1.The Impact of Preoperative Chemotherapy on the Surgical Management of Unresectable Gastric Cancer.
Sam Youl YOON ; Min Gyu KIM ; Sung Tae OH
Journal of the Korean Gastric Cancer Association 2009;9(4):269-274
PURPOSE: There have been reported that preoperative chemotherapy for treating noncurative gastric cancer could increase the R0 resection rate by downstaging the gastric cancer. Yet there have been only rare reports about the effect of preoperative chemotherapy on performing surgery for noncurative gastric cancer. Our study was designed to analyze our experiences with these effects. MATERIALS AND METHODS: We retrospectively analyzed 46 patients who had undergone gastrectomy after chemotherapy between December 2001 and January 2009. The patients' preoperative condition, the operative findings and the postoperative clinical coursed were analyzed. RESULTS: Preoperative chemotherapy was performed for a mean of 4.4 cycles. Four patients showed a level of ANC below 1,500 (micron/L) and above a 10 percentile weight loss, respectively. For an operation, we found fibrosis or fixation between the tumor and the adjacent organs in 29 patients, and 4 of the 13 patients who underwent resection with another organ were documented to have invasion by tumor. Forty one patients underwent curative resection. Ten patients developed postoperative complications. There was no mortality at postoperative 60 days. CONCLUSION: We assumed that preoperative chemotherapy had little effect on the patient preoperatively, and it had some effect on down-staging pathologically. Preoperative chemotherapy didn't increase the postoperative complication rate.
Benzeneacetamides
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Fibrosis
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Gastrectomy
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Humans
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Piperidones
;
Postoperative Complications
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Retrospective Studies
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Stomach Neoplasms
;
Weight Loss
2.The Clinicopathologic Characteristics of Patients with Gastric Carcinoid Tumor.
Jeong Moon JANG ; Seong Ho KONG ; Hong Man YOON ; Hye Seong AHN ; Hyuk Joon LEE ; Won Jae YOON ; Sang Kyoon KIM ; Han Kwang YANG ; Kuhn Uk LEE
Journal of the Korean Gastric Cancer Association 2009;9(4):262-268
PURPOSE: We wanted to analyze the clinicopathologic characteristics of patients with gastric carcinoid tumor, which is a rare gastric tumor (less than 2% of all gastric tumors). MATERIALS AND METHODS: We reviewed all the carcinoid patients who were treated from 1996 to 2006. The clinicopathologic characteristics, the treatment modalities and the survival rates were retrospectively analysed. RESULTS: There were 8 type I patients and 10 type III patients, but there were no type II patients. The mean age of onset for type I was 47.75 years and that for type III was 57.90 years. More type III patients were female, but the gender ratio of type I patients was equal at a ratio of 1:1. There were 4 cases of solitary tumor, which were all T1 except for one case, and there was neither distant metastasis nor lymph node involvement for the type T1 cases. In the 13 patients who had no metastasis, 5 underwent endoscopic mucosal resection and 8 underwent surgery, and their combined 5 year survival rate was 92.3%. For the 5 cases who had metastastses, their mean survival was 22 months and especially, 3 of them underwent palliative surgery and their median survival were 24 months (95%, +/-6.52). CONCLUSION: Higher incidence of type III gastric carcinoid tumor and less multiplicity in type I gastric tumor were identified in our study compared with previous reports. For the type III cases, there were some noteable differences compared with the Western country's survival rate for the patients who underwent palliative surgery, so physicians must pay close attention to the definite clinicopathologic characteristics of gastric carcinoid patients.
Age of Onset
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Carcinoid Tumor
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Female
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Humans
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Incidence
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Lymph Nodes
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Neoplasm Metastasis
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Palliative Care
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Retrospective Studies
;
Survival Rate
3.The Clinicopathologic Features of Synchronous and Metachronous Cancer in Patients with Gastric Cancer.
Young Sun YOO ; Eun Seo CHOI ; Sungsoo KIM ; Young Don MIN
Journal of the Korean Gastric Cancer Association 2009;9(4):256-261
PURPOSE: With the development of diagnostic techniques, second primary neoplasms such as synchronous or metachronous cancers in gastric cancer patients are being increasingly found. In this study, we investigated the clinicopathological features and clinical significance of gastric neoplasms combined with synchronous and metachronous cancers. MATERIALS AND METHODS: 1,048 patients who were diagnosed with gastric cancer in Chosun University Hospital from January 1998 to March 2008 were retrospectively reviewed. RESULTS: 38 of the 1,048 patients with gastric cancer (3.6%) had synchronous and metachronous cancers. Of the 38 patients, 16 patients (42.1%) had synchronous cancer and 22 patients (57.9%) had metachronous cancer. The average time interval between gastric cancer and the secondary primary cancer was 27.08+/-31.25 months. The most common second primary neoplasm was lung cancer (8/38, 21.1%), followed by colorectal cancer (8/38, 21.1%). Among the 27 patients who underwent surgical resection for gastric cancer, 5 patients (18.5%) were in the synchronous group and 22 patients (81.5%) were in the metachronous group. The mean survival time of the 38 patients was 49.8 months. The mean survival time was 24.6 months for the synchronous cancer patients and 68.1 month for the metachronous cancer patients. The 3 year survival rate of the synchronous group and the metachronous group was 33.3% and 81.1%, respectively. CONCLUSION: We must pay attention on the preoperative workup for synchronous cancer and on the postoperative follow-up for metachronous cancer in gastric cancer patients.
Colorectal Neoplasms
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Follow-Up Studies
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Humans
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Lung Neoplasms
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Neoplasms, Second Primary
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Retrospective Studies
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Stomach Neoplasms
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Survival Rate
4.The Prognostic Significance of the Number of Resected Lymph Nodes in Gastric Cancer Patients.
Se Jin KIM ; You Jin JANG ; Jong Han KIM ; Sung Soo PARK ; Seong Heum PARK ; Seung Ju KIM ; Young Jae MOK ; Chong Suk KIM ; Hyong Gin AHN
Journal of the Korean Gastric Cancer Association 2009;9(4):246-255
PURPOSE: The objectives of this study were to investigate the impact of the number of resected lymph nodes on the survival of gastric cancer patients who underwent curative resection, and to evaluate the cut-off values that can have an influence on survival on the tumor stage-stratified analysis. MATERIALS AND METHODS: The subjects were 949 gastric cancer patients who underwent curative resection at Korea University Medical Center from 1992 to 2002. They were classified according to the depth of tumor invasion, and the influence of the number of resected lymph nodes on survival was investigated. The cut-off value for the number of resected lymph nodes was determined as the smallest value that showed a significant survival difference. RESULTS: The tumor size, location, lymph node stage, the number of metastatic lymph nodes and the number of resected lymph nodes were significantly different according to the tumor stage. The average number of resected lymph nodes was about 39, and it showed linear correlation with the number of metastatic lymph nodes. On the Cox proportional hazard model, the cut-off values of the number of resected lymph nodes, as corrected by the number of metastatic lymph nodes, was 14 for all the patients, 15 for the pT1 patients, 28 for the pT2 patients and 37 for the pT3 patients, respectively. CONCLUSION: Retrieving a number of lymph nodes that is more than the cut-off value could improve the survival of gastric cancer patients. Surgeons should also make efforts to perform an exact and thorough D2 lymph node dissection. Therefore, we urge surgeons to perform D2 dissection and pathologists should examine an certain exact number of lymph nodes.
Academic Medical Centers
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Humans
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Korea
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Lymph Node Excision
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Lymph Nodes
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Proportional Hazards Models
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Stomach Neoplasms
5.Factors Affecting Prognosis in Early Gastric Cancer.
Ki Bin HAN ; You Jin JANG ; Jong Han KIM ; Sung Soo PARK ; Seong Heum PARK ; Seung Ju KIM ; Young Jae MOK ; Chong Suk KIM
Journal of the Korean Gastric Cancer Association 2009;9(4):238-245
PURPOSE: Treatment strategies for early gastric carcinoma (EGC) should be based on achieving a complete cure, but clear indications for limited surgery have not been established. We investigated surgical outcomes for early gastric cancer to determine the optimal? treatment strategy for EGC. MATERIALS AND METHODS: Subjects included 881 patients who underwent curative surgery for EGC between 1986 and 2003. Retrospective uni & multi-variate analysis for prognostic factors, factors affecting lymph node metastasis, and risk factors for cancer recurrence were analyzed. RESULTS: In multivariate survival analyses, age, operation method, macroscopic appearance and lymph node stage proved to be independent prognostic factors. Lymph node metastasis, depth of tumor invasion, tumor size, lymphatic and venous invasion were also significant risk factors in multivariate analyses. In multivariate analyses for cancer recurrence, depth of tumor invasion and lymph node metastasis proved to be significant risk factors. CONCLUSION: Appropriate surgical treatment with lymph node dissection is necessary for EGC patients with risk factors for lymph node metastasis.
Humans
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Lymph Node Excision
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Lymph Nodes
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Multivariate Analysis
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Neoplasm Metastasis
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Prognosis
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Recurrence
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Retrospective Studies
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Risk Factors
;
Stomach Neoplasms
6.Candida Infection in a Patient with Gastric Carcinoma; 1 Case Report.
Ju Won CHYUNG ; Chang Young YOO ; Dae Young CHEUNG ; Hoon HUR ; Hae Myung JEON
Journal of the Korean Gastric Cancer Association 2009;9(1):31-35
Most gastric candida infections have been reported in immune-insufficient patients with peptic ulcer, but there have been few reports on gastric candidiasis with malignant ulcer in the stomach. We experienced a case of candida infection with gastric carcinoma in a 72-year-old female with diabetic mellitus. The endoscopic view showed multiple whitish necrotic plaques with a huge ulcer in the body of the stomach. The pathologic findings showed that budding yeast and pseudohyphae had infiltrated through the ulcerated stomach wall and the stomach wall contained tubular adenocarcinoma. After treatment with Fluconazole medication for 14 days, the patient underwent total gastrectomy along with D2 lymph node dissection. For the final pathologic results, there was no evidence of any remnant candidiasis, and the patient was discharged without specific complications. Through our experience and with reviewing articles about gastric candidiasis, we recommend that the gastric candidiasis that is accompanied with gastric malignancy should be treated before administering definite treatments for the gastric cancer.
Adenocarcinoma
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Aged
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Candida
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Candidiasis
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Female
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Fluconazole
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Gastrectomy
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Humans
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Lymph Node Excision
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Peptic Ulcer
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Saccharomycetales
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Stomach
;
Stomach Neoplasms
;
Ulcer
7.The Prognostic Value of the Preoperative Lymphocyte Count in Patients with Gastric Cancer.
Shin Yong KANG ; Wan Sik YU ; Ho Young CHUNG ; Sung Hun PARK
Journal of the Korean Gastric Cancer Association 2009;9(1):26-30
PURPOSE: The aim of this study was to evaluate the prognostic value of the peripheral blood lymphocyte count before surgery in those patients with gastric cancer. MATERIALS AND METHODS: The study group was comprised of a series of 1,054 patients who underwent curative gastrectomy. The appropriate lymphocyte count cutoff value was determined. The prognostic factors were evaluated by univariate and multivariate analyses. RESULTS: The lymphocyte count cutoff value was 1,500/ul. The patients were classified into two groups: Group A had a lymphocyte count > or =1,500/ul (n=765) and Group B had a lymphocyte count <1,500/ul (n=289). There were statistically significant differences between the groups according to their age (P<0.001), the tumor stage (P=0.038) and the tumor size (P<0.001). The 5- and 10-year survival rates of Group A were 80.1% and 76.6%, respectively and those of Group B were 72.4% and 63.5%, respectively (P=0.002). When multivariate analysis was performed by the Cox proportional hazards model, the lymphocyte count was not an independent prognostic factor. CONCLUSION: Although the prognosis of patients with a high lymphocyte count was better than that of the patients with a low lymphocyte count, our results did not support using the preoperative peripheral blood lymphocyte count as an independent prognostic factor for patients with gastric cancer.
Gastrectomy
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Humans
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Lymphocyte Count
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Lymphocytes
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Multivariate Analysis
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Prognosis
;
Proportional Hazards Models
;
Stomach Neoplasms
;
Survival Rate
8.Is a Fast-track Critical Pathway Possible in Gastric Cancer Surgery?.
Jeong Min YI ; Hoon HUR ; Sung Keun KIM ; Kyo Young SONG ; Hyung Min CHIN ; Wook KIM ; Cho Hyun PARK ; Seung Man PARK ; Keun Woo LIM ; Hae Myung JEON
Journal of the Korean Gastric Cancer Association 2009;9(1):18-25
PURPOSE: The postoperative hospital stay after gastric cancer surgery is usually 8 to 14 days. The main reason for a prolonged hospital stay may be the 3 to 4 day period of postoperative starvation. The aim of this study is to investigate the feasibility of a critical pathway for early recovery after gastric cancer surgery, and this pathway included early postoperative feeding. MATERIALS AND METHODS: One hundred three consecutive patients who underwent gastric resection and reconstruction for gastric cancer from October 2007 to June 2008 at St. Mary's Hospital were prospectively enrolled in a fast-track critical pathway. The pathway included minimal preoperative procedures, optimal pain relief, proper fluid administration, early mobilization and early enteral nutrition at postoperative 1 day. The exclusion criteria were determined preoperatively, intraoperatively and postoperatively. RESULTS: Of the 103 patients, 19 patients were excluded for preoperative (5), intraoperative (7) and postoperative (7) reasons. Eighty-four patients (81.6%) were included in the fast-track critical pathway. Sixty-eight (88.6%) of 84 patients were discharged at the planned 8 day after surgery during the initial period of the study, and the postoperative hospital stay was shortened up to 6 days during the more recent period. Postoperative complications occurred in 22 patients (26.2%), and these were gastrointestinal track-related complications in 6 cases (3 cases of ileus, 1 case of stasis and 2 cases of leakage) and infection-related complications in 8 cases. There was no statistical difference in the incidence of morbidity according to the clinic-operative features that included age, gender, stomach resection and lymphadenectomy. CONCLUSION: The fast-track critical pathway with using the available exclusion criteria was a valid option for patients who underwent gastric cancer surgery.
Critical Pathways
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Early Ambulation
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Enteral Nutrition
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Humans
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Ileus
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Incidence
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Length of Stay
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Postoperative Complications
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Preoperative Care
;
Prospective Studies
;
Starvation
;
Stomach
;
Stomach Neoplasms
9.Hepatic Resection in Patients with Liver Metastasis from Gastric Cancer.
Kyong Hwa JUN ; Hyung Min CHIN
Journal of the Korean Gastric Cancer Association 2009;9(1):14-17
The clinical significance of hepatic resection for gastric metastases is controversial, even though hepatic resection has been widely accepted as a modality for colorectal metastases. Very few patients with gastric hepatic metastases are good candidates for hepatic resection because of multiple bilateral metastases, extrahepatic disease, or advanced cancer progression, such as peritoneal dissemination or extensive lymph node metastases. Therefore, several authors have reported the clinical significance of hepatic resection for gastric metastases in a small number of patients. Considering the present results with previous reports. The number and distribution of tumors in hepatic metastases from gastric cancer was considered based on the present and previous reports. Several authors have reported significantly better survival in patients with metachronous metastasis than in those with synchronous disease. However, metachronous hepatic resection necessitates the dissection of adhesions between the pancreas, liver, and residual stomach to prepare for Pringle's maneuver. Patients with unilobar liver metastasis, and/or metastatic tumors <4 cm in diameter may be good candidates for hepatic resection. Synchronous metastasis is not a contraindication for hepatic resection. Most of the long-term survivors underwent anatomic hepatic resection with a sufficient resection margin. After hepatic resection, the most frequent site of recurrence was the remaining liver, which was associated with a high frequency of mortality within 2 years. A reasonable strategy for improvement in survival would be to prevent recurrence by means of adjuvant chemotherapy and careful follow-up studies.
Chemotherapy, Adjuvant
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Follow-Up Studies
;
Gastric Stump
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Humans
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Liver
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Lymph Nodes
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Neoplasm Metastasis
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Pancreas
;
Recurrence
;
Stomach Neoplasms
;
Survivors
10.Hepatic Solitary Metastasis of Gastric Cancer: Radiofrequency.
Keun Won RYU ; Min Ju KIM ; Sook Ryun PARK ; Jong Seok LEE ; Jun Ho LEE ; Young Woo KIM
Journal of the Korean Gastric Cancer Association 2009;9(1):10-13
The prognosis of gastric cancer with hepatic metastasis is very poor, even though several treatment modalities exist, such as surgical resection. Indeed, a standard therapy has not been established in such patients. Recently, attempts were made to treat hepatic metastasis of gastric cancer with radiofrequency (RF), which was originally used in primary or metastatic liver cancer. RF has been reported to show similar survival compared to surgical resection and is emerging as a new treatment modality even though it is still not conclusive with respect to efficacy and safety due to the paucity of reports. A prospective study is warranted to evaluate the efficacy of RF in the treatment of gastric cancer with hepatic metastasis compared with conventional modalities.
Humans
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Liver Neoplasms
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Neoplasm Metastasis
;
Prognosis
;
Stomach Neoplasms