Goyang, South Korea
Goyang, South Korea

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Jang J.-Y.,Seoul National University | Kang M.J.,Seoul National University | Heo J.S.,Sungkyunkwan University | Choi S.H.,Sungkyunkwan University | And 8 more authors.
Annals of Surgery | Year: 2014

OBJECTIVE:: To prospectively evaluate the survival benefit of dissection of the nerve plexus and lymphadenectomy in patients with pancreatic head cancer. BACKGROUND:: Despite randomized controlled trials on the extent of surgery in pancreatic cancer, attempts have been made to perform more extended resections. METHODS:: A total of 244 patients were enrolled; of these, 200 were randomized to undergo standard resection or extended resection, with the latter including the dissection of additional lymph nodes and the right half of the nerve plexus around the superior mesenteric artery and celiac axis. We evaluated 167 patients from 7 centers who fulfilled all of the required criteria. RESULT:: Operation time was longer and estimated blood loss was higher in the extended resection group than in the standard resection group, but the R0 resection rate was comparable. The mean number of lymph nodes retrieved per patient was higher in the extended resection group than in the standard resection group (33.7 vs 17.3; P < 0.001). The morbidity rate was slightly higher in the extended resection group than in the standard resection group. Two patients in the extended resection group died in hospital. Median survival after R0 resection was similar in the extended resection and standard resection groups (18.0 vs 19.0 months; P = 0.239) regardless of lymph node metastasis. Adjuvant chemoradiation had a positive impact on overall survival. CONCLUSIONS:: This study suggests that extended lymphadenectomy with dissection of the nerve plexus does not provide a significant survival benefit compared with standard resection in pancreatic head cancer. Standard resection can be performed safely and efficiently, without negatively affecting oncologic efficacy or long-term survival, when compared with extended pancreaticoduodenal resection. (NCT00679913).


Park J.-W.,Center for Liver Cancer | Finn R.S.,University of California at Los Angeles | Kim J.S.,Korea University | Karwal M.,University of Iowa | And 7 more authors.
Clinical Cancer Research | Year: 2011

Purpose: Brivanib, a selective dual inhibitor of fibroblast growth factor and VEGF signaling, has demonstrated encouraging antitumor activity in preclinical and phase I studies. We performed a phase II open-label study of brivanib as first-line therapy in patients with unresectable, locally advanced, or metastatic hepatocellular carcinoma. Experimental Design: Brivanib was administered orally at a dose of 800 mg once daily. The primary objective was 6-month progression-free survival, progression-free survival rate; secondary objectives were tumor response rate, time to response, duration of response, median progression-free survival, median overall survival, disease control rate (complete response, partial response, or stable disease ≥ 42 days), and safety and tolerability. Results: Between March 2007 and May 2009, 55 patients were treated and were evaluable for response. Patients were assessed using modified World Health Organization (mWHO) criteria. According to mWHO criteria and as assessed by Independent Response Review Committee, the six-month progression-free survival rate (95% CI) was 18.2% (9.1%-30.9%). Median progression-free survival (95% CI) was 2.7 months (1.4-3.0). One patient achieved a complete response and three achieved a partial response. Twenty-two had stable disease. Median overall survival (95% CI) was 10 (6.8-15.2) months. Brivanib was generally well tolerated; the most common adverse events included fatigue, hypertension, and diarrhea. Conclusion: Brivanib as first-line therapy demonstrates promising antitumor activity and a manageable safety profile in patients with advanced, unresectable HCC. ©2011 AACR.


Lee J.M.,Seoul National University | Park J.-W.,Center for Liver Cancer | Choi B.I.,Seoul National University
Digestive Diseases | Year: 2014

Hepatocellular carcinoma (HCC) is the fifth most commonly occurring cancer in Korea and typically has a poor prognosis with a 5-year survival rate of only 28.6%. Therefore, it is of paramount importance to achieve the earliest possible diagnosis of HCC and to recommend the most up-to-date optimal treatment strategy in order to increase the survival rate of patients who develop this disease. After the establishment of the Korean Liver Cancer Study Group (KLCSG) and the National Cancer Center (NCC), Korea jointly produced for the first time the Clinical Practice Guidelines for HCC in 2003, revised them in 2009, and published the newest revision of the guidelines in 2014, including changes in the diagnostic criteria of HCC and incorporating the most recent medical advances over the past 5 years. In this review, we will address the noninvasive diagnostic criteria and diagnostic algorithm of HCC included in the newly established KLCSG-NCC guidelines in 2014, and review the differences in the criteria for a diagnosis of HCC between the KLCSG-NCC guidelines and the most recent imaging guidelines endorsed by the European Organisation for Research and Treatment of Cancer (EORTC), the Liver Imaging Reporting and Data System (LI-RADS), the Organ Procurement and Transplantation Network (OPTN) system, the Asian Pacific Association for the Study of the Liver (APASL) and the Japan Society of Hepatology (JSH). © 2014 S. Karger AG, Basel.


Kim S.H.,Center for Liver Cancer | Kim Y.K.,Center for Liver Cancer
British Journal of Surgery | Year: 2013

Background: Complication rates of living-donor right hepatectomy remain a matter of major concern. The aim of this study was to achieve near-zero morbidity for living-donor right hepatectomy in a single centre. Methods: All living donors who underwent right hepatectomy between January 2005 and September 2011 were enrolled in this retrospective study. During this interval, modifications in surgical technique and management included upper midline laparotomy, use of wound protectors, hanging manoeuvre during parenchymal transection using Glisson's approach, no intraoperative cholangiography, no intensive care unit stay after surgery, no central venous catheterization, and reduction in systemic heparin dose before graft removal. Donor characteristics, operative outcomes and complications graded according to Clavien's classification were recorded. Results: A total of 300 donors were enrolled and these were divided into three groups of 100 operated on in consecutive time periods. Groups were comparable with regard to donor characteristics. The overall complication rate was 16·0 per cent, with no deaths. From group 1 to group 3, the duration of operation (P < 0·001), length of hospital stay (P < 0·001), and rate of overall (P < 0·001) and grade IIIb (P = 0·019) complications decreased significantly. In the most recent group, the morbidity rate was 3·0 per cent without any major complications, reoperation or blood transfusions. All donors recovered completely. Conclusion: This study suggests that near-zero morbidity may be reached after right hepatectomy in carefully selected living donors by continuous refinement of surgical technique and management. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.


Kim H.Y.,Center for Liver Cancer | Park J.-W.,Center for Liver Cancer
Digestive Diseases | Year: 2011

Since sorafenib, a multikinase inhibitor targeting angiogenesis of hepatocellular carcinoma (HCC), demonstrated survival benefits in recent clinical trials, it has changed the treatment paradigm and become the standard first-line treatment for patients with advanced HCC. However, disease stabilization with sorafenib lasts a few months, possibly due to the development of resistance, and thus the survival advantage was modest, even in patients with preserved liver function. Furthermore, there is currently no biomarker for monitoring the response or resistance to sorafenib. Currently, various kinds of molecularly targeted agents have been developed and are being evaluated in clinical trials. There are several steps required to improve the outcome from sorafenib therapy. First, a reliable predictive and prognostic biomarker is urgently needed. Second, a compelling indication of sorafenib treatment for HCC needs more clinical studies and consensus. Third, the actual benefits of sorafenib to patients with advanced liver dysfunction should be clarified and a more effective strategy for targeted therapy needs to be developed, for example, using a combination of targeted agents acting on different pathways or different levels of a key pathway. Finally, sorafenib could be used with other treatment modalities, such as local ablation or transarterial chemoembolization, to synergize efficacy. Based on the successful introduction of sorafenib, future studies should focus on plans to further improve the outcome of HCC patients by overcoming resistance and maximizing the efficacy of molecularly targeted therapy. Copyright © 2011 S. Karger AG, Basel.


Kim B.H.,Center for Liver Cancer | Park J.-W.,Center for Liver Cancer | Nam B.-H.,National Cancer Center | Kwak H.W.,Center for Liver Cancer | Kim W.R.,Rochester College
Liver International | Year: 2014

Survival of patients with hepatocellular carcinoma (HCC) is determined by hepatic function and tumour extent. Recently, a new Model to Estimate Survival in Ambulatory HCC patients (MESIAH) was proposed to predict overall survival in ambulatory HCC patients. This study aimed to evaluate the prognostic performance of the MESIAH score in an independent cohort of HCC patients. Methods: A cohort of 1969 patients newly diagnosed with HCC at the National Cancer Center, Korea between January 2004 and December 2009 was used for validation of the MESIAH score. The model's performance was assessed using C-statistics, the likelihood ratio (LR) χ2 value and Akaike information criterion (AIC). Results: Patients in the cohort had a median age of 56 years and 83.2% were men. Hepatitis B virus infection was present in 74.6 and 81.6% had a Child-Pugh class A. The median overall survival was 21.4 months. The MESIAH score had a higher degree of discrimination, with a C-statistic of 0.792 [95% confidence interval (CI), 0.782-0.803], when compared with the Barcelona Clinic Liver Cancer (BCLC) staging system [0.665 (95% CI, 0.653-0.678), P < 0.001]. The LR χ2 value and the AIC of MESIAH were also better than those of BCLC, Cancer of the Liver Italian Program, Japan Integrated Scoring and Tokyo score. The observed survival in the cohort closely matched that predicted by the MESIAH score. Conclusions: The new prognostication model MESIAH accurately estimated the overall survival of Korean HCC patients and may be useful in future research as well as individual patient care. © 2014 John Wiley & Sons A/S.


Kim S.H.,Center for Liver Cancer | Kim Y.K.,Center for Liver Cancer
HPB | Year: 2013

Objectives The optimal incision for liver resection in living donors or patients with small tumours should be revisited. This study introduces the upper midline incision (UMI) above the umbilicus for various liver resections using a conventional open-surgery technique. Methods A retrospective study based on a prospectively collected database of 308 liver resections performed by a single surgeon was conducted to evaluate the feasibility, safety and applicability of the UMI. Results From September 2006 to September 2010, this incision was used successfully in 308 consecutive liver resections in all patients with tumours measuring ≤ 5 cm and all living donors without any extension of the incision. The median length of the incision was 16.4 cm (range: 12-20 cm).The median operating time was 189 min (range: 54-305 min). The median postoperative hospital stay was 8 days (range: 6-17 days). One patient died in the postoperative period from heart failure. All other patients fully recovered and returned to their previous level of activity. Over a median follow-up of 31 months (range: 20-68 months), 25 complications (8.1%) developed. Seven wound infections (2.3%) occurred with no incisional hernia. Conclusions The UMI can be used safely and effectively in conventional open surgery in various liver resections and should therefore be given priority as the first-line technique in living liver donors and patients with tumours measuring ≤ 5 cm. © 2012 International Hepato-Pancreato-Biliary Association.


Choi D.H.,Hanyang University | Park S.J.,Center for Liver Cancer | Kim H.K.,Biomolecular Function Research Branch
Hepatobiliary and Pancreatic Diseases International | Year: 2015

Distinguishing ampullary carcinoma from pancreatic carcinoma is important because of their different prognoses. microRNAs are differentially expressed according to the tissue of origin. However, there is rare research on the differential diagnosis between the two types of cancers by microRNA in periampullary cancers. The present study was undertaken to compare microRNA profiles between ampullary and pancreatic carcinomas using microarrays. miR-215 was most significantly overexpressed in ampullary carcinomas; whereas the expressions of miR-134 and miR-214 were significantly lower in ampullary carcinomas than in pancreatic carcinomas. When these discriminatory microRNAs were applied to liver metastases, they were correctly predicted for the tissue of origin. Although this study is limited by small sample size, striking difference in microRNA expression and concordant expression of discriminating microRNAs in primary tumors and metastases suggest that these novel discriminatory microRNAs warrant future validation. © 2015, Hepatobiliary Pancreat Dis Int. All rights reserved.


Park J.-W.,Center for Liver Cancer | Koh Y.H.,Center for Liver Cancer | Kim H.B.,Center for Liver Cancer | Kim H.Y.,Center for Liver Cancer | And 4 more authors.
Journal of Hepatology | Year: 2012

Background & Aims: Transarterial chemoembolization (TACE) is an important palliative treatment for unresectable hepatocellular carcinoma (HCC), but TACE-induced ischemic injury can upregulate angiogenic factors and is associated with poor prognosis. The aim of this study was to evaluate the safety and efficacy of concurrent conventional TACE and sorafenib in patients with unresectable HCC. Methods: The primary objectives of this prospective, single-arm, phase II study were to evaluate safety and time to progression (TTP). Sorafenib was given 3 days after TACE and was administered for up to 24 weeks. Repeated TACE was performed on demand. Tumor response was assessed every 8 weeks. Results: Fifty patients were treated and followed from July 2009 to May 2011. All patients were in Barcelona Clinic Liver Cancer (BCLC) stage B (82%) or C (18%). The median time of follow-up was 14.9 months and a median of 1 TACE session was given (range, 1-4). The median dose intensity of sorafenib was 68.7% (range, 37.3-100) of 800 mg daily. The most common reasons for dose reduction were hand-foot syndrome and thrombocytopenia. Thirty patients completed the study and 17 patients discontinued sorafenib due to disease progression. The overall median TTP was 7.1 months (95% confidence interval (CI), 4.8-7.5 months): 7.3 months in BCLC stage B; 5.0 months in BCLC stage C. The 6-month progression-free survival rate was 52% (95% CI, 37.3-66.1). Conclusions: Concurrent treatment of unresectable HCC with conventional TACE and sorafenib demonstrates a manageable safety profile and a possibility of promising efficacy. © 2012 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.


Kim S.H.,Center for Liver Cancer | Kim Y.K.,Center for Liver Cancer
World Journal of Surgery | Year: 2012

Background: The purpose of this study was to introduce an advanced technique for the best living donor right hepatectomy (LDRH) using the hanging maneuver by Glisson's approach under an upper midline incision. Methods: From January 2005 to February 2010, a total of 196 consecutive LDRHs have been performed at the National Cancer Center, Korea. To assess the overall outcomes of LDRH done with two significant technical developments-the upper midline incision and the initial Glisson's approach-we performed a comparative analysis involving all consecutive living donors, who we divided into three groups based on the two technical modifications over 5 years. Results: Compared with the previous two groups, the third group of 32 consecutive living donors, from September 2009 to February 2010, demonstrated shorter operative time, shorter duration of hospital stay, and lower complication rate with no operative mortality, major morbidity, blood transfusion, or reoperation. All donors were fully recovered and returned to their previous activities. Conclusions: This LDRH using the hanging maneuver by Glisson's approach can be completed safely and effectively with good outcomes through an upper midline incision above the umbilicus, which may be a new milestone toward the best LDRH that donor surgeons can pursue. © 2011 Société Internationale de Chirurgie.

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