Publications by authors named "Young Woo Do"

30 Publications

  • Page 1 of 1

Genetic Polymorphisms in Activating Transcription Factor 3 Binding Site and the Prognosis of Early-Stage Non-Small Cell Lung Cancer.

Oncology 2021 Feb 24:1-9. Epub 2021 Feb 24.

Department of Biochemistry, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.

Background: Activating transcription factor 3 (ATF3) plays a significant role in cancer development and progression. We investigated the association between variants in expression quantitative trait loci (eQTLs) within ATF3 binding regions and the prognosis of non-small cell lung cancer (NSCLC) after surgery.

Methods: A total of 772 patients with NSCLC who underwent curative surgery were enrolled. Using a public database (http://galaxyproject.org), we selected 104 single nucleotide polymorphisms (SNPs) in eQTLs in the ATF3 binding regions. The association of those SNPs with disease-free survival (DFS) was evaluated.

Results: Among those SNPs, HAX1 rs11265425T>G was associated with significantly worse DFS (aHR = 1.30, 95% CI = 1.00-1.69, p = 0.05), and ME3 rs10400291C>A was associated with significantly better DFS (aHR = 0.66, 95% CI = 0.46-0.95, p = 0.03). Regarding HAX1 rs11265425T>G, the significant association remained only in adenocarcinoma, and the association was significant only in squamous cell carcinoma regarding ME3 rs10400291C>A. ChIP-qPCR assays showed that the two variants reside in active enhancers where H3K27Ac and ATF3 binding occurs. Promoter assays showed that rs11265425 G allele had significantly higher HAX1 promoter activity than T allele. HAX1 RNA expression was significantly higher in tumor than in normal lung, and higher in rs11265425 TG+GG genotypes than in TT genotype. Conversely, ME3 expression was significantly lower in tumor than in normal lung, and higher in rs10400291 AA genotype than in CC+CA genotypes.

Conclusions: In conclusion, this study shows that the functional polymorphisms in ATF3 binding sites, HAX1 rs11265425T>G and ME3 rs10400291C>A are associated with the clinical outcomes of patients in surgically resected NSCLC.
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http://dx.doi.org/10.1159/000514131DOI Listing
February 2021

Clinical implication of minimal presence of solid or micropapillary subtype in early-stage lung adenocarcinoma.

Thorac Cancer 2021 01 24;12(2):235-244. Epub 2020 Nov 24.

Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea.

Background: We investigated the clinical features and surgical outcomes of lung adenocarcinoma with minimal solid or micropapillary (S/MP) components, with a focus on stage IA.

Methods: We enrolled 506 patients with lung adenocarcinoma who underwent curative resection in this study. Clinical features and surgical outcomes were compared between the groups with and without the S/MP subtype (S/MP+ and S/MP-, respectively), and between the group with an S/MP proportion of ≤5% (S/MP5) and the S/MP-.

Results: The S/MP subtype was present in 247 patients (48.8%); 129 (25.5%) were grouped as the S/MP5 group. The S/MP+ and S/MP5 groups had larger tumors, higher frequency of lymph node metastasis, and more advanced stages of disease than the S/MP- group (P < 0.001, all comparisons). Pleural, lymphatic, and vascular invasions occurred more frequently in the S/MP+ and S/MP5 groups (P < 0.001, all comparisons for S/MP+ vs. S/MP-; P ≤ 0.01, all comparisons for S/MP5 vs. S/MP-). The S/MP+ and S/MP5 groups showed a shorter time to recurrence and cancer-related death than the S/MP- group(P < 0.001, both comparisons). For stage I, the presence or absence of the S/MP subtype defined prognostic subgroups better than the stage IA/IB classification. Notably, in the multivariate analysis, the minimal S/MP component was a significant predictor of recurrence, even in stage IA.

Conclusions: The presence of the minimal S/MP component was a significant predictor of poor prognosis after surgery, even in stage IA patients. Clinical trials to evaluate the advantages of adjuvant chemotherapy for this subset of patients and further investigations to understand underlying biological mechanisms of poor prognosis are needed.

Key Points: Significant findings of the study: We demonstrated that only minimal presence of solid or micropapillary component was profoundly associated with aggressive clinicopathological features and poor prognosis after complete resection even in stage IA lung adenocarcinoma.

What This Study Adds: Our results suggest that minimal presence of these subtypes is a strong prognostic factor which should be taken into account in the risk assessment for adjuvant chemotherapy in lung adenocarcinoma.
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http://dx.doi.org/10.1111/1759-7714.13754DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7812076PMC
January 2021

Ultrasound-guided Percutaneous Needle Biopsy for Small Pleural Lesions: Diagnostic Yield and Impact of CT and Ultrasound Characteristics.

AJR Am J Roentgenol 2020 Oct 7. Epub 2020 Oct 7.

Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu, 41944, South Korea.

Ultrasound (US)-guided percutaneous pleural needle biopsy (PCPNB) is widely used to evaluate pleural lesions, though has variable diagnostic accuracy. To assess the diagnostic yield of US-guided PCPNB for small (≤ 2 cm) pleural lesions and the impact of CT and US morphologic and technical factors. 103 patients (73 men, 30 women; age, 60.8±13.3 years) who underwent US-guided PCPNB of a small pleural lesion by a single experienced operator from July 2013 to December 2019 were retrospectively analyzed. Final diagnosis was established via histopathological results, including from repeat US-guided and CT-guided biopsies, as well as imaging and clinical follow-up. Pleural morphology and thickness were assessed on CT and US, and needle pathway length throughout the pleura was measured on US. Accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. The association between diagnostic yield with imaging and technical factors was evaluated. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal CT pleural thickness cutoff value. Multivariable logistic regression was performed to identify independent predictors of diagnostic yield. Diagnostic accuracy, sensitivity, specificity, PPV, and NPV of US-guided PCPNB were 85.4%, 84.8%, 100%, 100%, and 21.1%, respectively. Diagnostic, compared with non-diagnostic, procedures more commonly (p≤0.002) exhibited nodular morphology on CT (96.4% vs. 3.6%) and US (97.3% vs. 2.7%,), greater pleural thickness on CT (7.5 mm vs. 3.2 mm) and US (7.4 mm vs. 3.0 mm), and greater needle pathway length (11.0 mm vs. 6.1 mm). Optimal CT pleural thickness cut-off value was 4.5 mm. Diagnostic yield was 96.4% for nodular CT lesions, 95.0% for diffuse CT lesions with thickness ≥4.5 mm, 55.6% for diffuse CT lesions with thickness <4.5 mm, and 100.0% for diffuse CT lesions with nodular US morphology. Nodular US morphology (p=0.002) and needle pathway length (p=0.035) were independent predictors of diagnostic yield. US-guided PCPNB has excellent diagnostic accuracy for small pleural lesions; imaging characteristics influence this accuracy. US-guided PCPNB is highly likely to be diagnostic for small pleural lesions with nodular morphology on CT or US, or with pleural thickness ≥4.5 mm.
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http://dx.doi.org/10.2214/AJR.20.24120DOI Listing
October 2020

Large Venous Sac Thrombus Formation after Endovascular Embolization of Ruptured Pulmonary Arteriovenous Malformation: Usefulness of Time-Resolved MR Angiography in Decision Making.

J Vasc Interv Radiol 2020 11 19;31(11):1892-1895.e1. Epub 2020 Sep 19.

Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, 130 Dongdeok-ro, Junggu, Daegu, Republic of Korea 41944.

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http://dx.doi.org/10.1016/j.jvir.2020.02.019DOI Listing
November 2020

Genetic Variants in One-Carbon Metabolism Pathway Predict Survival Outcomes of Early-Stage Non-Small Cell Lung Cancer.

Oncology 2020 13;98(12):897-904. Epub 2020 Aug 13.

Department of Biochemistry and Cell Biology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.

Background: This study was conducted to investigate the association between genetic variants in one-carbon metabolism and survival outcomes of surgically resected non-small cell lung cancer (NSCLC).

Methods: We genotyped 41 potentially functional variants of 19 key genes in the one-carbon metabolism pathway among 750 NSCLC patients who underwent curative surgery. The association between genetic variants and overall survival (OS)/disease-free survival (DFS) were analyzed.

Results: Among the 41 single-nucleotide polymorphisms (SNPs) analyzed, 4 SNPs (MTHFD1L rs6919680T>G and rs3849794T>C, MTR rs2853523C>A, and MTHFR rs4846049G>T) were significantly associated with survival outcomes. MTHFD1L rs6919680T>G and MTR rs2853523C>A were significantly associated with better OS (adjusted hazard ratio [aHR] = 0.73, 95% confidence interval [CI] = 0.54-0.99, p = 0.04) and worse OS (aHR = 2.14, 95% CI = 1.13-4.07, p = 0.02), respectively. MTHFD1L rs3849794T>C and MTHFR rs4846049G>T were significantly associated with worse DFS (aHR = 1.41, 95% CI = 1.08-1.83, p = 0.01; and aHR = 1.97, 95% CI = 1.10-3.53, p = 0.02, respectively). When the patients were divided according to histology, the associations were significant only in squamous cell carcinoma (SCC), but not in adenocarcinoma (AC). In SCC, MTHFD1L rs6919680T>G and MTR rs2853523C>A were significantly associated with better OS (aHR = 0.64, 95% CI = 0.41-1.00, p = 0.05) and worse OS (aHR = 2.77, 95% CI = 1.11-6.91, p = 0.03), respectively, and MTHFD1L rs3849794T>C and MTHFR rs4846049G>T were significantly associated with worse DFS (aHR = 1.73, 95% CI = 1.17-2.56, p = 0.01; and aHR = 2.78, 95% CI = 1.12-6.88, p = 0.03, respectively).

Conclusions: Our results suggest that the genetic variants in the one-carbon metabolism pathway could be used as biomarkers for predicting the clinical outcomes of patients with early-stage NSCLC.
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http://dx.doi.org/10.1159/000509658DOI Listing
December 2020

Transpedal lymphatic embolization for lymphorrhea at the graft harvest site after coronary artery bypass grafting.

Yeungnam Univ J Med 2021 Jan 20;38(1):74-77. Epub 2020 Jul 20.

Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Daegu, Korea.

Lymphorrhea is a rare but potentially severe complication that occurs after various surgical procedures. Untreated lymphorrhea may lead to wound dehiscence, infection, and prolonged hospital stay. Currently, there is no standard effective treatment. Early management usually includes leg elevation, drainage, and pressure dressing. However, these methods are associated with prolonged recovery and high recurrence rates. We report a case of lymphorrhea from a calf wound after endoscopic great saphenous vein (GSV) harvesting for coronary artery bypass grafting (CABG). The patient presented with intractable oozing from the postoperative wound on the right calf. Lymphorrhea perGsisted for 6 weeks despite negative-pressure wound therapy with a long-acting somatostatin. We performed unilateral pedal lymphangiography that confirmed wound lymphorrhea, followed by glue embolization. No recurrence was observed after 8 months of follow-up. This case report demonstrates the successful use of lymphangiography with glue embolization in the control of lymphorrhea after GSV harvesting for CABG.
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http://dx.doi.org/10.12701/yujm.2020.00297DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7787900PMC
January 2021

Idiopathic Pleural Effusions: Characteristics and Discrimination From Cytology-Negative Malignant Pleural Effusions.

Am J Med Sci 2020 09 25;360(3):236-242. Epub 2020 Apr 25.

Department of Internal Medicine, Kyungpook National University, School of Medicine, Daegu, Republic of Korea. Electronic address:

Background: The etiology of pleural effusions often remained unknown notwithstanding surgical pleural biopsy and further clinical observation. A better understanding of clinical characteristics of patients with idiopathic pleural effusion (IPE) may improve the ability to differentiate between IPEs and cytology-negative malignant pleural effusions (MPEs) and facilitate the identification of patients requiring invasive investigation. However, little is known about the clinical factors that can help distinguish patients with IPE from those with cytology-negative MPE.

Materials And Methods: Patients who were diagnosed with IPE or cytology-negative MPE between 2010 and 2017 were enrolled in this retrospective study. Clinical, laboratory and radiologic characteristics were compared between patients with IPE and cytology-negative MPE. Diagnostic performances of predictors for IPE were assessed using receiver operating characteristic curves.

Results: Of 146 patients undergoing pleural biopsy owing to cytology-negative pleural effusion of uncertain cause, MPE was confirmed in 54 patients. IPE was ultimately diagnosed in 22 patients. Multivariate analysis demonstrated that a minimal amount of pleural effusion (odds ratio [OR] = 12.41, P = 0.039), presence of pleural nodularity (OR = 0.01, P < 0.001) and pleural fluid carcinoembryonic antigen levels less than 14 ng/mL (OR = 87.59, P = 0.002) were independent factors for distinguishing IPEs from cytology-negative MPEs. A combination of the absence of pleural nodularity with pleural fluid carcinoembryonic antigen levels less than 14 ng/mL yielded an area under the curve of 0.94 (sensitivity = 91% and specificity = 96%).

Conclusions: Using these readily available parameters to identify IPE in patients with cytology-negative exudative effusion of unknown cause can help guide decision-making when choosing to perform an invasive pleural biopsy or to take a conservative approach.
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http://dx.doi.org/10.1016/j.amjms.2020.04.020DOI Listing
September 2020

Characteristics and survival impact of polymorphonuclear leucocyte-predominant malignant pleural effusions secondary to lung cancer.

Clin Respir J 2020 Apr 15. Epub 2020 Apr 15.

Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.

Introduction: In comparison with mononuclear leucocyte (MNL)-predominant malignant pleural effusions (MPEs), polymorphonuclear leucocyte (PMNL)-predominant MPEs have rarely been investigated and may be associated with a poorer prognosis.

Objectives: To investigate the characteristics and survival impact of PMNL-predominant MPEs secondary to lung cancer.

Methods: This retrospective study included patients with MPE secondary to lung cancer, which were classified into the PMNL- and MNL-predominant groups according to cellular predominance in the pleural fluid. Clinical, hematological, radiological, and pleural fluid data were compared between the groups, and the survival impact of PMNL predominance in MPE was evaluated.

Results: Of the 193 MPEs included, 37 (19%) were characterised by PMNL predominance. Compared to the MNL-predominant group, the PMNL-predominant group showed significantly poorer patient performances (P = .001), higher white blood cell counts (P = .009), higher neutrophil counts, higher blood neutrophil-to-lymphocyte ratio (P = .046), higher serum C-reactive protein (P = .003), lower serum albumin (P < .001), lower pleural fluid pH (P = .002) and higher pleural fluid lactate dehydrogenase (P = .029) levels. In contrast, most clinical and radiological findings, including the duration of symptoms, showed no significant intergroup differences. A shift towards MNL predominance was observed in only 38% of the PMNL-predominant patients who underwent repeat thoracentesis. Overall survival of the PMNL-predominant group was significantly shorter than the MNL-predominant group (P = .003).

Conclusions: PMNL predominance in MPEs secondary to lung cancer may be observed in variable phases with respect to the duration of symptoms and the time of thoracentesis. Overall, PMNL-predominant MPEs were associated with more advanced stages and poorer survival outcomes, compared to MNL-predominant MPEs.
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http://dx.doi.org/10.1111/crj.13195DOI Listing
April 2020

Over-the-wire deployment techniques of option elite inferior vena cava filter: 3D printing vena cava phantom study.

Eur J Radiol Open 2020 21;7:100227. Epub 2020 Mar 21.

Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.

Purpose: To compare filter tilt and filter jumping during Option inferior vena cava (IVC) filter deployment with 3 different wires techniques using a 3-dimensional (3D) printing vena cava phantom.

Materials And Methods: An IVC 3D printed vena cava phantom was made from a healthy young male's computed tomographic data. Option IVC filters were deployed with 3 different wires: i) original push wire, ii) hydrophilic stiff wire, and iii) bent stiff wire. Right internal jugular and right femoral access were used 5 times with each wire. Filter tilt angle, tilt ratio, jumping, and tip abutment to the IVC wall were analyzed.

Results: The transfemoral approach with original push wire had significantly higher tilt angle than did the transjugular approach (6.1˚ ± 1.9 vs. 3.5˚ ± 1.3, = 0.04). Mean tilt ratio was significantly lower with the bent wire with transfemoral access (0.49 ± 0.13 vs. 0.78 ± 0.18 [original push-wire] and 0.67 ± 0.08 [stiff wire], = 0.019). The ratio was lower also with original push wire with transjugular access (0.34 ± 0.19 vs. 0.57 ±0.11 [stiff wire] and 0.58 ±0.17 [bent wire], = 0.045). Filter jumping occurred more often with the transjugular approach with original push wire than with stiff or bent-wire delivery. Filter tip abutment to the IVC wall occurred only with the transfemoral approach.

Conclusions: Bent wire with transfemoral access and original push wire with transjugular access had lower filter tilt ratio at Option IVC filter deployment. However, filter jumping was common using the original push wire with transjugular access.
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http://dx.doi.org/10.1016/j.ejro.2020.100227DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7096752PMC
March 2020

Serratus Anterior Plane Block and Intercostal Nerve Block after Thoracoscopic Surgery.

Thorac Cardiovasc Surg 2020 Mar 29. Epub 2020 Mar 29.

Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea.

Background:  This study aimed to compare the postoperative analgesic effect between ultrasound-guided serratus anterior plane block (Group S, SAPB) and intercostal nerve block (Group I, ICNB) after single port video-assisted thoracoscopic surgery (S-VATS) in primary spontaneous pneumothorax.

Methods:  In this prospective randomized controlled study, 54 patients were randomly assigned to two groups. Patients in Group S underwent the SAPB before the surgical drape by an anesthesiologist, and in Group I, ICNBs were performed just before the wound closure after S-VATS by an attending thoracic surgeon. The primary outcome was the numeric pain rating scale (NRS) score given by the patients for pain at the surgical incision site. NRS was assessed during resting and coughing statuses at 3, 6, and 12 hours postoperatively and at the time of the chest tube removal. The secondary outcomes included the number of nonsteroidal anti-inflammatory drugs (NSAIDs) and opioid administration until time to chest tube removal.

Results:  There were no statistical differences between the two groups regarding age, body mass index, duration of operation, duration of anesthesia, and average NRS scores for the assigned time periods. There was no statistical significance in the number of opioid injections; however, NSAIDs were administered 2.8 times per patient in Group I, and 1.9 times per patient in Group S ( = 0.038).

Conclusion:  In the patients who underwent S-VATS with primary spontaneous pneumothorax, the SAPB provided similar postoperative pain relief with reducing the NSAIDs consumption compared with ICNB.
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http://dx.doi.org/10.1055/s-0040-1705152DOI Listing
March 2020

Traumatic Right Pulmonary Artery Rupture after Accidentally Being Stepped on the Chest.

Korean J Thorac Cardiovasc Surg 2019 Oct 5;52(5):380-383. Epub 2019 Oct 5.

Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea.

Traumatic pulmonary artery rupture is a rare, life-threatening injury. Currently, no strict guidelines for its management exist. Herein, we report a successful surgical repair of a right pulmonary artery rupture caused by being stepped on.
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http://dx.doi.org/10.5090/kjtcs.2019.52.5.380DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6785159PMC
October 2019

Thoracic aortic aneurysms exerting high extrinsic pressure on the airway.

J Cardiothorac Surg 2019 Sep 18;14(1):169. Epub 2019 Sep 18.

Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, Republic of Korea.

Background: Thoracic aortic aneurysms, although mostly asymptomatic, are life threatening owing to the risk of rupture. Moreover, the extrinsic pressure of a ruptured aneurysm may encroach the mediastinum.

Case Presentation: A 74-year-old woman diagnosed with ruptured descending thoracic aortic aneurysm compressing the lower trachea and both main bronchi underwent thoracic endovascular aortic repair; however, the extrinsic pressure on the airway persisted. Following failing of endobronchial silicon stents insertion, extracorporeal membrane oxygenation support was required, and endobronchial metallic stents were inserted. The patients' hypoventilation resolved, and the patient was withdrawn from the ventilator.

Conclusions: Technological improvement in endovascular or endobronchial procedures has provided more options for managing complex cases. However, we must be aware of how high the extrinsic pressure might be before management and take steps to minimize complications.
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http://dx.doi.org/10.1186/s13019-019-0992-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6751665PMC
September 2019

Under-recognized primary spontaneous pneumothorax in ALS: a multicenter retrospective study.

Neurol Sci 2019 Dec 2;40(12):2509-2514. Epub 2019 Jul 2.

Department of Rehabilitation Medicine, Daegu Fatima Hospital, Ayangro 99, Dong gu, Daegu, 41199, Republic of Korea.

Primary spontaneous pneumothorax (PSP) is not an uncommon disease, especially in patients with risk factors such as male gender, history of smoking, and low body mass index (BMI). Amyotrophic lateral sclerosis (ALS) is a rare disease caused by neurodegeneration of the motor neurons that share risk factors with PSP. The aim of this study was to determine the prevalence of PSP in ALS and find the significant risk factors related to PSP. We retrospectively reviewed the data from 86 patients with clinically probable or definite ALS from three different centers. Clinical characteristics, including age, sex, subtype, disease duration, body mass index, history of smoking, tracheostomy state, and ventilator use, were obtained. The ALS Functional Rating Scale-Revised Form (ALSFRS-R) total score and subscores were also retrieved from the medical records. In the results, six of the 86 patients (7%) had PSP. There were no statistically significant differences among the clinical characteristics and the ALSFRS-R scores between the patients with and without PSP, except for BMI and smoking (p < 0.022 and p < 0.019, respectively). A multivariate logistic regression analysis of smoking and BMI showed an odds ratio of 19.25. In conclusion, the existence of PSP in ALS may be under-recognized. Further well-designed, large studies are needed to elucidate the prevalence and pathophysiology of pneumothorax in ALS.
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http://dx.doi.org/10.1007/s10072-019-03989-yDOI Listing
December 2019

Mid-term outcomes of endovascular repair for traumatic thoracic aortic injury: a single-center experience.

Eur J Trauma Emerg Surg 2019 Dec 10;45(6):965-972. Epub 2019 Jun 10.

Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, Republic of Korea.

Purpose: Thoracic endovascular aortic repair (TEVAR) for traumatic thoracic aortic injury (TTAI) reports short-term benefits. However, long-term durability and the need of reintervention remain unclear. Here, we determined mid-term outcome of TEVAR for TTAI and investigated the influence of the length of proximal landing zone on aorta.

Methods: Between October 2009 and February 2018, 69 patients diagnosed TTAI and 42 included patients underwent TEVAR. Patients were divided into two groups by the length of proximal landing zone; ≤ 20 mm and > 20 mm. The primary endpoint was success and survival rate, and the secondary endpoint was the increase of aorta size and the need of reintervention.

Results: The mean follow-up period was 47.9 ± 29.6 months and 100% success rate. No endoleaks or additional reinterventions during the follow-up period. The cumulative survival of all-cause death was 90.5 ± 2.3%, 85.7 ± 4.1% and 61.7 ± 8.4% at 1, 5 and 7 years, respectively. There was no statistically significant difference in the increase of aorta size due to the length of the proximal landing zone (p = 0.65).

Conclusion: In selective TTAI patients for TEVAR, the length of proximal landing zone did not considerably influence the aorta size or needed further reintervention.
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http://dx.doi.org/10.1007/s00068-019-01166-6DOI Listing
December 2019

Successful Treatment Using Endoluminal Vacuum Therapy after Failure of Primary Closure in Boerhaave Syndrome.

Korean J Gastroenterol 2019 Apr;73(4):219-224

Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Daegu, Korea.

Boerhaave syndrome is a transmural perforation of the esophagus and typically occurs after forceful emesis. Boerhaave syndrome is a destructive disease with a high mortality rate, though surgical intervention within 24 hours has a beneficial effect. On the other hand, late surgical intervention is associated with poorer prognoses. Several therapeutic strategies, ranging from medical to surgical management, are available for Boerhaave syndrome. Recently, endoscopic endoluminal vacuum therapy (EVT) was introduced as a treatment option. Here, we report the case of a 56-year-old male patient with Boerhaave syndrome who was successfully treated by EVT after primary closure failure. The patient recovered without complication.
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http://dx.doi.org/10.4166/kjg.2019.73.4.219DOI Listing
April 2019

Complete resection of primary pulmonary malignancy extending into the left atrium via the left pulmonary vein using cardiopulmonary bypass and single incision: A case series.

Thorac Cancer 2019 05 27;10(5):1260-1262. Epub 2019 Mar 27.

Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea.

If the best treatment for a patient with a primary pulmonary tumor extending into the left atrium via the left pulmonary vein is surgical resection, it is necessary to determine the appropriate approach, that is, whether cardiopulmonary bypass (CPB) or complete resection, would be more suitable. Lung resections under CPB are rarely performed because of the unpredictable prognosis. We report two successful cases of safe and rapid complete resection of primary pulmonary malignancy extending into the left atrium with the support of CPB via median sternotomy. Our experiences support the application of CPB in extended left pulmonary resections to achieve complete resection.
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http://dx.doi.org/10.1111/1759-7714.13028DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6500958PMC
May 2019

Infarction of torsed extralobar pulmonary sequestration in adolescence.

Gen Thorac Cardiovasc Surg 2020 Jan 14;68(1):77-80. Epub 2019 Mar 14.

Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, South Korea.

Torsion of pulmonary extralobar sequestration is extremely rare in childhood and adolescence, and as it presents with a variety of symptoms ranging from intermittent pain to fever from infarction, differential diagnosis is necessary. Herein, we report a rare case of 13-year-old girl who presented with abdominal pain and fever was diagnosed as infarction of torsed extralobar pulmonary sequestration. Torsed extralobar pulmonary sequestration was removed by thoracoscopic surgery, and the patient remained in good clinical condition.
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http://dx.doi.org/10.1007/s11748-019-01105-7DOI Listing
January 2020

Iatrogenic Fracture of Filter Arm during Removal of Embedded Inferior Vena Cava Filter Using Endoscopic Forceps.

J Vasc Interv Radiol 2018 09;29(9):1338-1340

Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu 41944, Republic of Korea.

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http://dx.doi.org/10.1016/j.jvir.2018.02.026DOI Listing
September 2018

Central venous catheterization-induced right brachiocephalic vein pseudoaneurysm: Successfully treated with stent-assisted coiling.

J Vasc Access 2018 May 14;19(3):319-323. Epub 2018 Mar 14.

3 Department of Radiology, Kyungpook National University Hospital, Daegu, Republic of Korea.

Introduction: Central venous catheterization-induced central vein pseudoaneurysm is rare. Several treatment options have been recommended. We describe a case of central venous catheterization-induced right brachiocephalic vein pseudoaneurysm successfully treated with an uncovered self-expandable stent-assisted coil embolization and discuss the imaging findings, treatment strategy, and review of literature associated with thoracic venous pseudoaneurysm.

Case Report: A 77-year-old woman was referred to our trauma center to undergo treatment for central venous catheterization-induced central vein pseudoaneurysm. The initial contrast-enhanced chest computed tomography revealed a 3.4-cm pseudoaneurysm arising from the right brachiocephalic vein and a surrounding mediastinal hematoma. The pseudoaneurysm was successfully embolized with stent-assisted coiling. Computed tomography angiography was performed 10 days after the procedure and demonstrated a completely embolized pseudoaneurysm and resolved mediastinal hematoma. Blood flow from the right subclavian and left innominate veins was not disturbed by the stent-assisted coils.

Conclusion: To our knowledge, this is the first report of treatment of a right brachiocephalic vein pseudoaneurysm with stent-assisted coil embolization. We think that uncovered stent-assisted coil embolization is the safest and most fundamental treatment for wide-neck venous pseudoaneurysm especially in a hemodynamically unstable setting.
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http://dx.doi.org/10.1177/1129729817746581DOI Listing
May 2018

Risk of Primary Spontaneous Pneumothorax According to Chest Configuration.

Thorac Cardiovasc Surg 2018 10 19;66(7):583-588. Epub 2018 Jan 19.

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

Background: We compared the chest configurations of patients with primary spontaneous pneumothorax (PSP) and age-sex-matched controls to determine the presence of chest wall deformities in patients with PSP.

Methods: We retrospectively enrolled 166 male patients with PSP (age, 18-19 years) and 85 age-sex-matched controls without PSP, who simultaneously underwent chest computed tomography (CT) and radiography at one of two institutes. After correcting for height, the following thoracic parameters were comparatively evaluated between the two groups: maximal internal transverse () and anteroposterior () diameters of the chest, maximal internal lung height (), Haller index (/), and /Height, /, /Height, /, and /Height ratios.

Results: Patients were taller than the control subjects (176.5 cm ± 5.9 cm versus 174.4 cm ± 5.6 cm;  = 0.007). After controlling for height, the patient group exhibited lower and and greater and Haller index values than the control group (: 95% confidence interval [CI], 24.8-25.2 cm versus 25.9-26.5; : 95% CI, 8.9-9.2 cm versus 10.1-10.6 cm; H: 95% CI, 25.2-25.9 cm versus 23.4-24.4 cm; and Haller index, 95% CI, 2.7-2.9 versus 2.4-2.6; all,  < 0.001). The patient group also exhibited lower /Height, /H, /Height, and /H ratios and greater /Height ratio than the control group.

Conclusions: Patients with PSP have an anteroposteriorly flatter, laterally narrower, and craniocaudally taller thorax than subjects without PSP, suggesting that chest configuration is associated with the development of pneumothorax.
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http://dx.doi.org/10.1055/s-0037-1620273DOI Listing
October 2018

Phlegmonous Esophagitis Treated with Internal Drainage and Feeding Jejunostomy.

Korean J Thorac Cardiovasc Surg 2017 Dec 5;50(6):453-455. Epub 2017 Dec 5.

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

We report the case of a 67-year-old woman presenting with epigastric pain. Computed tomography identified diffuse phlegmonous esophagitis. Esophagogastroduodenoscopy revealed multiple perforations in the mucosal layer of the esophagus. A large amount of pus was drained internally through the gut. The patient was treated with antibiotics and early jejunostomy feeding. Although phlegmonous esophagitis is a potentially fatal disease, the patient was successfully treated medically with only a minor complication (esophageal stricture).
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http://dx.doi.org/10.5090/kjtcs.2017.50.6.453DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5716649PMC
December 2017

Successful Management of Delayed Esophageal Rupture with T-Tube Drainage Using Video-Assisted Thoracoscopic Surgery.

Korean J Thorac Cardiovasc Surg 2016 Dec 5;49(6):478-480. Epub 2016 Dec 5.

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

Spontaneous perforation of the esophagus after forceful vomiting is known as Boerhaave syndrome, a rare and life-threatening condition associated with a high rate of mortality. The management of Boerhaave syndrome is challenging, especially when diagnosed late. Herein, we report the successful management of late-diagnosed Boerhaave syndrome with T-tube drainage in a 55-year-old man. The patient was transferred to our institution 8 days after the onset of symptoms, successfully managed by placing a T-tube, and was discharged on postoperative day 46 without complications.
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http://dx.doi.org/10.5090/kjtcs.2016.49.6.478DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5147477PMC
December 2016

Combined Bilateral Lung Transplantation and Off-Pump Coronary Artery Bypass.

Korean J Thorac Cardiovasc Surg 2016 Dec 5;49(6):461-464. Epub 2016 Dec 5.

Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine.

Coronary artery disease has historically been a contraindication to lung transplantation. We report a successful combined bilateral lung transplantation and off-pump coronary artery bypass in a 62-year-old man. The patient had a progressive decline in lung function due to idiopathic pulmonary fibrosis and a history of severe occlusive coronary artery disease.
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http://dx.doi.org/10.5090/kjtcs.2016.49.6.461DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5147472PMC
December 2016

The Oncologic Outcome of Esophageal Squamous Cell Carcinoma Patients After Robot-Assisted Thoracoscopic Esophagectomy With Total Mediastinal Lymphadenectomy.

Ann Thorac Surg 2017 Apr 6;103(4):1151-1157. Epub 2016 Dec 6.

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

Background: The oncologic outcome of esophageal squamous cell carcinoma (ESCC) patients after robot-assisted thoracoscopic esophagectomy (RATE) with total mediastinal lymphadenectomy (ML) has not been reported. This study was performed to determine the oncologic outcome of RATE and the effectiveness of total ML for ESCC.

Methods: The 115 patients who underwent RATE without neoadjuvant therapy from 2006 to 2014 were reviewed. The efficacy index (EI) was calculated by multiplying the incidence of metastasis by the 3-year survival rate of the patients for each node station.

Results: The majority of patients were male (92.2%), and the mean age was 63.2 ± 0.8 years. Tumor location was the upper esophagus in 12 patients (10.4%), the middle esophagus in 59 patients (51.3%), and the lower esophagus in 44 patients (38.3%). R0 resection was achieved in 110 (95.7%) patients; the mean number of dissected nodes was 49.0 ± 1.9. Operative mortalities were 4 (3.5%) cases; in the remaining 111 patients, the mean follow-up time was 32.4 ± 2.2 months. Overall survival (OS) and recurrence-free interval (RFI) at 3 years were 85.0% and 79.4%, respectively. The 3-year OS and RFI were 94.4% and 96.2% in patients with stage I disease, 86.2% and 80.1% in stage II disease, and 77.8% and 79.5% in stage IIIA disease, respectively. High EI values were determined in the bilateral recurrent laryngeal nerve (RLN) nodes in upper and middle ESCC, and in the left gastric and paracardial nodes in lower ESCC.

Conclusions: The oncologic outcome of RATE was acceptable. Total ML, including dissection of the RLN nodes, is recommended especially in upper or middle ESCC.
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http://dx.doi.org/10.1016/j.athoracsur.2016.09.037DOI Listing
April 2017

Limited thymectomy as a potential alternative treatment option for early-stage thymoma: A multi-institutional propensity-matched study.

Lung Cancer 2016 11 7;101:22-27. Epub 2016 Sep 7.

Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea. Electronic address:

Objectives: For early-stage thymoma, complete thymectomy has classically been regarded as the standard treatment protocol. However, several studies have shown that limited thymectomy may be an alternative treatment option for thymoma. This study compared perioperative outcomes, survival, and recurrence rates between patients undergoing limited thymectomy and complete thymectomy.

Materials And Methods: Between January 2000 and December 2013, a total of 762 patients underwent thymectomy for stage I or II thymomas at four institutions participating in the Korean Association for Research on the Thymus. Patients were divided into two groups: limited thymectomy group (n=295) and complete thymectomy group (n=467). Comparative clinicopathological, surgical, and oncological features were reviewed retrospectively.

Results: The median follow-up time was 49 months (range: 0.2-189 months). A propensity score-matching analysis, based on seven variables (age, sex, surgical approach, tumor size, WHO histological type, Masaoka-Koga stage, and adjuvant radiotherapy), was performed using 141 patients selected from each group. The 5- and 10-year freedom-from-recurrence rates in the limited thymectomy group were 96.3% and 89.7%, respectively, and those in the complete thymectomy group were 97.0% and 85.0%, respectively. No significant differences in these rates were observed between groups (p=0.86). A multivariate Cox regression analysis showed that overall survival and freedom-from-recurrence rates did not significantly differ by surgery extent (p=0.27, 0.66, respectively). Perioperative outcomes were better in the limited thymectomy group.

Conclusion: Limited thymectomy was not inferior to complete thymectomy with respect to recurrence, and had better perioperative outcomes. Limited thymectomy may be a viable treatment option for early-stage thymoma.
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http://dx.doi.org/10.1016/j.lungcan.2016.06.021DOI Listing
November 2016

Sarcopenia of thoracic muscle mass is not a risk factor for survival in lung transplant recipients.

J Thorac Dis 2016 Aug;8(8):2011-7

Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea ;

Background: In lung transplantation (LTx), patients with thoracic muscle sarcopenia may have to require longer to recovery. We measured thoracic muscle volume by using the cross sectional area (CSA) and assessed its effect on early outcomes after LTx.

Methods: A retrospective analysis was conducted to evaluate the effect of thoracic sarcopenia in patients undergoing LTx between January 2010 and July 2015. The lowest CSA quartile (Q1) was defined as sarcopenia.

Results: In total, 109 patients were enrolled. The mean CSA was 58.24±15.82 cm(2). Patients in the highest CSA quartile were more likely to be male (92.6% vs. 17.9%, P<0.001), older (55.2±10.1 vs. 43.2±14.9 years, P=0.001), to have a higher body mass index (BMI) (22.3±4.0 vs. 19.4±3.7 kg/m(2), P=0.007), and to have pulmonary fibrosis (85.2% vs. 35.7%, P=0.003) compared with the lowest CSA quartile. Early outcomes including ventilator support duration [32.9±49.2 vs. 24.5±39.9 days, P= not significant (ns)], intensive care unit (ICU) stay duration (28.4±43.7 vs. 24.4±35.9 days, P= ns) and hospital stay duration (61.4±48.2 vs. 50.8±37.2 days, P= ns) tended to be longer in Q1 than Q4, but the difference was not significant. However, the 1-year survival rate was better in Q1 compared with Q4 (66.6% vs. 46.0%, P=0.04).

Conclusions: Although patients with thoracic sarcopenia seem to require a longer post-operative recovery time after LTx, this does not compromise their early outcomes. By contrast, patients with larger thoracic muscle volume (Q4) showed poorer survival times.
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http://dx.doi.org/10.21037/jtd.2016.07.06DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4999703PMC
August 2016

Transition to routine use of venoarterial extracorporeal oxygenation during lung transplantation could improve early outcomes.

J Thorac Dis 2016 Jul;8(7):1712-20

Department of Thoracic and Cardiovascular Surgery, College of Medicine, Yonsei University, Seoul, Korea ;

Background: The study objective was to compare the outcomes of intraoperative routine use of venoarterial (VA) extracorporeal membrane oxygenation (ECMO) versus selective use of cardiopulmonary bypass (CPB).

Methods: Between January 2010 and February 2013, 41 lung transplantations (LTx) were performed, and CPB was used as a primary cardiopulmonary support modality by selective basis (group A). Between March 2013 and December 2014, 41 LTx were performed, and ECMO was used routinely (group B). The two groups were compared retrospectively.

Results: The operative time was significantly longer in group A (group A, 458 min; group B, 420 min; P=0.041). Postoperatively, patients in group B had less fresh frozen plasma (FFP) transfusion (P=0.030). Complications were not different between the two groups. The 30- and 90-day survival rates were better in group B (30-day survival: group A, 75.6%; group B, 95.1%, P=0.012; 90-day survival: group A, 68.3%; group B, 87.8%, P=0.033). The 1-year survival showed better trends in group B, but it was not significant. Forced vital capacity (FVC) at 1, 3, and 6 months after LTx was better in group B than in group A (1 month: group A, 43.8%; group B, 52.9%, P=0.043; 3 months: group A, 45.5%; group B, 59.0%, P=0.005; 6 months: group A, 51.5%; group B, 65.2%, P=0.020). Forced expiratory volume in 1 second (FEV1) at 3 months after LTx was better in patients in group B than that in patient in group A (group A, 53.3%; group B, 67.5%, P=0.017).

Conclusions: Routine use of ECMO during LTx could improve early outcome and postoperative lung function without increased extracorporeal-related complication such as vascular and neurologic complications.
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http://dx.doi.org/10.21037/jtd.2016.06.18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4958818PMC
July 2016

Tumor perimeter and lobulation as predictors of pleural recurrence in patients with resected thymoma.

Lung Cancer 2016 08 25;98:79-83. Epub 2016 May 25.

Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Republic of Korea. Electronic address:

Objectives: Recurrence of resected thymoma frequently occurs during follow-up, with pleural recurrence as the most common type. The aim of our study was to identify risk factors for pleural recurrence after complete resection of thymoma by investigating clinical, radiological, surgical, and pathological findings.

Materials And Methods: Retrospective study was performed with 309 patients who had undergone complete resection of thymoma between January 2000 and December 2013. Among these cases, the patients were divided into the no pleural recurrence group (n=285) and the pleural recurrence group (n=24). Radiologic parameters such as maximum tumor diameter, tumor perimeter that contacted the lung (TPCL) and lobulated tumor contour were measured based on computed tomography. A multivariate analysis was performed to estimate risk factors for pleural recurrence including maximum tumor diameter, TPCL, lobulated tumor contour, World Health Organization (WHO) histologic classification, and Masaoka-Koga (M-K) stage.

Results: The median follow-up period was 62 months. The pleural recurrence rate was 7.8% (24/309). After univariate analysis, longer maximum tumor diameter (p<0.001), longer TPCL (p<0.001), lobulated tumor contour (p=0.001), WHO histologic type B2, B3 (p=0.002), and M-K stage III/IV (p<0.001) demonstrated significant differences with risk factors of pleural recurrence. Multivariate analysis revealed that TPCL (per 1cm increase: hazard ratio [HR]: 1.040, 95% confidence interval [CI]: 1.019-1.061, p<0.001), lobulated tumor contour (HR: 5.883, CI: 1.201-28.824, p=0.029), WHO histologic classification B2/B3 (HR: 5.331, CI: 1.453-19.558, p=0.012) and advanced M-K stage (HR: 3.900, CI: 1.579-9.632, p=0.003) were significantly associated with pleural recurrence.

Conclusion: TPCL and lobulated tumor contour as well as WHO histologic classification and M-K stage were independent predictors of pleural recurrence after thymoma resection. Our study demonstrated that radiologic parameters could be useful predictor of pleural recurrence in patients with resected thymoma.
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http://dx.doi.org/10.1016/j.lungcan.2016.05.017DOI Listing
August 2016

Direct Axillary Arterial Cannulation Using Seldinger's Technique in Aortic Dissection.

Korean J Thorac Cardiovasc Surg 2011 Oct 6;44(5):338-42. Epub 2011 Oct 6.

Department of Thoracic and Cardiovascular Surgery, Kyungpook University Hospital, Korea.

Background: The axillary artery is frequently used for cardiopulmonary bypass, especially in acute aortic dissection. We have cannulated the axillary artery using a side graft or by directly using Seldinger's technique. The purpose of this study was to assess the technical problems and complications of both cannulation techniques.

Materials And Methods: From January 2003 to December 2009, 53 patients underwent operations using the axillary artery for arterial cannulation. The axillary artery was cannulated with a side graft in 35 patients (side graft group) and directly using Seldinger's technique in 18 patients (direct group).

Results: The results were compared between two groups, focusing on cannulation-related morbidities including neurologic morbidity. Arterial damage or dissection of the axillary artery occurred in 1 (2.9%) patient in the side graft group and in 1 (5.6%) patient in the direct group. Malperfusion and insufficient flow did not occur in either group. There were no postoperative complications related to axillary cannulation, such as brachial plexus injury, compartment syndrome, or local wound infection, in either group.

Conclusion: Technical problems and complications of the axillary arterial cannulation in both techniques were rare. Direct arterial cannulation using Seldinger's technique was done safely and more simply than the previous technique. It was concluded that both axillary arterial cannulation techniques are acceptable and it remains the surgeon's preference which technique should be used.
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http://dx.doi.org/10.5090/kjtcs.2011.44.5.338DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3249336PMC
October 2011

Comparison of costs for video-assisted thoracic surgery lobectomy and open lobectomy for non-small cell lung cancer.

Surg Endosc 2011 Apr 11;25(4):1054-61. Epub 2010 Sep 11.

Department of Thoracic and Cardiovascular Surgery, Kyungpook National University, School of Medicine, Daegu, Korea.

Background: To promote the broad use of video-assisted thoracic surgery (VATS) for lobectomy (VATSL) in the management of lung cancer, it should be proved cost-effective, especially in the current cost-sensitive climate. This study evaluated and compared the costs of VATSL and open lobectomy (OL) and analyzed how the surgeon's experience level with VATSL affected the cost.

Methods: In this study, 86 patients in a VATSL group and 97 patients in an OL group underwent surgery for lung cancer. Cost comparisons were performed for the VATSL and OL groups between patients who had no complications and patients with and without complications according to tumor location and the learning period of the surgeon.

Results: Postoperative complications occurred for 56 patients (30.6%) (14 VATSL vs 42 OL patients; p < 0.05). Patients who underwent VATSL had significant reductions in both chest tube duration (5.4 vs 9.1 days; p = 0.000) and length of hospital stay (7.1 vs 12.0 days; p = 0.000). The mean operation time for VATSL was not significantly longer than for OL (145.8 vs 136.4 min; p = 0.782). The total hospital cost (i.e., that paid by the patient and national insurance combined) was lower for VATSL than for OL according to comparisons both among all patients ($5,391 vs $5,593, respectively) and among only noncomplicated patients ($4,684 vs $4,769, respectively). In terms of tumor location, the total hospital cost for the VATSL group was lower than for the OL group when the surgery was performed on the right lower lobe (RLL), left upper lobe (LUL), and left lower lobe (LLL). The costs were not significantly different between the two learning periods of the surgeons, except for the cost of anesthesia.

Conclusions: In Korea, VATSL for lung cancer had lower complication rates, shorter hospital stays, and lower total hospital costs than OL.
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http://dx.doi.org/10.1007/s00464-010-1315-4DOI Listing
April 2011