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Management of bleeding from pseudoaneurysms following pancreaticoduodenectomy

World Journal of Gastroenterology 2010年第10期16卷 1239-1244页

作者： Hyung Geun Lee jin seok heo Seong Ho Choi Dong Wook Choi Department of Surgery Samsung Medical CenterSungkyunkwan University School of Medicine

AIM:To review the clinical course and the management of pseudoaneurysms post-pancreaticoduodenectomy.METHODS: Medical records of 907 patients who underwent pancreaticoduodenectomies from January 1995 to May 2007 were evaluated retrospectively. The clinical course, management strategy, and outcome of ruptured pseudoaneurysms cases were analyzed.RESULTS: Twenty-seven (3.0%) of 907 cases had post-operative hemorrhage from ruptured pseudoan-eurysms. Pancreatic fistula was evident in 12 (44%) cases. Sentinel bleeding appeared in 21 (77.8%) cases. Of the 27 cases, 11 (41%) cases demonstrated bleeding pseudoaneurysm of the ligated gastroduodenal artery, 8 (30%) of the right, proper, common hepatic artery, 2 (7%) of the right gastric artery, and 4 (15%) of the peripancreatic arteries. The remaining two patients died due to sudden-onset massive hemorrhage and pseudoaneurysm rupture was suspected. Emergent operation was performed on 2 cases directly without angiography. Angiography was attempted in 23 cases. Eighteen (78.2%) cases succeeded to hemostasis; the five failed cases were explored. After embolization of the hepatic artery, five cases developed liver abscesses or infarction and a single case of hepatic failure expired. Gastroduodenal artery embolization with common hepatic artery stent insertion was performed to enhance hepatic artery flow in a single case and was successfully controlled.CONCLUSION: Bleeding pseudoaneurysms are among the most serious and fatal complications following pancreaticoduodenectomy. Diagnostic angiography has been preferred over endoscopy and is rapidly becoming the standard therapeutic treatment for bleeding pseudoaneurysms.

关键词： Pseudoaneurysm Pseudoaneurysm Angi-ography Embolization Stent graft

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Potential risk factors for nonalcoholic steatohepatitis related to pancreatic secretions following pancreaticoduodenectomy

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World Journal of Gastroenterology 2011年第32期17卷 3716-3723页

作者： Sun Choon Song Seong Ho Choi Dong Wook Choi jin seok heo Woo seok Kim Min Jung Kim Department of Surgery Samsung Medical Center Sungkyunkwan University School of Medicine

AIM: To identify risk factors for nonalcoholic steatohepatitis following pancreaticoduodenectomy, with a focus on factors related to pancreatic secretions. METHODS: The medical records of 228 patients who had a pancreaticoduodenectomy over a 16-mo period were reviewed retrospectively. The 193 patients who did not have fatty liver disease preoperatively were included in the final analysis. Hepatic steatosis was diagnosed using the differences between splenic and hepatic attenuation and liver-to-spleen attenuation as measured by non-enhanced computed tomography. RESULTS: Fifteen patients (7.8%) who showed postoperative hepatic fatty changes were assigned to Group A, and the remaining patients were assigned to Group B. Patient demographics, preoperative laboratory findings (including levels of C-peptide, glucagon, insulin and glucose tolerance test results), operation types, and final pathological findings did not differ significantly between the two groups; however, the frequency of pancreatic fistula (P = 0.020) and the method of pancreatic duct stenting (P = 0.005) showed significant differences between the groups. A multivari- ate analysis identified pancreatic fistula (HR = 3.332, P = 0.037) and external pancreatic duct stenting (HR = 4.530, P = 0.017) as independent risk factors for the development of postoperative steatohepatitis. CONCLUSION: Pancreatic fistula and external pancreatic duct stenting were identified as independent risk factors for the development of steatohepatitis following pancreaticoduodenectomy.

关键词：危险因素十二指肠脂肪肝切除术酒精性分泌物肝炎胰腺

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Carcinoma of the middle bile duct:Is bile duct segmental resection appropriate?

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World Journal of Gastroenterology 2009年第47期15卷 5966-5971页

作者： Hyung Geun Lee Sang Hoon Lee Dong Do Yoo Kwang Yeol Paik jin seok heo Seong Ho Choi Dong Wook Choi Department of Surgery Samsung Medical CenterSungkyunkwan University School of MedicineSeoul 135-710South Korea

AIM:To compare survival between bile duct segmental resection(BDSR)and pancreaticoduodenectomy(PD) for treating distal bile duct cancers. METHODS:Retrospective analysis was conducted for 45 patients in a BDSR group and for 149 patients in a PD group. RESULTS:The T-stage(P<0.001),lymph node invasion (P=0.010)and tumor differentiation(P=0.005)were significant prognostic factors in the BDSR group.The 3-and 5-year overall survival rates for the BDSR group and PD group were 51.7%and 36.6%,respectively and 46.0%and 38.1%,respectively(P=0.099).The BDSR group and PD group did not show any significant difference in survival when this was adjusted for the TNM stage.The 3-and 5-year survival rates were: stageⅠa[BDSR(100.0%and 100.0%)vs PD(76.9% and 68.4%)(P=0.226)];stageⅠb[BDSR(55.8% and 32.6%)vs PD(59.3%and 59.3%)(P=0.942)]; stageⅡb[BDSR(19.2%and 19.2%)vs PD(31.9%and 14.2%)(P=0.669)]. CONCLUSION:BDSR can be justified as an alternative radical operation for patients with middle bile duct inselected patients with no adjacent organ invasion and resection margin is negative.

关键词：胆管管段癌十二指肠入侵性生存率 PD 切除术

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Risk prediction platform for pancreatic fistula after pancreatoduodenectomy using artificial intelligence

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World Journal of Gastroenterology 2020年第30期26卷 4453-4464页

作者： In Woong Han Kyeongwon Cho Youngju Ryu Sang Hyun Shin jin seok heo Dong Wook Choi Myung jin Chung Oh Chul Kwon Baek Hwan Cho Department of Surgery Samsung Medical CenterSungkyunkwan University School of MedicineSeoul 06351South Korea Medical Artificial Intelligence Research Center Department of Medical Device Management and ResearchSAIHSTSamsung Medical CenterSungkyunkwan University School of MedicineSeoul 06351South Korea Department of Radiology Samsung Medical CenterSungkyunkwan University School of MedicineSeoul 06351South Korea Artificial Intelligence Research Center Medical DataBase IncorporatedSeoul 06048South Korea

BACKGROUND Despite advancements in operative technique and improvements in postoperative managements,postoperative pancreatic fistula(POPF)is a life-threatening complication following pancreatoduodenectomy(PD).There are some reports to predict POPF preoperatively or intraoperatively,but the accuracy of those is questionable.Artificial intelligence(AI)technology is being actively used in the medical field,but few studies have reported applying it to outcomes after PD.AIM To develop a risk prediction platform for POPF using an AI model.METHODS Medical records were reviewed from 1769 patients at Samsung Medical Center who underwent PD from 2007 to 2016.A total of 38 variables were inserted into AI-driven algorithms.The algorithms tested to make the risk prediction platform were random forest(RF)and a neural network(NN)with or without recursive feature elimination(RFE).The median imputation method was used for missing values.The area under the curve(AUC)was calculated to examine the discriminative power of algorithm for POPF prediction.RESULTS The number of POPFs was 221(12.5%)according to the International Study Group of Pancreatic Fistula definition 2016.After median imputation,AUCs using 38 variables were 0.68±0.02 with RF and 0.71±0.02 with NN.The maximal AUC using NN with RFE was 0.74.Sixteen risk factors for POPF were identified by AI algorithm:Pancreatic duct diameter,body mass index,preoperative serum albumin,lipase level,amount of intraoperative fluid infusion,age,platelet count,extrapancreatic location of tumor,combined venous resection,co-existing pancreatitis,neoadjuvant radiotherapy,American Society of Anesthesiologists’score,sex,soft texture of the pancreas,underlying heart disease,and preoperative endoscopic biliary decompression.We developed a web-based POPF prediction platform,and this application is freely available at http://popfrisk.***.org.CONCLUSION This study is the first to predict POPF with multiple risk factors using AI.This platform is reliable(AUC 0.74),so it could be used to select pat

关键词： Postoperative pancreatic fistula Pancreatoduodenectomy Neural networks Recursive feature elimination

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Predictive factors associated with malignancy of intraductal papillary mucinous pancreatic neoplasms

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World Journal of Gastroenterology 2010年第42期16卷 5353-5358页

作者： jin Hee Lee Kyu Taek Lee Jongwook Park Sun Youn Bae Kwang Hyuck Lee Jong Kyun Lee Kee-Taek Jang jin seok heo Seong Ho Choi Dong Wook Choi Jong Chul Rhee Department of Medicine Samsung Medical CenterSungkyunkwan University School of MedicineSeoul 135710South Korea Department of Pathology Samsung Medical CenterSungkyunkwan University School of MedicineSeoul 135710South Korea Department of Surgery Samsung Medical CenterSungkyunkwan University School of MedicineSeoul 135710South Korea

AIM:To identify preoperative predictive factors associated with malignancy of intraductal papillary mucinous neoplasms(IPMNs) of the pancreas.METHODS:Between April 1995 and April 2010,129 patients underwent surgical resection for IPMNs at our institute and had confirmed pathologic diagnoses.The medical records were retrospectively reviewed and immunohistochemical staining for mucin(MUC) in pancreatic tissues was performed.RESULTS:Univariate analysis showed that the following five variables were closely associated with malignant IPMNs preoperatively:absence of extrapancreatic malignancy;symptoms;tumor size > 4 cm;main pancreaticduct(MPD) size > 7 mm;and lymph node enlargement on preoperative computed tomography(CT).Multivariate analysis revealed that the following two factors were significantly associated with malignant IPMNs preoperatively:MPD size > 7 mm [odds ratio(OR) = 2.50];and lymph node enlargement on preoperative CT(OR = 3.57).No significant differences in the expression of MUC1,MUC2 and MUC5AC were observed between benign and malignant IPMNs.CONCLUSION:MPD size > 7 mm and preoperative lymph node enlargement on CT are useful predictive factors associated with malignancy of IPMNs.

关键词： Intraductal papillary mucinous neoplasms Malignancy Predictive factors Pancreatic neoplasms

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Analysis of liver metastasis after resection for pancreatic ductal adenocarcinoma

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World Journal of Gastrointestinal Oncology 2012年第5期4卷 109-114页

作者： Kwang Yeol Paik Seong Ho Choi jin seok heo Dong Wook Choi Department of Surgery Yeouido St.Mary's HospitalCatholic UniversityCollege of Medicine# 62 Yeouido-dongYeongdeungpo-gu150-713 SeoulSouth Korea Department of Surgery Samsung Medical CenterSungkyunkwan University School of Medicine135-710 SeoulSouth Korea

AIM:To investigate the risk factors affecting the liver metastasis(LM) of pancreatic ductal adenocarcinoma(PDAC) after resection.METHODS:We retrospectively analyzed 101 PDAC patients who underwent surgical resection at the Samsung Medical Center between January 2000 and December 2004.Forty one patients with LM were analyzed for the time of metastasis,prognostic factors affecting LM,and survival.RESULTS:LM was found in 40.6%.The median time of the LM(n = 41) was 6.0 ± 4.6 mo and most LM occurred within 1 year.In univariate analysis,tumor size,preoperative carbohydrate antigen 19-9,and perineural invasion were factors affecting LM after resection.In multivariate analysis,tumor size was the most important factor for LM.In univariate analysis,tumor cell differentiation was significant to LM in low-risk groups.CONCLUSION:LM after resection of PDAC occurs early and shows poor survival.Tumor size is the key indicator for LM after resection.

关键词： Pancreatic ductal adenocarcinoma Liver metastasis Recurrence

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Hepatectomy vs radiofrequency ablation for colorectal liver metastasis:A propensity score analysis

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World Journal of Gastroenterology 2015年第11期21卷 3300-3307页

作者： Huisong Lee jin seok heo Yong Beom Cho Seong Hyeon Yun Hee Cheol Kim Woo Yong Lee Seong Ho Choi Dong Wook Choi Department of Surgery Samsung Medical CenterSungkyunkwan University School of Medicine

AIM:To compare outcomes from radiofrequency ablation(RFA) and hepatectomy for treatment of colorectal liver metastasis(CRLM).METHODS:From January 2000 to December 2009,408 patients underwent curative intent treatment for CRLM.We excluded patients using the criteria:size of CRLM > 3 cm,number of CRLM ≥ 5,percutaneous RFA,follow-up period 2 cm) CRLM(P = 0.034).However,survival curves were similar for single or small(≤ 2 cm) CRLM(P = 0.714,P = 0.740).CONCLUSION:Hepatectomy is better than RFA for the treatment of CRLM.However,RFA might be suitable for selected patients with single,small(≤ 2 cm) CRLM.

关键词： Colorectal neoplasm Metastasis Catheter ablation H

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Clinical validation of scoring systems of postoperative pancreatic fistula after pancreatoduodenectomy: applicability to Eastern cohorts?

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Hepatobiliary Surgery and Nutrition 2019年第3期8卷 211-218页

作者： Jae Seung Kang Taesung Park Youngmin Han Seungyeon Lee Jae Ri Kim Hongbeom Kim Wooil Kwon Sun-Whe Kim jin seok heo Seong Ho Choi Dong Wook Choi Song Cheol Kim Tae Ho Hong Dong Sup Yoon Joon Seong Park Sang Jae Park Sung-Sik Han Sae-Byeol Choi Joo Seop Kim Chang-Sup Lim jin-Young Jang Department of Surgery and Cancer Research Institute Seoul National University College of MedicineSeoulRepublic of Korea Department of Statistics and Interdisciplinary Program in Biostatistics Seoul National UniversitySeoulRepublic of Korea Department of Mathematics and Statistics Sejung UniversitySeoulRepublic of Korea Department of Surgery Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea Division of Hepatobiliary and Pancreatic Surgery Department of SurgeryUlsan University College of Medicine and Asan Medical CenterSeoulRepublic of Korea Department of Surgery Seoul St.Mary’s HospitalThe Catholic University of KoreaCollege of MedicineSeoulRepublic of Korea Pancreatobiliary Cancer Clinic Department of SurgeryGangnam Severance HospitalYonsei University College of MedicineSeoulRepublic of Korea Center for Liver Cancer National Cancer CenterGyeonggidoRepublic of Korea Department of Surgery Korea University Guro HospitalKorea University College of MedicineSeoulRepublic of Korea Department of Surgery Kangdong Sacred Heart HospitalHallym University College of MedicineSeoulRepublic of Korea Department of Surgery Seoul Metropolitan Government-Seoul National University Boramae Medical CenterSeoul National University College of MedicineSeoulRepublic of Korea

Background:Although several prediction models for the occurrence of postoperative pancreatic fistula(POPF)after pancreatoduodenectomy(PD)exist,all were established using Western cohorts.Large-scale external validation studies in Eastern cohorts that consider demographic variables including lower body mass index(BMI)are scarce.The purpose of this study was to externally validate POPF prediction models using nationwide large-scale Korean cohorts.Methods:Nine tertiary university hospitals in the Republic of Korea participated.Patients'preoperative characteristics,intraoperative factors,and pathologic findings were evaluated.POPF grades were determined according to the 2016 International Study Group on Pancreatic Surgery definition.Three POPF risk models(Callery,Roberts,and Mungroop)were selected for external validation.Results:A total of 1,898 PD patients were enrolled.A non-pancreatic disease diagnosis[hazard ratio(HR),1.856;95%confidence interval(CI),1.223–2.817;P=0.004),higher preoperative BMI(HR,1.069;95%CI,1.019–1.121;P=0.006),and soft pancreatic texture(HR,1.859;95%CI,1.264–2.735;P=0.002)were independent risk factors for clinically relevant POPF(CR-POPF).The area under the receiver operating characteristic curve(AUC)values were 0.61,0.64,and 0.63 on the Callery,Roberts,and Mungroop models,respectively;all were lower than those published in each external validation study.Conclusions:Western POPF prediction models performed less well when applied to Korean cohorts.Thus,a large-scale Eastern-specific and externally validated POPF prediction model is needed.

关键词： Pancreatic fistula pancreatoduodenectomy(PD) predictive score

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Highly Aligned Ternary Nanofiber Matrices Loaded with MXene Expedite Regeneration of Volumetric Muscle Loss

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Nano-Micro Letters 2024年第4期16卷 269-292页

作者： Moon Sung Kang Yeuni Yu Rowoon Park Hye jin heo seok Hyun Lee Suck Won Hong Yun Hak Kim Dong‑Wook Han Department of Cogno‑Mechatronics Engineering College of Nanoscience and NanotechnologyPusan National UniversityBusan 46241Republic of Korea Medical Research Institute School of MedicinePusan National UniversityYangsan 50612Republic of Korea Department of Anatomy School of MedicinePusan National UniversityYangsan 50612Republic of Korea Engineering Research Center for Color‑Modulated Extra‑Sensory Perception Technology Pusan National UniversityBusan 46241Republic of Korea Department of Biomedical Informatics School of MedicinePusan National UniversityYangsan 50612Republic of Korea Periodontal Disease Signaling Network Research Center and Dental and Life Science Institute School of DentistryPusan National UniversityYangsan 50612Republic of Korea BIO‑IT Fusion Technology Research Institute Pusan National UniversityBusan 46241Republic of Korea Present Address:Osstem Implant Inc. Seoul 07789Republic of Korea

Current therapeutic approaches for volumetric muscle loss(VML)face challenges due to limited graft availability and insufficient bioactivities.To overcome these limitations,tissue-engineered scaffolds have emerged as a promising alternative.In this study,we developed aligned ternary nanofibrous matrices comprised of poly(lactide-co-ε-caprolactone)integrated with collagen and Ti_(3)C_(2)T_(x)MXene nanoparticles(NPs)(PCM matrices),and explored their myogenic potential for skeletal muscle tissue regeneration.The PCM matrices demonstrated favorable physicochemical properties,including structural uniformity,alignment,microporosity,and hydrophilicity.In vitro assays revealed that the PCM matrices promoted cellular behaviors and myogenic differentiation of C2C12 myoblasts.Moreover,in vivo experiments demonstrated enhanced muscle remodeling and recovery in mice treated with PCM matrices following VML injury.Mechanistic insights from next-generation sequencing revealed that MXene NPs facilitated protein and ion availability within PCM matrices,leading to elevated intracellular Ca^(2+)levels in myoblasts through the activation of inducible nitric oxide synthase(i NOS)and serum/glucocorticoid regulated kinase 1(SGK1),ultimately promoting myogenic differentiation via the m TOR-AKT pathway.Additionally,upregulated i NOS and increased NO–contributed to myoblast proliferation and fiber fusion,thereby facilitating overall myoblast maturation.These findings underscore the potential of MXene NPs loaded within highly aligned matrices as therapeutic agents to promote skeletal muscle tissue recovery.

关键词： Ti_(3)C_(2)T_(x)MXene nanoparticle Ternary nanofibrous matrices Myogenesis Regeneration of volumetric muscle loss Next generation sequencing

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Repeat hepatic resection in patients with colorectal liver metastases

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World Journal of Gastroenterology 2015年第7期21卷 2124-2130页

作者： Huisong Lee Seong Ho Choi Yong Beom Cho Seong Hyeon Yun Hee Cheol Kim Woo Yong Lee jin seok heo Dong Wook Choi Kyung Uk Jung Ho-Kyung Chun Department of Surgery Samsung Medical Center Sungkyunkwan University School of Medicine Department of Surgery Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine

AIM:To investigate the survival outcomes of secondaryhepatectomy for recurrent colorectal liver metastases(CRLM).METHODS:From October 1994 to December 2009,patients with CRLM who underwent surgical treatment with curative intent were investigated.Patients were divided into two groups:patients who underwent primary hepatectomy(Group 1)and those who underwent secondary hepatectomy for recurrent CRLM(Group 2).RESULTS:Survival and prognostic factors were analyzed.A total of 461 patients were included:406patients in Group 1 and 55 patients in Group 2.After a median 39-mo(range,3-195 mo)follow-up,there was a significant difference between Groups 1 and 2in terms of disease-free survival(P=0.029)although there was no significant difference in overall survival(P=0.206).Secondary hepatectomy was less effective in patients with multiple recurrent CRLM than primary hepatectomy for initial CRLM(P=0.008).Multiple CRLM and radiofrequency ablation therapy were poor prognostic factors of secondary hepatectomy in multivariate Cox regression analysis(P=0.006,P=0.004,respectively).CONCLUSION:Secondary hepatectomy for single recurrent CRLM is as effective as primary surgical treatment for single recurrent CRLM.However,secondary hepatectomy for multiple recurrent CRLM is less effective than that for single recurrent CRLM.

关键词： Colorectal neoplasm Metastasis Recurrence Hepatect

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