Purpose

Bariatric surgery is considered an efficient treatment for severe obesity, but postoperative complications and psychosocial problems may impact quality of life (QoL). Although QoL is an important aspect of bariatric surgery, few studies have evaluated the changes in QoL. We examined whether severely obese patients who had undergone bariatric surgery had better QoL compared with severely obese adults who had not undergone bariatric surgery in Korea.

Methods

Data were obtained from 78 participants in two groups; bariatric surgery group (n = 53) and nonsurgery group (n = 25). EuroQoL-5D (EQ-5D), the impact of weight on quality of life-lite (IWQoL-lite) and the obesity-related psychosocial problem scale (OP-scale) were used to assess the improvement of QoL.

Results

A total of 78 patients completed the QoL forms as part of their surgical consultation. In the EQ-5D, the changes of EQ-5D 3 level and EQ-5D visual analogue scale in the surgery group was 0.174 and 24.6 versus 0.017 and 17.8 in the nonsurgery group (P = 0.197 and P = 0.179). The changes of IWQoL-lite and OP-scale were significantly improved after bariatric surgery. In the IWQoL-lite, the mean changes in the surgery group was 33.4 versus 14.3 points in the nonsurgery group (P = 0.000). In the OP-scale, the mean changes in the surgery group patients scored 39.3 versus 9.0 points in the nonsurgery group (P = 0.000).

Conclusion

We demonstrated significant improvement of QoL observed after bariatric surgery compared to nonsurgical procedure. The results of this comparative study favor bariatric surgery for the treatment of severe obesity.

Purpose

The objective of this study was to translate the obesity-related problems (OP) scale for Koreans and to validate it for use in Korean populations.

Methods

Translation and back-translation of the OP scale was performed and a pilot test was conducted. Following this, patients who had received treatment at the Obesity Center of Inha University Hospital were selected for participation in the field test. Cronbach's alpha (α) was used for assessment of the internal consistency of the OP scale. Spearman's correlation coefficients were used to assess the concurrent validity between the OP scale, the EuroQoL-5D (EQ-5D), and the Beck depression inventory (BDI) scale. One-way analysis of variance and t-test were used to assess the factors associated with the OP scale.

Results

A total of 67 individuals participated in the field study. The standardized Cronbach's α of the OP was 0.913. A significant negative correlation was observed between the OP scale and the EQ-5D and a positive correlation was observed between the OP scale and the BDI (the correlation coefficient with EQ-5D = -0.316, and the BDI = 0.305, P < 0.05).

Conclusion

The results of this study prove that the Korean version of the OP has been translated and adapted correctly in order to meet the standard of its use.

Purpose

The aim of our study is to evaluate the factors affecting surgical margin positivity among patients with invasive ductal breast cancer who underwent breast-conserving surgery (BCS) after preoperative diagnostic core biopsy.

Methods

Two hundred sixteen patients with stage I, II invasive ductal breast carcinoma who had histological diagnosis with preoperative tru-cut biopsy and underwent BCS were included in the present study. Potential factors that affect the positive surgical margin were analyzed. In univariate analysis, the comparisons of the factors affecting the surgical margin positivity were made by chi-square test. Logistic regression test was used to detect the independent factors affecting the surgical margin positivity.

Results

Positive axillary lymph node (odds ratio [OR], 8.2; 95% confidence interval [CI], 3.01 to 22.12), lymphovascular invasion (LVI; OR, 3.9; 95% CI, 1.62 to 9.24), extensive intraductal component (EIC; OR, 6.1; 95% CI, 2.30 to 16.00), presence of spiculation (OR, 5.1; 95% CI, 2.00 to 13.10) or presence of microcalcification in the mammography (OR, 13.7; 95% CI, 4.04 to 46.71) have been found to be the independent and adverse factors affecting surgical margin positivity.

Conclusion

Considering decision making for the extent of the excision and for achieving negative surgical margin before BCS, positive axillary lymph node, LVI, EIC, spiculation or microcalcification in mammography are related as predictor factors for positive surgical margin.

Purpose

The aim of this study was to investigate the current status of the use of antiadhesive agents (AAdAs) via a questionnaire and to discuss the availability of AAdAs.

Methods

The survey was sent to a list of members that was approved by the Korean Gastric Association. The survey included questions on AAdA use by surgeons, the type of AAdAs used, and the reasons for not using AAdAs. Surgeons were also asked to describe complications related to AAdAs, and the reliability of its use.

Results

The response rate was 21%. The rates of frequent use stratified by procedure were 26.9% (14/52) for open gastrectomy, 5.9% (3/51) for laparoscopic gastrectomy, and 31.5% (17/54) for surgery for postoperative bowel obstruction (P < 0.01). After including data from the occasional use group, the corresponding values were 51.9% (27/52), 19.6% (10/51), and 70.4% (38/54), respectively (P < 0.01). Sefrafilm and Guardix were most commonly used for open procedures. Guardix and Interceed were most commonly used for laparoscopic surgery. The primary reasons for nonuse of AAdAs were ineffectiveness and high cost. Ten percent (4/40) of surgeons observed complications associated with AAdAs. A minority (17.3%, 9/52) had positive attitudes toward AAdAs. The majority of respondents expressed neutral (73.1%, 38/52) or negative (9.6%, 5/52) attitudes toward AAdAs.

Conclusion

The low use rates of AAdAs in gastric cancer surgery may be attributable to perceptions that AAdAs are ineffective, unreliable, and costly. We anticipate the emergence of promising antiadhesive strategies that reach far beyond the limitations of current products.

Purpose

It is increasingly being recognized that the lymph node ratio (LNR) is an important prognostic factor for gallbladder carcinoma patients. The present study evaluated predictors of tumor recurrence and survival in a large, mono-institutional cohort of patients who underwent surgical resection for gallbladder carcinoma, focusing specifically on the prognostic value of lymph node (LN) status and of LNR in stage IIIB patients.

Methods

Between 2004 and 2011, 123 patients who underwent R0 radical resection for gallbladder carcinoma at the Chonnam National University Hwasun Hospital were reviewed retrospectively. Patients were staged according to the American Joint Committee on Cancer 7th edition, and prognostic factors affecting disease free survival, such as age, sex, comorbidity, body mass index, presence of preoperative symptoms, perioperative blood transfusion, postoperative complications, LN dissection, tumor size, differentiation, lymph-vascular invasion, perineural invasion, T stage, presence of LN involvement, N stage, numbers of positive LNs, LNR and implementation of adjuvant chemotherapy, were statistically analyzed.

Results

LN status was an important prognostic factor in patients undergoing curative resection for gallbladder carcinoma. The total number of LNs examined was implicated with prognosis, especially in N0 patients. LNR was a powerful predictor of disease free survival even after controlling for competing risk factors, in curative resected gallbladder cancer patients, and especially in stage IIIB patients.

Conclusion

LNR is confirmed as an independent prognostic factor in curative resected gallbladder cancer patients, especially in stage IIIB gallbladder carcinoma.

Purpose

To identify the risk factors of major adverse cardiac event (MACE) in patients with chronic atherosclerotic lower extremity ischemia (CALEI) undergoing revascularization without noninvasive stress testing (NIST).

Methods

From January 2007 to January 2012, patients with CALEI who underwent revascularization were retrospectively reviewed. Emergent operations, revision procedures for previous surgery, or patients with active cardiac conditions were excluded. NIST was not performed for patients without active cardiac conditions. Cardiac risk was categorized into low, intermediate and high risk, according to the Lee's revised cardiac risk index. MACE was defined as acute myocardial infarction or any cardiac death within 30 days after surgery.

Results

A total of 459 patients underwent elective lower extremity revascularization procedures (240 open surgeries, 128 endovascular procedures, and 91 hybrid surgeries). The treated lesions comprised of 18% aorto-iliac, 58% infrainguinal, and 24% combined lesions. With regard to cardiac risk, low-, intermediate- and high risks were 67%, 32% and 2%, respectively. MACE was developed in 7 patients (2%). High or intermediate risk group by the Lee's index was related to postoperative MACE. Subgroup analysis for open surgery or hybrid surgery group identified female gender as an independent risk factor of MACE (P = 0.049; odds ratio, 5.168; confidence interval, 1.011 to 26.423).

Conclusion

The Lee's index was a useful predictor of MACE. MACE is more common in female patients than male patients after open or hybrid surgery. Routine preoperative NIST is not suggested for all patients undergoing revascularization for CALEI, especially for those in the low risk group.

Purpose

The reflux of pancreatic enzymes into the biliary tract is associated with chronic inflammation and increases cellular proliferation of the biliary epithelium, leading to biliary carcinoma. The aim of this study is to detect the incidence of occult pancreaticobiliary reflux (OPBR) in patients who underwent elective cholecystectomy.

Methods

Forty-seven patients with symptomatic gallstones who underwent cholecystectomy were recruited for this study. The gallbladder bile samples were obtained from the specimen of gallbladder and the amylase level was measured. The immunohistochemistry of p53, SMAD4 and Ki-67 were performed for the detection of metaplasia and dysplasia.

Results

Biliary amylase was higher than the serum amylase in 10 patients (group A, 15,402.66 ± 33,592.43 IU/L; group B, 13.06 ± 18.12 IU/L). The mean age was 67.2 years in group A and 51.2 in group B (P < 0.01). The ratio of male to female was 1:2.3 and 1:1.8 in group A and B, respectively (P = 0.297). Eight patients in group A and thirteen patients in group B had inflammation (P = 0.014). The positive results of the Ki-67 test were exhibited in five cases in each group (P = 0.024).

Conclusion

Results from the study indicate that the age was older, degree of inflammation and positive rate of Ki-67 were higher when OPBR was suspected. In conclusion, the patients with OPBR would need long-term follow-up, because the OPBR can cause dysplasia and the reflux of pancreatic juice may be considered as a risk factor for extrahepatic bile duct carcinoma.

Purpose

Radiofrequency ablation (RFA) is a widely accepted to treat the varicose vein. However, outcome studies for occlusion rate and patterns of the saphenous vein after RFA are scarce. The purpose of our study is to report the results of RFA in patients with varicose vein.

Methods

We retrospectively reviewed the clinical outcomes after RFA using ClosureFAST (Covidien) catheter. We evaluated the occlusion rate and patterns with duplex scanning after RFA.

Results

A total of 200 limbs (148 patients) underwent RFA. The truncal veins were ablated in 163 great saphenous veins (GSV) and 41 small saphenous veins (SSVs). The mean age was 52.1 ± 11.9 years and female to male ratio was 125 : 87. At the mean follow-up of 13.9 months, the CEAP score, VCSS, and QoL score were significantly improved 2.33 ± 0.78 to 1.29 ± 0.96 (P < 0.0001), 3.48 ± 0.98 to 0.63 ± 1.16 (P < 0.0001), and 6.91 ± 6.69 to 3.38 ± 4.74 (P < 0.0001), respectively. The occlusion rate was 94.6% (53/56) in GSV and 94.5% (17/18) in SSV. The most common occlusion pattern in GSV was total occlusion of main trunk with patent superficial inferior epigastric vein in 41.1%. And, the most common pattern in SSV was the total occlusion of SSV with stump in 66.7%.

Conclusion

RFA is an effective modality in the treatment of varicose vein. At the mean follow-up of 13.9 months, the occlusion rate was 94.6%in GSV and 94.5% in SSV. There are several patterns of saphenous occlusion after RFA.

A randomized controlled trial to evaluate the long-term outcomes of laparoscopic distal gastrectomy for gastric cancer is currently ongoing in Korea. Patients with cT1N0M0-cT2aN0M0 (American Joint Committee on Cancer, 6th edition) distal gastric cancer were randomized to receive either laparoscopic or open distal gastrectomy. For surgical quality control, the surgeons participating in this trial had to have performed at least 50 cases each of laparoscopy-assisted distal gastrectomy and open distal gastrectomy and their institutions should have performed more than 80 cases each of both procedures each year. Fifteen surgeons from 12 institutions recruited 1,415 patients. The primary endpoint is overall survival. The secondary endpoints are disease-free survival, morbidity, mortality, quality of life, inflammatory and immune responses, and cost-effectiveness (ClinicalTrials.gov ID: NCT00452751).

Purpose

The main issue with the current ultrasonography (US) guidelines is the overestimation of malignant and indeterminate nodules as they do not aid in making decisions to treat patients. To overcome this, new US guidelines for thyroid nodules that have been shown to be better correlated with cytologic results have been proposed. We also suggested specific indications for US-guided fine needle aspiration (FNA) using the new US guidelines.

Methods

Clinical and pathologic data from 925 patients and 1,419 thyroid nodules were retrospectively collected. All subjects underwent US- and US-guided FNA at Department of Surgery, Wonju Christian Hospital, between March 2010 and July 2011. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were calculated for both the current guidelines and the new guidelines.

Results

The accuracy, sensitivity, specificity, PPV, and NPV for the current guidelines in predicting malignancy were 24.1%, 99.3%, 62.2%, 25.0%, and 99.8%, respectively. The accuracy, sensitivity, specificity, PPV, and NPV for the new guidelines in predicting malignancy were 66.0%, 96.0%, 86.7%, 47.7%, and 99.4%, respectively.

Conclusion

The use of the new US guidelines allow for a more accurate and specific diagnosis and a better treatment plan than the current guidelines. Additionally, the use of the new FNA guidelines may help prevent unnecessary FNAs and promote cost-effective follow-up for patients.

Purpose

Before laparoscopic gastrectomy for gastric cancer can be planned, it is very important to know the precise location of the tumor. The aim of this study was to evaluate 3 methods of predicting the exact location of the tumor: preoperative gastrofibroscopy (GFS), preoperative computed tomography gastroscopy (CT), and intraoperative gastroscopy-guided laparoscopy (Lap).

Methods

In this study, 15 patients were prospectively identified, and endoscopic clips were preoperatively placed on the proximal 1 cm of the tumor, at the angle on the greater curvature and opposite the angle on the greater curvature. The distances between the pylorus and the proximal tumor clip (PT), the angle clip (PA), the greater curvature clip (PG), and the gastroesophageal junction were measured by preoperative GFS, preoperative CT, intraoperative Lap, and visual inspection (Vis).

Results

PT, PA, and PG values measured by preoperative GFS differed significantly from the Vis values (P < 0.01). However, preoperative CT measurements of PT, PA, and PG did not differ from the Vis values (P = 0.78, P = 0.48, and P = 0.53, respectively). Intraoperative Lap and Vis PT values differed by only 1.1 cm on an average (P = 0.10), but PA and PG values varied by 1.9 and 3.4 cm, respectively (P = 0.01 for both).

Conclusion

Endoscopic clipping combined with preoperative CT gastroscopy is more useful than preoperative GFS for preoperatively predicting the location of early gastric cancers and will be helpful for planning laparoscopic gastrectomy.

Purpose

It is unclear whether metabolic surgery is effective in non obese type 2 diabetes mellitus (T2DM) and the result after gastrectomy and conventional reconstruction for gastric cancer with non obese T2DM are not satisfactory for improvement of T2DM. Prospective single-arm pilot study with long limb Roux-en Y reconstruction after gastrectomy was evaluated on its safety and efficacy as a potential cure for T2DM in patients with non obese gastric cancer.

Methods

Fifteen patients with non obese T2DM and gastric cancer were enrolled. After gastrectomy, the gastrointestinal tract was reconstructed by Roux-en Y gastrojejunostomy or esophagojejunostomy. The biliopancreatic and Roux limb were 100 to 120 cm long each.

Results

There was no surgery-related mortality, but four cases experienced complications (26.7%). Before surgery, the mean body mass index was 25.2 ± 3.4 kg/m2 and mean glycated hemoglobin (HbA1c) was 7.7 ± 1.4% with antidiabetic medications. The mean BMI decreased to 21.7 ± 3.1 kg/m2 (P < 0.05) and the mean HbA1c decreased to 6.3 ± 0.8% (P < 0.05) 6 months after surgery. At the end of the study (follow-up duration, 12.5 ± 5.5 months), HbA1c decreased to <6% in 11 patients (78.6%) without any antidiabetic medications. There were no patients who had anemia, and/or malnutrition after surgery except one patient who died due to recurrence four months after surgery.

Conclusion

Long limb Roux-en Y reconstruction after gastrectomy is feasible and has the potential to cure T2DM in non obese gastric cancer patients. A randomized controlled trial is needed to confirm this result.

Purpose

The aim of this study was to analyze oncologic outcomes after transanal local excision (LE) to ensure adequate surveillance of recurrence in order to treat with curative intent.

Methods

Between January 2000 and June 2009, 102 patients who underwent transanal LE for rectal adenocarcinoma were retrospectively reviewed.

Results

Of the 102 patients, 53 (52.0%) were male. The mean age was 57 ± 11 years. Postoperative pathologic examination revealed 93 cases (91.2%) of pathologic T stage (pT)1 and 9 cases (8.8%) of pT2. Forty-eight patients (47.1%) underwent adjuvant postoperative radiotherapy. The median follow-up interval was 60 months (range, 3 to 146 months). Seven (6.9%) out of 15 patients who suffered recurrence had locoregional recurrence, three (2.9%) had systemic recurrence and five (4.9%) had both systemic and locoregional recurrence. The latter five patients and two of the three patients with systemic recurrence died because of the disease recurrence. On the other hand, only one of the seven patients with locoregional recurrence died because of disease recurrence.

Conclusion

Systemic recurrence after transanal LE results in fatal consequences. Therefore, not only is it important to identify ideal candidates for LE, but intensive postoperative surveillance is important as well to identify curable recurrence as soon as possible.

Purpose

We evaluated the predictive value of preoperative lung spirometry test for postoperative morbidity and the nature of complications related to an abnormal pulmonary function after gastric cancer surgery.

Methods

Between February 2009 and March 2010, 538 gastric cancer patients who underwent laparoscopic (n = 247) and open gastrectomy (n = 291) were divided into the normal (forced expiratory volume in 1 second [FEV1]/forced vital capacity [FVC] ≥ 0.7, n = 441) and abnormal pulmonary function group (FEV1/FVC < 0.7, n = 97), according to the preoperative lung spirometry test. The predictive value of lung spirometry for postoperative morbidity was evaluated using the univariate and multivariate analysis.

Results

After surgery, the abnormal pulmonary function group showed a significantly increased incidence of local (29.9% vs. 18.1%, P = 0.009) and systemic complications (8.2% vs. 2.0%, P = 0.005) than the normal group. Of local complications, anastomosis leakage and wound complication were found to be more common in the abnormal pulmonary function group. In the univariate and multivariate analysis, an abnormal pulmonary function was an independent predictor for postoperative local complication (odds ratio, 1.75; 95% confidence interval, 1.03 to 2.97) after adjusted by old age, total gastrectomy, open surgery, and tumor-node-metastasis stage. Meanwhile, an old age and a history of pulmonary disease were independent predictors for systemic complication.

Conclusion

Preoperative lung spirometry is a simple and useful means to predict postoperative morbidity after gastric cancer surgery. In view of its simplicity and low cost, we recommend adding preoperative lung spirometry test to assess the operative risk and aid in proper perioperative treatment planning.

Purpose

The purpose of this study was to investigate the safety and usefulness of the Hem-o-lok clip for the closure of appendicular stumps and limitations of the Hem-o-lok clip.

Methods

From May 2010 to August 2011, 105 consecutive patients underwent laparoscopic appendectomies by three surgeons. XL size Hem-o-lok clips were used for the closure of appendicular stumps by one surgeon. The remaining surgeons used double endoloop ligatures. Prospectively collected data from patients who underwent laparoscopic appendectomy due to acute appendicitis were retrospectively reviewed.

Results

A total of 105 laparoscopic appendectomies were performed. The endoloop group consisted of 66 patients (mean age, 34.6 years; range, 16 to 82 years), while the Hem-o-lok group consisted of 39 patients (mean age, 43.5 years; range, 11 to 88 years). In three cases, the Hem-o-lok clip was not used due to enlargement and severe inflammation of the appendix base. No specific intraoperative or postoperative complications were observed in either group.

Conclusion

The use of Hem-o-lok clips for the closure of appendicular stumps in laparoscopic appendectomy is a feasible, safe, fast and cost-effective procedure in patients with a mildly to moderately inflamed appendix base of less than 10 mm in diameter.

Purpose

Diverticulitis of vermiform appendix is known as a rare cause of acute appendicitis, most of which are diagnosed after surgery. We compared appendiceal diverticulitis with acute appendicitis to study the clinical characteristics of appendiceal diverticulitis.

Methods

Among 1,029 patients who received appendectomy from January 2009 to May 2011, 38 patients with appendiceal diverticulitis (diverticulitis group) were compared with 98 randomly collected patients with acute appendicitis (appendicitis group) during the same period. Patients' characteristics, clinical features, laboratory findings, operative findings, and postoperative course were compared between the two groups.

Results

Thirty-eight patients (3.7%) were pathologically diagnosed with acute appendiceal diverticulitis among 1,029 cases of appendectomy. The mean age of patients in the diverticulitis group was significantly older than that of the appendicitis group (49.0 ± 15.2 years vs. 25.4 ± 14.2 years, P < 0.05). Mean duration of preoperative symptoms was longer in the diverticulitis group (3.6 ± 3.8 days vs. 1.8 ± 3.2 days, P < 0.05). The site of abdominal pain, fever, signs of localized peritonitis, accompanying gastrointestinal symptoms, and white blood cell count showed no differences between the two groups. Twenty-five patients (65.8%) of the diverticulitis group and 10 patients (10.2%) of the appendicitis group showed perforation of appendix (P < 0.05). Mean operating time and postoperative hospital stay were longer in the diverticulitis group (55.3 ± 28.8 minutes vs. 41.4 ± 17.8 minutes, 6.8 ± 3.4 days vs. 4.9 ± 1.5 days, P < 0.05).

Conclusion

Acute diverticulitis of the appendix can be classified into quite different disease entities compared with acute appendicitis. Regarding high rates of perforation, immediate surgical treatment is needed for patients with a high index of suspicion of acute diverticulitis of the appendix.

Purpose

Laparoscopic techniques have gained wide clinical acceptance in surgical practice today. The laparoscopic approach has been established as the technique of choice for elective splenectomies performed on normal sized spleens. The purpose of this study was to evaluate the outcome of patients undergoing laparoscopic splenectomy (LS) at the TOBB University of Economics and Technology (ETU) Hospital and Kecioren Training and Research Hospital.

Methods

One hundred and thirty-five patients underwent splenectomy between January 2000 and July 2010. For comparison, the records of 130 patients undergoing splenectomy were evaluated for age, gender, hospital stay, time to start of diet, conversion rate, operation time and wound infection.

Results

Mean operation time means the time interval between surgeon commencing operation to end of operation. Mean operation time in patients treated by LS was 132 minutes and 121 minutes in open splenectomy (OS). Mean hospital stay was 5.65 days in patients undergoing LS and starting of diet was 1.21 days. In patients treated by OS, mean hospital stay was 9.17 days, starting of diet was 2.37 days. Four patients were converted to open surgery. Conversion rate was 6.4 percent. In the early post operative period (within 10 days of surgery) 9.2%, LS group had lower incidences of wound infection rate after surgery than OS group (4.8%, 7.4%, respectively; P = 0.06).

Conclusion

LS is a safe and effective alternative to OS for treatment of splenic diseases in patients of all ages.

Purpose

The aim of this study was to investigate the clinical and radiological incidence of parastomal hernia and to analyze the risk factors for parastomal hernia.

Methods

We reviewed retrospectively 108 patients with end colostomy from January 2003 to June 2010. Age, sex, surgical procedure type, body mass index (kg/m2), stoma size, and respiratory comorbidity were documented.

RESULTS

There were 61 males (56.5%) and 47 females (43.5%). During an overall median follow-up of 25 months (range, 6 to 73 months), 36 patients (33.3%) developed a radiological parastomal hernia postoperatively and 29 patients (26.9%) presented with a clinical parastomal hernia. In multivariate analysis, gender (odds ratio [OR], 6.087; P = 0.008), age (OR, 1.109; P = 0.009) and aperture size (OR, 6.907; P < 0.001) proved to be significant and independent risk factors after logistic regression analysis.

Conclusion

This study showed that the incidence of radiological parastomal hernia is higher than clinical parastomal hernia. Risk factors for parastomal hernia proved to be female, age, and aperture size.

Purpose

Varicose veins are a major problem worldwide and improvement in quality of life (QoL) is the ultimate goal after treatment of this benign disease. However QoL is highly dependent on personal and social factors. This study compares high ligation and stripping (HS) and radiofrequency ablation (RFA) in terms of QoL and recurrence in Korea.

Methods

A retrospective analysis of prospectively collected data between August 2006 and October 2008 was performed for patients undergoing HS and RFA at a single institution. QoL was assessed with a questionnaire preoperatively, at 3 months postoperatively and annually thereafter. Recurrence was assessed by Duplex ultrasound annually after surgery.

RESULTS

A total of 272 patients completed the questionnaire at 3 months. Among these patients, 155 patients returned for their annual follow-up. There were no significant differences between HS and RFA in global QoL scores, although RFA showed less pain. However, paresthesia rates were also higher after RFA. Recurrence rates were similar between the two modalities, although technical failures were more common after RFA.

Conclusion

Overall QoL and recurrence rates were similar between the two modalities. The benefits of RFA do not seem to be enough to overcome the higher costs of HS in Korea.

Purpose

We evaluated the relationship between the degree of osteopontin (OPN) expression in papillary thyroid carcinoma (PTC) specimens and the presence of the BRAF mutation and clinicopathologic variables.

Methods

Fifty-six snap-frozen thyroid tumor samples, including those of 49 PTCs, four follicular adenomas, two follicular carcinomas, and one Hürthle cell adenoma, were studied. We performed reverse transcription-polymerase chain reaction (RT-PCR) to assess the OPN expression levels. We also tested the BRAF codon 599 mutations using RT-PCR with the direct sequencing method. All of the tumors were microscopically reexamined by a pathologist with a special interest in thyroid neoplasia.

Results

OPN mRNA was significantly overexpressed in the PTC samples compared with other thyroid tumors (P = 0.011). In PTCs, the OPN expression level was higher in the BRAF mutation group than in the wild-type group (P = 0.041). Among the clinicopathologic variables, nonfollicular variant histologic subtypes (P = 0.002) and the presence of lymph node metastases (P = 0.042) were correlated with elevated level of OPN expression.

Conclusion

OPN might play a crucial role in tumorigenesis and the progression of PTC.

Purpose

In Korea, the results of bariatric surgery have not been compared with those of nonsurgical treatment. The purpose of this study was to evaluate the effectiveness and safety of bariatric surgery vs. conventional nonsurgical treatment in severely obese Koreans.

Methods

In this retrospective cohort study, we reviewed the medical charts of 261 consecutive subjects who underwent bariatric surgery and 224 subjects who were treated with weight control medication and lifestyle modification therapy between January 2008 and February 2011. Measures of clinical effectiveness, including change in weight (%) and comorbid diseases, and occurrence of complications, were investigated for 18 months after bariatric surgery.

Results

Body mass index (BMI) was higher in the surgery group than in the conventionally treated group (mean ± standard deviation, 39.0 ± 6.2 vs. 34.3 ± 3.8). Diabetes was more prevalent in the surgery group than in the conventionally treated group (39.1% vs. 12.9%). The change in weight (%) between baseline and 18 months posttreatment was significantly greater in the surgery group (22.6%) than in the conventional therapy group (6.7%). While 57%, 47%, and 84% of subjects recovered from diabetes, hypertension, and dyslipidemia, respectively, in the surgery group, 10%, 20%, and 24% of subjects recovered from these conditions in the conventional group. Fifty-one subjects (19.5%) in the surgery group reported 61 complications (23.4%).

Conclusion

Bariatric surgery in Korea was significantly more effective than conventional treatment for weight loss and recovery from comorbidities such as diabetes, hypertension, and dyslipidemia, with a reasonable complication rate.

Purpose

This study investigated the impact of subclinical borderline changes on the development of chronic allograft injury in patients using a modern immunosuppression protocol.

Methods

Seventy patients with stable renal allograft function and who underwent protocol biopsies at implantation, 10 days and 1 year after transplantation were included and classified based on biopsy findings at day 10. The no rejection (NR) group included 33 patients with no acute rejection. The treatment (Tx) group included 21 patients with borderline changes following steroid pulse therapy, and the nontreatment (NTx) group included 16 patients with borderline changes nontreated.

Results

The Banff Chronicity Score (BChS) and modified BChS (MBChS) were not different among the three groups at implantation (P = 0.48) or on day 10 (P = 0.96). Surprisingly, the NTx group had more prominent chronic scores at the 1-year biopsy, including BChS (3.07 ± 1.33, P = 0.005) and MBChS (3.14 ± 1.41, P = 0.008) than those in the Tx and NR group, and deterioration of BChS was more noticeable in the NTx group (P = 0.037), although renal function was stable (P = 0.66). No difference in chronic injury scores was observed between the Tx and NR groups at the 1-year biopsy.

Conclusion

Subclinical borderline changes can be a risk factor for chronic allograft injury and should be considered for antirejection therapy.

Purpose

Immunosuppression is a characteristic of cancer recurrence after curative resection. The neutrophil-to-lymphocyte ratio (NL ratio) in peripheral blood is associated with immune function. However, it is not clear whether the postoperative NL ratio is a predictor for cancer relapse after resection. Thus, we investigated the effectiveness of the short-term postoperative NL ratio in the prediction of disease recurrence within 5 years after stomach cancer surgery by a retrospective chart review.

Methods

Ninety-three patients with stomach cancer were enrolled. Significant risk factors for cancer recurrence were determined by multivariate Cox regression. Independent variables to increase the NL ratio to >7.7 by postoperative day (POD) 3 were examined by multivariate logistic regression analysis.

Results

The 5-year risk of cancer recurrence after gastrectomy was 4.2 times higher for patients with a POD3 NL ratio of >7.7 (P = 0.005), 3.4 times higher for normal-weight patients compared with overweight patients (P = 0.008), and 20 times higher for stage III compared with stage 0 according to the tumor-node-metastasis cancer staging system (P = 0.003). The surgical duration (hours) increased the chance of high NL ratio >7.7 (odds ratio, 2.5; P = 0.006).

Conclusion

The postoperative NL ratio, especially the POD3 NL ratio, predicts long-term recurrence after stomach cancer surgery.

Purpose

The intraumbilical incision is being used more frequently, with increasing cases of single incision laparoscopic surgery. Since the umbilicus is deeper than the surrounding wall, it has abundant bacteria. No study has compared the adverse outcomes of periumbilical and intraumbilical incisions. We analyzed the wound complication rates of perforated appendicitis patients according to the types of umbilical incision.

Methods

A retrospective review was done of 280 patients with perforated appendicitis. One hundred fifty nine patients were treated with the intraumbilical incision, and 121 patients were treated with the periumbilical incision. We compared the perioperative outcomes according to each laparoscopic incision.

Results

There was no difference in operation time, postoperative hospital stay and analgesic requirement between the two groups. One case in the intraumbilical group (0.6%) and three cases in the periumbilical group (2.5%) developed wound infections. The umbilical complication rate showed no difference.

Conclusion

The wound complication rate of intraumbilical and periumbilical incisions are not different. Although this retrospective study has inherent limitations, the intraumbilical incision seems to be a safe and feasible alternative for the periumbilical incision that can be easier to perform, with better cosmetic results.

Purpose

The aim of the present study was to evaluate the predictive value of volume of the specimen/body mass index (VS/BMI) ratio for recurrence after surgical therapy of pilonidal disease.

Methods

Ninety-eight patients with primary pilonidal disease were enrolled in this study. The VS/BMI ratio was calculated for each patient. This ratio was defined as the specimen index (SI). VS, BMI and SI were evaluated to determine whether there is a relationship between these parameters and recurrence of pilonidal disease. In addition, the predictive ability of SI for recurrence was analyzed by receiver operating characteristic (ROC) curve.

Results

VS and SI were found to be higher in patients with recurrence. ROC curve analysis showed that VS and SI are predictive factors for recurrence in patients treated with primary closure, nevertheless our new index had higher sensitivity and specificity than VS (sensitivity 85.7% vs 71.4% and specificity 90.7% vs 85.1%, respectively). The cut-off level for the greatest sensitivity and specificity for SI was 1.29.

Conclusion

Recurrence is higher in patients with high VS regardless of the operation method. SI may be a predictive value in patients treated with primary closure.