac survival (P=0.25), re-operation (P=0.68) and thrombo-embolic complication (P=0.20) rates. Replacement patients had more anticoagulation therapy-related complications (P=0.030). Independent factors positively associated with combined cardiac death and major morbidities included older patient age (P=0.010), uncorrected AF (P=0.015) and the presence of significant tricuspid regurgitation (P=0.012) or coronary disease (P=0.043). The influence of the type of MV surgery was statistically marginal (P=0.093).

Conclusions: When performed for selected patients, MV repair had excellent durability comparable to mechanical valve replacement in rheumatic disease. Both MV repair and replacement had comparable long-term clinical results; therefore, repair surgery seems to be more beneficial by avoiding troublesome life-long anticoagulation and risks of bleeding.
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http://dx.doi.org/10.1016/j.ejcts.2009.11.019DOI Listing
May 2010
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