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[KINGCA 2018]

ÀϽÃ: 2018³â 4¿ù 26ÀÏ (¸ñ) - 4¿ù 28ÀÏ (Åä)

Àå¼Ò: ±×·£µå ¿öÄ¿Èú ¼­¿ï


1. [10:00-11:30] GEJ Cancer - General principle

1) History of GEJ cancer treatment strategy (Arnulf H. Holscher)

À¯·´¿¡¼­´Â Siewert ºÐ·ù(Chirurg 1987;58:25-32)°¡, ÀϺ»¿¡¼­´Â Nishi ºÐ·ù(1973)°¡ »ç¿ëµË´Ï´Ù.

ìíÜâãÝÔ³äßÝÂ×¾, 2017

2) Endoscopic finding and results of ESD (Ichiro Oda)

Clinicopatholgical characteristics of early GEJ cancer
Male
Differentiated type
HP -
Gastric atrophy -
0~6 o'clock location
IIc or IIa
Reddish in color

His angle¿¡ À§Ä¡ÇÑ GEJ cancerÀÇ ³»½Ã°æ Ä¡·á Àü·«: ½Äµµ ÂÊÀ» ¸ÕÀú ÀýÁ¦ÇÑ ÈÄ À§ ºÎºÐÀ» ÀýÁ¦ÇÑ´Ù. Oda ¼±»ý´ÔÀº Dual knife·Î precuttingÀ» ÇÏ°í IT-2 knife·Î submucosal dissectionÀ» ÇÏ´Â ºñµð¿À Ŭ¸³À» º¸¿©ÁÖ¾ú½À´Ï´Ù.

µ¿°æ¾Ï¼¾ÅÍ¿¡¼­´Â ¸Å³â gastric ESD 500¿¹, ½Äµµ ESD 200¿¹ Á¤µµ ½ÃÇàµÇÁö¸¸ GEJ ¾Ï¿¡ ´ëÇÑ ESD´Â 5-10¿¹ Á¤µµ ½ÃÇàµÈ´Ù°í ÇÕ´Ï´Ù.

3) LN metastasis & recurrence patten (¿ï»ê´ë ÀÌÀμ·)

µ¶ÀÏ ÀÚ·á: Feith M. Surg Oncol Clin N Am 2006, Gertler R. Ann Surg 2014

ÀϺ» ÀÚ·á: Yamashita. Gastric Cancer 2017

Çѱ¹ ÀÚ·á: Suh. Ann Surg Oncol 2017

4) Upfront surgery vs. CCRTx: from the view of oncologist compared to esophageal cancer (ÃæºÏ´ë Ç÷¾×Á¾¾ç³»°ú ÇÑÇý¼÷)

GEJ adenocarcinoma is a 'Zone Disease' rather than an 'Oragn disease'

Type I GEJ adenocarcinoma should be regarded as similar to esophageal cancers, and treated like esophageal cancer with preoperative CCRT followed by esophagectomy and mediastinal lymphadenectomy.

Type II and III GEJ adenocarcinoma should be regarded as similar to gastric cancers, and treated like gastric cancer with total gastrectomy and D2 lymphadenectomy.

* Âü°í: EndoTODAY GEJ cancer

* Âü°í: Japanese classification of esophageal cancer, 2017


2. [11:40-12:10] JS Min memorial lecture. ¹æ¿µÁÖ


[13:10-14:40] Basics for gastric cancer treatment

1) Pathological classification of gastric cancer

2) Endoscopy and EUS findings of gastric cancer (¼º±Õ°ü´ëÇб³ ÀÌÁØÇà)

PPT PDF 5.0M

Traditionally learning endoscopy means learning endoscopy insertion techniques. After observing a few cases, I just started inserting the endoscope into the patient¡¯s stomach. When I found an ulcer or polyp, I had no idea whether it is benign or malignant. But everything changed. Or everything must be changed. You should not insert the endoscope without sufficient training. Our endoscopy learning program at Samsung Medical Center starts with BOXIM, which means box simulator training and DEX, description exercise.

There are many kinds of simulators. Pictures on the top are full electronic endoscopy simulator, GI Mentor and GI Mentor II. Although expensive, we don¡¯t use it anymore. I think box simulators are much useful than GI Mentor II.

The left-hand side is the old style, and the right-hand side is the new model. We start with old style simulator because it is easier to teach and learn.

We started box simulator training in the year 2005. However, our training session was always in the evening. Why? Because we didn¡¯t have a training room.

So, I changed a small warehouse into the box simulator training room.

Now, we can teach and learn the basic endoscopy skills in the box simulator training room before the sunset.

A few days ago, box simulator training session was held for the foreign doctors in the KINGCA Master Class in the BOXIM training room.

All the education materials for endoscopy beginners are available at my personal homepage at endotoday.com. The next course after BOXIM training is description exercise.

The beginners make a description for the endoscopy cases following the SMC style, which means location, size, major finding, minor findings, impression and classification. Teachers usually give personalized feedback.

[¿Ü°ú ¼±»ý´Ô Áú¹®]

ÀúÈñ ±â°ü¿¡¼­´Â ¼ö¼ú ÈÄ È¯ÀÚ ³»½Ã°æÀ» ¿Ü°ú¿¡¼­ ÇÏ°í ÀÖ½À´Ï´Ù. ¾î¶² °æ¿ì¿¡ Á¶Á÷°Ë»ç¸¦ ÇØ¾ß Çմϱî?

[ÀÌÁØÇà ´äº¯]

(1) Subtotal gastrectmoy ÈÄ remnant stomachÀ» °üÂûÇÏ´Â °ÍÀº ¸Å¿ì ¾î·Á¿î ÀÏÀÔ´Ï´Ù. ÀϹÝÀûÀÎ À§³»½Ã°æ¿¡ ¸Å¿ì Àͼ÷ÇØÁø ÈÄ remnant stomach¿¡ ´ëÇÑ ³»½Ã°æÀ» ÇÏ´Â °ÍÀÌ ÁÁ°Ú½À´Ï´Ù.

(2) ¼ö¼ú º´¸®¸¦ È®ÀÎÇÑ ÈÄ °Ë»çÇÏ´Â °ÍÀÌ ÁÁ½À´Ï´Ù. Undifferentiated histologyÀÌ°í resection marginÀÌ ÃæºÐÇÏÁö ¾ÊÀº °æ¿ì´Â anastomosis site recurrence¸¦ ´õ¿í ÁÖÀÇÇØ¾ß Çϱ⠶§¹®ÀÔ´Ï´Ù.

(3) Remnant stomachÀÇ º¸¸¸ 4Çü ÁøÇ༺ À§¾ÏÀ» ÁÖÀÇÇϽʽÿä.

(4) ´Ù¸¥ ºÎÀ§¿Í ¸¶Âù°¡Áö·Î erosion, ulcer, localized tumor´Â Á¶Á÷°Ë»çÀÇ ´ë»óÀÔ´Ï´Ù.

(Á¤Ä¡ÀûÀÎ À̽´¶§¹®¿¡ ´ÙÀ½Àº ¸»ÇÏÁö ¾Ê¾Ò½À´Ï´Ù. ²À ¸»ÇØÁÖ°í ½Í¾úÁö¸¸ Âü¾Ò½À´Ï´Ù. "¿Ü°ú ÀÇ»ç·Î¼­ ÀϹÝÀûÀÎ À§³»½Ã°æÀ» ÇÒ ±âȸ°¡ ¸¹Áö ¾Ê±â ¶§¹®¿¡ postop ȯÀÚ¿¡ ´ëÇÑ ³»½Ã°æÀ» ÇÏ°í ÀÖ´Â °ÍÀ¸·Î ÀÌÇص˴ϴٸ¸, ³»°ú¿Í »óÀÇÇÏ¿© ¿Ü°ú ÀÇ»çÀÇ ³»½Ã°æ ±³À° ÇÁ·Î±×·¥À» ´Ùµë°í ¾÷¹«¸¦ Á¶ÀýÇÏ¸é ¾î¶»°Ú½À´Ï±î? Àú´Â ¿Ü°ú Àǻ絵 À§³»½Ã°æÀ» ¹è¿ö¾ß ÇÑ´Ù°í »ý°¢ÇÕ´Ï´Ù. Á÷Á¢ °Ë»çÇÒ »ý°¢À̸é Àß ¹è¿î ÈÄ ³»½Ã°æÀ» Àâ¾Æ¾ß ÇÕ´Ï´Ù. ÃæºÐÈ÷ ¹è¿ìÁö ¾Ê°í ³»½Ã°æÀ» ÇÑ´Ù´Â °ÍÀº ¸Å¿ì À§ÇèÇÑ ÀÏÀÔ´Ï´Ù. Àǻ翡°Ô³ª ȯÀÚ¿¡°Ô³ª...... µ¶¸³ÀûÀÎ ³»½Ã°æÀ» Çϱâ À§Çؼ­´Â ÃÖ¼ÒÇÑ 3´Þ Á¤µµÀÇ full time endoscopy trainingÀÌ ÇÊ¿äÇÕ´Ï´Ù. Àú´Â ³»½Ã°æÀ» ÇÏ°íÀÚ ÇÏ´Â »ç¶÷Àº ´©±¸³ª °¡¸£Ä£´Ù´Â ¹æħÀ» °¡Áö°í ÀÖ½À´Ï´Ù. ¹è¿ì°Ú´Ù´Âµ¥ Áø·á°ú ±âµæ±ÇÀ» ³íÇϸ鼭 ±âȸÁ¶Â÷ ÁÖÁö ¾Ê´Â´Ù´Â °ÍÀº ¸»ÀÌ µÇÁö ¾Ê½À´Ï´Ù. º¹ºÎ ÃÊÀ½ÆÄ °Ë»ç¸¦ ¹è¿ì°í ½ÍÀ¸³ª ¿µ»óÀÇÇаú¿¡¼­ °¡¸£ÃÄÁÖÁö ¾Ê´Â´Ù°í ¿åÇÏ´Â ºÐµéÀÌ ¸¹½À´Ï´Ù. ¿µ»óÀÇÇаú¸¦ ¿åÇÏ´Â ³»°ú Àǻ簡 ³»½Ã°æÀ» ¹è¿ì°íÀÚ ÇÏ´Â ¿Ü°ú Àǻ翡°Ô ±âȸÁ¶Â÷ ÁÖÁö ¾Ê´Â´Ù´Â °ÍÀº ¸»ÀÌ µÇÁö ¾Ê½À´Ï´Ù. ¸øÇÏ°Ô ÇÒ ±ÇÇÑÀÌ ¾øÀ¸¸é °¡¸£ÃÄ¾ß ÇÕ´Ï´Ù. °¡¸£Ä¡Áö ¾Ê´Â´Ù°í ¾ÈÇÏ´Â °ÍÀÌ ¾Æ´Õ´Ï´Ù. ¾ûÅ͸®·Î ÇÒ »ÓÀÔ´Ï´Ù. ±×·¡¼­ °¡¸£ÃÄ¾ß ÇÕ´Ï´Ù. ȯÀÚ¸¦ À§ÇÏ¿©. ")

3) Intial considerations for radiologic evaluation in gastric cacner (¼­¿ï´ëÇб³ ¿µ»óÀÇÇаú ±è¼¼Çü)


[Selected posters]

1) ¼ö¼úÀå¿¡¼­ peritoneal seeding nodule·Î »ý°¢µÇ´Â º´¼Ò°¡ ÀÖ¾î frozenÀ» Çߴµ¥ metastasis·Î ³ª¿Í O&C¸¦ ÇÑ È¯ÀÚ¿´½À´Ï´Ù. Formal report´Â ÀüÀÌ°¡ ¾Æ´Ï°í mesothelial hyperplasia¿´´Ù°í ÇÕ´Ï´Ù. ´Ù½Ã ¼ö¼úÀ» ÇÏ¿´½À´Ï´Ù. ȯÀÚ´Â °í»ýÀ» ¸¹ÀÌ ÇϼÌÁö¸¸ ±×´ë·Î ´ÙÇàÀÎ °æ¿ìÀÔ´Ï´Ù.

2) Retrograde jejunogastric intussusception of efferent loop after Billroth II gastrectomy


[Master Class at SMC]

Âü¼®ÀÚ: Elisabetta Marino (Italy), Bishnu Kandel (Nepal), Olga Ilina (Russia), Kelvon Voon (Malaysia)

À§¾ÏÆÀ ¿Ü°ú¿¡ trainingÀ» ¿À½Å ¼±»ý´ÔÀ» ´ë»óÀ¸·Î ESD¿Í ³»½Ã°æ¿¡ ´ëÇÏ¿© °£´ÜÇÑ introductionÀ» ÇÏ¿´½À´Ï´Ù.

1) Introduction of SMCDE and mini-lectures

Surgical and endoscopic treatment of gastric cancer at Samsung Medical Center

»ï¼º¼­¿ïº´¿ø ³»½Ã°æ½Ç ¼Ò°³. PPT PDF

PPT PDF

2) Description exercise (DEX): ±âº» °­ÀÇ(YouTube µ¿¿µ»ó)´Â °¢ÀÚ °øºÎÇÑ ÈÄ, ÇÔ²² 7¹®Á¦¸¦ Ç®¾ú°í, ÀÌ ÈÄ 35¹®Á¦¸¦ Ç®¾î ÀÌÁØÇà¿¡°Ô mailÀ» º¸µµ·Ï ÇÏ¿´°í ÷»èÁöµµ¸¦ ÇÏ¿´À½.

in English (2017-7-10)

SMC style - (1) Location, (2) Size, (3) Major finding, (4) Minor findings, (5) Impression, (6) Classification

Description exercise 1

Description exercise 2

Description exercise 3

Description exercise 4

Description exercise 5

3) Box simulator hands on training

4) ESD procedure observation (¹Îº´ÈÆ ±³¼ö´Ô, ÀÌÇõ ±³¼ö´Ô)


[2018-5-5] KINGCA 2018 Master Class·Î »ï¼ºº´¿ø¿¡ ¹æ¹®ÇϽŠ¼±»ý´ÔµéÀ» ±³À°ÇÏ¿´½À´Ï´Ù. ¸çÄ¥ ÈÄ Description exercise 1ȸ¿¡ ´ëÇÑ ´äº¯ÀÌ µµÂøÇÏ¿´½À´Ï´Ù. ¾à°£ÀÇ Ã·»èÀ» Çؼ­ ÀÇ°ßÀ» º¸³»µå·È½À´Ï´Ù (÷»èÁöµµ). ȨÆäÀÌÁöÀÇ ¿µ¹®È­ Çʿ伺À» ´À²¼½À´Ï´Ù. ÀϺζóµµ...


[References]

1) À§¾ÏÇÐȸ ÇмúÇà»ç on-line Áß°è

© ÀÏ¿ø³»½Ã°æ±³½Ç ¹Ù¸¥³»½Ã°æ¿¬±¸¼Ò ÀÌÁØÇà. EndoTODAY Endoscopy Learning Center. Lee Jun Haeng.