Jae Keun Kim

Postoperative Nutritional Effects of Early Enteral Feeding Compared with Total Parental Nutrition in Pancreaticoduodectomy Patients: A Prosepective, Randomized Study

The benefits of early enteral feeding (EEN) have been demonstrated in gastrointestinal surgery. But, the impact of EEN has not been elucidated yet. We assessed the postoperative nutritional status of patients who had undergone pancreaticoduodenectomy (PD) according to the postoperative nutritional method and compared the clinical outcomes of two methods. A prospective randomized trial was undertaken following PD. Patients were randomly divided into two groups; the EEN group received the postoperative enteral feed and the control group received the postoperative total parenteral nutrition (TPN) management. Thirty-eight patients were included in our analyses. The first day of bowel movement and time to take a normal soft diet was significantly shorter in EEN group than in TPN group. Prealbumin and transferrin were significantly reduced on post-operative day (POD) 7 and were slowly recovered until POD 90 in the TPN group than in the EEN group. EEN group rapidly recovered weight after POD 21 whereas it was gradually decreased in TPN group until POD 90. EEN after PD is associated with preservation of weight compared with TPN and impact on recovery of digestive function after PD.

The Effect of Visceral Fat Mass on Pancreatic Fistula after Pancreaticoduodenectomy

ABSTRACT Background: Obesity is associated with perioperative complications and has been considered a risk factor for surgical outcomes of patients undergoing abdominal surgery. The aim of this study is to evaluate the impact of the amount of visceral fat on postoperative morbidity of patients who underwent pancreaticoduodenectomy (PD). Methods: We reviewed 181 patients who underwent surgery for periampullary lesions at the Department of Surgery, Gangnam Severance Hospital, Yonsei University Health System between January 2003 and June 2010. The visceral fat area (VFA) and subcutaneous fat area were calculated by computed tomography software. Results: The mean body mass index (BMI) was 23.4 kg/m2 (±3.1 kg/m2), and the mean VFA was 94.4 cm2 (±49.5 cm2). The mean intraoperative blood loss, and the incidence of clinically relevant pancreatic fistula (grade B/C) and clinically relevant delayed gastric emptying (grade B/C) were significantly higher in the high-VFA group (≥100 cm2). In univariate analysis, the incidence of clinically relevant pancreatic fistula (grade B/C) was significantly higher in the high-BMI group (≥25 kg/m2), the high-VFA group(≥100 cm2), the large intraoperative blood loss and transfusion group, and in patients with pathology of nonpancreatic origin (ampulla, bile duct, or duodenum). In multivariate analysis, the high-VFA group (≥100 cm2) and patients with pathology of nonpancreatic origin were identified as independent factors for clinically relevant pancreatic fistula. Conclusion: VFA is a better indicator for the development of pancreatic fistula after PD than BMI. High VFA (≥100 cm2) is a risk factor for developing a pancreatic fistula after PD.

The role of abdominal drainage to prevent of intra-abdominal complications after laparoscopic cholecystectomy for acute cholecystitis: prospective randomized trial

BackgroundRoutine drainage of the abdominal cavity after surgery has been a robust dogma for many decades. Nevertheless, the policy of routine abdominal drainage is increasingly questioned. Many surgeons believe that routine drainage after surgery may prevent postoperative intra-abdominal infection. The goal of this study was to assess the role of drains in laparoscopic cholecystectomy (LC) for acute cholecystitis.Materials and methodsFrom May 2008 to July 2012, 160 patients that underwent LC due to acute cholecystitis at Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea, were enrolled in this study. After surgery, patients were randomly allocated to undergo drain placement in the subhepatic space (Group A) or no drainage (Group B).ResultsThere was no significant difference in the intra-abdominal abscess rate, which was 0.0xa0% with Group A and 1.3xa0% with Group B (Pxa0=xa00.319). The median subhepatic fluid collection was 4.1xa0mL (1.1–60xa0mL) in Group A and 4.5xa0mL (1.1–80.0xa0mL) in Group B (Pxa0=xa00.298). However, the median hospital stay was 2xa0days (1–4xa0days) in Group B and 3xa0days (2–7xa0days) in group A (Pxa0=xa00.001). The subgroup of empyema patients did not have any significant differences in intra-abdominal fluid collection or intra-abdominal abscess rate.ConclusionsThis study suggests that postoperative routine drainage of the abdominal cavity for acute cholecystitis does not prevent intra-abdominal infections.

Robotic versus laparoscopic left lateral sectionectomy of liver.

BackgroundA few studies have reported only short-term outcomes of various robotic and laparoscopic liver resection types; however, published data in left lateral sectionectomy (LLS) have been limited. The aim of this study was to compare the long- and short-term outcomes of robotic and laparoscopic LLS.MethodsWe retrospectively compared demographic and perioperative data as well as postoperative outcomes of robotic (nxa0=xa012) and laparoscopic (nxa0=xa031) LLS performed between May 2007 and July 2013. Resection indications included malignant tumors (nxa0=xa031) and benign lesions (nxa0=xa012) including intrahepatic duct (IHD) stones (nxa0=xa09).ResultsThere were no significant differences in perioperative outcomes of estimated blood loss, major complications, or lengths of stay, but operating time was longer in robotic than in laparoscopic LLS (391 vs. 196xa0min, respectively) and the operation time for IHD stones did not differ between groups (435 vs. 405xa0min, respectively; pxa0=xa00.190). Disease-free (pxa0=xa00.463) and overall (pxa0=xa00.484) survival of patients with malignancy did not differ between groups. The 2- and 5-year disease-free survival rates were 63.2 and 36.5xa0%, respectively. However, robotic LLS costs were significantly higher than laparoscopic LLS costs (

P16 Hypermethylation Predicts Surgical Outcome Following Curative Resection of Mid/Distal Bile Duct Cancer

8183 vs.

Can We Predict Postoperative Pancreatic Leakage After Pancreaticoduodenectomy Using Preoperative Fecal Elastase-1 Level?

5190, respectively; pxa0=xa00.009).ConclusionsRobotic LLS was comparable to laparoscopic LLS in surgical outcomes and oncologic integrity during the learning curve. Although robotic LLS was more expensive and time intensive, it might be a good option for difficult indications such as IHD stones.

A model for predicting pancreatic leakage after pancreaticoduodenectomy based on the international study group of pancreatic surgery classification.

BackgroundBile duct cancer has very poor prognosis. Important prognostic factors include the TNM stage, cell differentiation, and histologic type; however, we often observe patients whose prognosis is not consistent with the TNM stage. Additional prognostic indicators are mandatory to complement those used presently. We evaluated the hypermethylation status of genes for the power to predict overall survival following curative resection of mid/distal bile duct cancer.MethodsPyrosequencing hypermethylation status at the loci of interest was analyzed in 65 mid/distal bile duct carcinoma specimens obtained at Severance Hospital of Yonsei University College of Medicine from January 2000 to December 2006.ResultsSignificant methylation frequencies (MtI >5xa0%) were obtained for 5 genes (which P16 [17xa0%], DAPK [54xa0%], E-cadherin [60xa0%], RASSF-1 [46.2xa0%], and hMLH1 [43.1xa0%]). MtI status of P16, DAPK, and RASSF-1 were correlated with perineural invasion, tumor depth, and age, respectively. In the multivariate analysis of overall survival, the presence of lymph node metastasis and P16 methylation status were identified as independent prognostic factors for overall survival. Patients with unmethylated of P16 had the 3- and 5-year survival rates of 60.8 and 54.9xa0%, respectively. In patients with hypermethylated P16, the 3- and 5-year survival rates were 27.3 and 0.0xa0%, respectively.ConclusionsP16 hypermethylation and lymph node metastasis may predict overall survival in curative resected mid/distal bile duct cancer. Classification of mid/distal bile duct cancer by both genetic and epigenetic profiles may improve the accuracy in predicting outcome and the effectiveness of tailored therapy in these diseases.

Prognostic significance of angiogenesis by Chalkley counting in node negative cancer of the ampulla of Vater.

The measurement of fecal elastas‐1 in stools is a sensitive and relatively inexpensive noninvasive test. The aim of this study was to study fecal elastase levels in patients who develop pancreatic leakage after pancreaticoduodenectomy (PD) to determine if fecal elastase level can be used to predict patients at high risk for pancreatic leakage after PD.

Correlation of Early Recurrence With In Vitro Adenosine Triphosphate Based Chemotherapy Response Assay in Pancreas Cancer With Postoperative Gemcitabine Chemotherapy

Backgrounds/Aims With recent advances in pancreatic surgery, pancreaticoduodenectomy (PD) has become increasingly safe. However, pancreatic leakage is still one of the leading postoperative complications. An accurate prediction model for pancreatic leakage after PD can be helpful for pancreas surgeons. The aim of this study was to provide a new model that was simple and useful with high accuracy for predicting pancreatic leakage after PD. Methods To predict the occurrence of pancreatic leakage, several factors were selected using bivariate analysis and univariate logistic regression analysis. The final model was developed using multivariable logistic regression analysis in the model construction data set. Results Overall, 41 of 100 patients had pancreatic leakage by the International Study Group on Pancreatic Fistula (ISGPF) criteria. Soft pancreatic parenchyma, small pancreatic duct diameter (≤3 mm), and combined resection of SMV and portal vein were independently predictive of pancreatic leakage. The risk score (R) for individual patients can be calculated by combining the 3 prognostic values with the regression test: R=0.5986+(0.5533×pancreatic parenchyma)+(0.5448×pancreatic duct diameter)+(0.8453×combined resection). The overall predictive accuracy of the model, as measured by the receiver operating characteristic (ROC) curve, was 0.728. Conclusions Although continued refinements and improvements in the model are needed, the present model may assist pancreatic surgeons in the prediction of pancreatic leakage after PD.

A survey of attitudes to clinical practice guidelines in general and adherence of the Korea practical guidelines for management of gallbladder polyp: a survey among private clinicians in Korea.

Angiogenesis is essential for tumor growth and metastasis. Currently, the Chalkley assay with CD34 immunostaining is the proposed standard method for angiogenesis quantification in solid tumor sections. The purpose of this study was to evaluate the expression of CD34 and its prognostic significance using the Chalkley method in node negative carcinoma of the ampulla of Vater. Between January 1997 and December 2006, 56 node negative patients who had curative resection for carcinoma of the ampulla of Vater were retrospectively reviewed. The Chalkley count was expressed as the mean value of the three counts for each tumor and further divided into two groups according to the mean value of the Chalkley count: low < 4 or high ≥ 4. The mean Chalkley count value was 4.0 (± 3.1). In the low Chalkley group, the 1- and 3-yr recurrence rates were 18.3%, 47.6% respectively; in the high Chalkley group, the 1- and 3-yr recurrence rates were 26.5% and 60.6% respectively. Only high Chalkley count had statistical significance as a factor in recurrence of node negative ampulla of Vater carcinoma. Assessment of angiogenesis may have an important role in the prognostic evaluation of node negative cancer of the ampulla of Vater.