Sungsoo Lee

Despite the high surgical success rate, postoperative compensatory hyperhidrosis (CH) remains a persistent concern in the treatment of primary palmar hyperhidrosis using endoscopic thoracic sympathectomy (ETS). This study aims to compare the early clinical outcomes of two surgical techniques-T3 ganglionectomy and R4 sympathicotomy-to determine which approach minimizes CH occurrence and enhances patient satisfaction. A retrospective analysis of medical records was conducted on patients who underwent either T3 ganglionectomy or R4 sympathicotomy for primary palmar hyperhidrosis at Gangnam Severance Hospital from January 2023 to December 2023. Demographic data and postoperative outcomes were evaluated. CH and degree of satisfaction were assessed during outpatient visits at 3 weeks and 3 months after surgery. In this study, 44 patients underwent T3 ganglionectomy and 225 patients underwent R4 sympathicotomy. There were no statistically significant differences in baseline characteristics (age, sex, body mass index, smoking history, and family history) or operative complications between the two groups. However, CH at 3 weeks and 3 months after surgery was significantly lower in T3 ganglionectomy group [4 (9.1%) vs. 143 (63.6%); Pvs. 150 (66.7%); P<0.001]. Additionally, patient satisfaction was significantly higher in the T3 ganglionectomy group compared to the R4 sympathicotomy group (P<0.001). T3 ganglionectomy exhibited superior surgical outcomes in terms of both CH and patient satisfaction for primary palmar hyperhidrosis when compared to R4 sympathicotomy. Nonetheless, a larger prospective study with long-term follow-up is necessary to validate these findings.

Joon Young Chang, M.D., Chansop Hwang, M.D., Beatrice Chia-Hui Shih, M.D., Du-Young Kang, M.D., Ph.D., Duk Hwan Moon, M.D., Sungsoo Lee, M.D., Ph.D.. J Chest Surg -0001;0:. https://doi.org/10.5090/jcs.25.118

Chansop Hwang, M.D., Beatrice Chia-Hui Shih, M.D., Duk Hwan Moon, M.D., Sungsoo Lee, M.D., Ph.D.. J Chest Surg -0001;0:. https://doi.org/10.5090/jcs.25.034

Background/Objectives: Endoscopic lumbar sympathectomy (ELS) is the definitive treatment for primary plantar hyperhidrosis (PPLH). This study analyzed the mid-term clinical outcomes and technical factors related to ELS. Methods: Retrospective reviews of patients who had ELS for PPLH between July 2019 and May 2023 were analyzed. The study period was categorized into three eras based on the timing when laser Doppler flowmetry (LDF) and PMR (psoas muscle relaxation) were applied; period A represented the initial surgical approach, period B included LDF, and period C included LDF and PMR during surgery. The impacts of these techniques on operative and short-term outcomes were assessed. Additionally, risk factor analysis was performed to find relevant factors related to the reappearance of plantar sweating in long-term follow up. As most patients underwent endoscopic thoracic sympathectomy (ETS) as well, risk assessment for compensatory hyperhidrosis was also investigated. Results: A total of 474 patients were included, and the numbers of patients by periods were as follows: n = 28 in period A, n = 198 in period B, and n = 248 in period C. Operating times were significantly different, with proportional decreases seen with the introduction of LDF and PMR (p < 0.001). In the long-term, reappearance of plantar sweating was noted in 21 patients (4.4%). Risk factors for the reappearance of plantar sweating included an age over 35 years [odds ratio {OR} (95% confidence interval {CI}) 4.57 (1.56–13.40), p = 0.006] and a history of lumbar sympathetic ganglion block (LSGB) prior to ELS [OR (95% CI), 269 (29.30–2460), p < 0.001]. Of 474 patients, 390 (82.3%) patients underwent both ETS and ELS. Risk factors for compensatory hyperhidrosis were age >25 years [OR (95% CI) 0.60 (0.40–0.90), p = 0.014] and concomitant ETS [OR (95% CI) 5.63 (1.88–16.90), p = 0.002]. Compensatory hyperhidrosis among patients who only had ELS was less observed (4/24, 16.7%). Conclusions: ELS is highly effective in treating plantar hyperhidrosis, and LDF and PMR improved perioperative outcomes. Age over 35 and a prior history of LSGB were found to be related to worse long-term outcomes of ELS. Our findings suggest that ELS with additional LDF and PMR could improve outcomes for patients with PPLH.

Background/Objectives: Minimally invasive repair of pectus excavatum (MIRPE) techniques are classified into non-double-bar methods, which elevate the chest wall only, and double-bar methods, which involve both elevation and compression. Our objective was to compare the clinical outcomes of MIRPE procedures between the double-bar and non-double-bar techniques, with a particular focus on bar removal operation time and its associated complications. Methods: This retrospective study included 103 patients who were diagnosed with pectus excavatum and underwent MIRPE between January 2015 and July 2022. Propensity score matching was performed to adjust for confounding variables between patients who underwent the double-bar procedure and those who underwent the non-double-bar procedure. Comparative analyses between the groups were conducted using t-tests and chi-square tests, and linear regression was used to identify the risk factors for a prolonged bar removal time. Results: After propensity score matching, 48 patients were matched, with each group consisting of 24 patients. The double-bar group had a shorter hospital stay after bar insertion (p < 0.001), a reduced bar removal operation time (p < 0.001), and a lower incidence of chest X-ray bony spurs (p = 0.018) compared to the non-double-bar group. Multivariate linear regression model showed non-double-bar use and the presence of a chest X-ray bony spur were significant risk factors for a prolonged bar removal operation time. Conclusions: The double-bar technique demonstrated significant advantages, such as reduced bar removal operation times and fewer complications, making it the preferable surgical approach. Nevertheless, further prospective studies with larger sample sizes are needed to validate these findings.

Objectives: Patients with cancer often experience severe mental distress, and suicide is an important issue, particularly prevalent in individuals with lung cancer. The present study aimed to investigate the longitudinal incidence of suicide among patients with lung cancer using national registry data. Methods: A population-based retrospective review of patients diagnosed with lung cancer in 2008 was conducted. Longitudinal medical records, including clinical outcomes and medical insurance data, were investigated. The primary outcome was the incidence of suicide, compared between patients undergoing the first curative treatment option (surgery or non-surgery). Cox proportional hazard regression models were used to adjust for medical history, sociodemographic variables, and lifestyle factors. Results: Among the 4495 patients included, 1306 (29.1%) underwent surgery as the first treatment. Compared to the non-surgery group, the surgery group was younger and had a lower Charlon comorbidity score (p < 0.001), higher physical activity (p < 0.001), and higher income level (p < 0.001). The total number of suicides was 28 (0.62%). The surgery group demonstrated similar trends in the development of suicide and early 5-year follow-up to those of the non-surgery group. Conclusions: The longitudinal risk of suicide among patients with lung cancer increased. Both surgical and non-surgical treatment groups demonstrated similar suicide trends, although patients in the surgery group had multiple protective factors.

Ji Hoon Kim, M.D., Won-Gi Woo, M.D., Yong-Ho Jung, M.D., Duk Hwan Moon, M.D., Sungsoo Lee, M.D., Ph.D.. J Chest Surg 2024;57:484-9. https://doi.org/10.5090/jcs.24.021

Background: Minimally invasive repair of pectus excavatum (MIRPE) improves clinical outcomes and chest wall morphology. However, asymmetry in patients with pectus excavatum (PE) remains as an important issue, even after surgery. Here, we evaluated the benefit of double-bar technique in achieving a symmetric chest wall. Methods: This retrospective study included 79 patients with PE who underwent MIRPE between 2017 and 2021. The patients were divided into the double- or non-double-bar groups. Asymmetric degree (AD) and sternal rotation angle (SRA) were used to assess the severity of asymmetry based on computed tomography (CT) images. The primary outcome was the change in radiologic parameters. Secondary outcomes were clinical results, including hospital stay, pain scores, and complication rates. Subgroup analysis of patients with preoperative asymmetric PE was performed. Results: Patients in the double-bar group (n=23) were younger than those in the non-double-bar group (n=56). Additionally, the double-bar group exhibited lower pain scores and shorter hospital stay. Based on radiological assessments, the double-bar group demonstrated a greater decrease in AD without compromising improvement in the Haller index (HI). The benefit of the double-bar technique was more obvious among patients with asymmetry with a preoperative AD >5%, resulting in a significant reduction in AD. In this subgroup, a better correction of sternal rotation was observed. Conclusions: The double-bar technique may be a promising option for correcting asymmetry in patients with PE. Simplified AD and SRA radiologic assessments can be used to evaluate improvements in chest wall configuration.

Yong Ho Jeong, M.D., Ph.D., Duk Hwan Moon, M.D., Sungsoo Lee, M.D., Ph.D.. J Chest Surg 2024;57:300-1. https://doi.org/10.5090/jcs.24.034

Background: Pure ground glass nodules (GGNs) have been increasingly detected through lung cancer screening programs. However, there were limited reports about pathologic characteristics of pure GGN. Here we presented a meta-analysis of the histologic outcome and proportion analysis of pure GGN. Methods: This study included previous pathological reports of pure GGN published until June 14, 2022 following a systematic search. A meta-analysis estimated the summary effects and between-study heterogeneity for pathologic diagnosis of invasive adenocarcinoma (IA), minimally invasive adenocarcinoma (MIA), adenocarcinoma in situ (AIS), and atypical adenomatous hyperplasia (AAH). Results: This study incorporated 24 studies with 3,845 cases of pure GGN that underwent surgery. Among them, sublobar resection was undertaken in 60% of the patients [95% confidence interval (CI): 38–78%, I²=95%]. The proportion of IA in cases of resected pure GGN was 27% (95% CI: 18–37%, I²=95%), and 50% of IA had non-lepidic predominant patterns (95% CI: 35–65%, I²=91%). The pooled proportions of MIA, AIS, and AAH were 24%, 36%, and 11%, respectively. Among nine studies with available clinical outcomes, no recurrences or metastases was observed other than one study. Conclusions: The portion of IA in cases of pure GGN is significantly larger that expected. More than half of them owned invasiveness components if MIA and IA were combined. Furthermore, there were quite number of lesions with aggressive histologic patterns other than the lepidic subtype. Therefore, further attempts are necessary to differentiate advanced histologic subtype among radiologically favorable pure GGN.