An exceedingly rare case of perforated early gastric cancer is reported. A 68-year-old man developed peritonitis due to perforation of early gastric cancer. An emergency radical operation was performed and was followed by an uneventful recovery. Histologic examination of the surgical specimen showed type III early gastric cancer composed of a signet ring cell carcinoma. Five years after surgery, the patients was alive with no evidence of tumor recurrence. The rarity of this complication in early gastric cancer is discussed, and a review of the literature is presented.
Aged ; Carcinoma, Signet Ring Cell ; Emergencies ; Humans ; Peritonitis ; Recurrence ; Stomach Neoplasms*

PURPOSE: The aim of this study was to analyze the clinical and the histopathological characteristics of mucosa associated lymphoid tissue (MALT) lymphomas in the stomach. MATENRIALS AND METHODS: We retrospectively reviewed the medical records of 22 patients who had been treated at Samsung Medical Center from Jan. 1995 to Sep. 2000 and who had been pathologically proven to have a MALT lymphoma. The factors we analyzed were operative procedure, tumor stage, and histopathological characteristics. RESULTS: Of 3658 patients with a gastric malignancy, 22 patients proved to have a MALT lymphoma (0.6%). There were 7 men and 15 women whose ages ranged from 25 years to 70 years (mean, 48.8 years). Forteen cases were located in the antrum, 4 (18%) in the body and 4 (18%) in the fundus or the high body. Nineteen of these patients were managed with total gastrectomy and splenectomy and 3 with radical subtotal gastrectomy. Histopathologically the tumor was limited to the mucosa in 3 patients (13.6%), to the submucosa in 13 (59.1%) and extended to the muscularis propria in 6 (27.3%). Lymph node involvement was seen in 12 patients (54.6%). There was no splenic or hepatic involvement. Bone marrow involvement was not seen in any patients. H. pylori was identified in 11 patients (50%). During the mean follow-up period of 32.7 months, there were no reports of tumor recurrence or death. CONCLUSION: MALT lymphomas rarely disseminate by the time of diagnosis and rarely involve the bone marrow. Lymph node involvement is relatively high and a total gastrectomy is effective in managing patients with a MALT lymphoma.
Bone Marrow ; Diagnosis ; Female ; Follow-Up Studies ; Gastrectomy ; Humans ; Lymph Nodes ; Lymphoid Tissue ; Lymphoma ; Lymphoma, B-Cell, Marginal Zone* ; Male ; Medical Records ; Mucous Membrane ; Recurrence ; Retrospective Studies ; Splenectomy ; Stomach* ; Surgical Procedures, Operative

PURPOSE: Several studies of an endoscopic mucosal resection (EMR) have been reported, but reports about benign protruding lesions that arise at the scar of EMR for early gastric cancer (EGC) or a gastric adenoma are rare. The purpose of this study was to elucidate endoscopic and histological characteristics of benign protruding lesions which arise at the scar of an EMR for EGC and a gastric flat adenoma. MATENRIALS AND METHODS: In 101 lesions (73 gastric flat adenomas and 28 EGCs) from 96 patients, 16 lesions developed new protruding lesions that arose at the scar of the EMR. We retrospectively analyzed the endoscopic findings of initial and protruding lesions, and several other clinical factors (H. pylori infection, eradication therapy, and proton pump inhibitor (PPI) or H2-blocker use). RESULTS: 1. The mean duration until detection of the protruding lesion was 8.9 months (1.5~7). Protruding lesions arose at the scar of the EMR in 1 of 28 EGCs (3.6%) and from 15 of 73 gastric flat adenomas (20.5%). All of the patients were men. 2. With respect to the endoscopic findings, the shapes of the protruding lesions were as follows: 10 Yamada (Y) I, 4 Y-II, 1 Y-III, and 1 flat lesion. Histological examination of the protruding lesions revealed regenerating hyperplasia in 5 lesions, intestinal metaplasia in 5, and both in 6. 3. The incidence of these lesions was higher in cases of tubular adenomas with focal high-grade dysplasia than in cases of tubular adenomas without dysplasia (p<0.05). 4. The incidence of H. pylori infection was higher in patients (81.7%) who developed a protruding lesion than in those (51.8%) who did not develop (p=0.029); also, the incidence of use of PPI was higher in those patients (p=0.045). However, eradication therapy for H. pylori and duration of use of PPI or H2-blocker showed no difference between groups. CONCLUSION: It may be possible that the potential hyperplasia that may reside in normal mucosa surrounding EGC or a gastric adenoma might awaken during the healing process of the EMR ulcer and develop to benign protruding lesions. And, H. pylori and PPI might also be related to the development of the protruding lesions.
Adenoma* ; Cicatrix* ; Humans ; Hyperplasia ; Incidence ; Male ; Metaplasia ; Mucous Membrane ; Proton Pumps ; Retrospective Studies ; Stomach Neoplasms ; Ulcer

PURPOSE: The aim of this study was to analyze the outcomes of patients with gastrointestinal stromal tumors (GISTs) of the stomach who were treated in our hospital. MATENRIALS AND METHODS: We retrospectively studied 31 patients who were treated for primary gastrointestinal stromal tumors of the stomach from 1990 to 1999 at Korea University Guro Hospital. Clinical characteristics, including age, sex and tumor size were analyzed. In addition, the relation between the 5-year survival rate and tumor size, operative procedure, and malignancy were analyzed to identify the factors that predict survival. RESULTS: The malignant GISTs were 11 cases, borderline GISTs were 2 cases, and benign GISTs were 18 cases. The overall 5-year cumulative survival rate of the patients was 84.6%, and the 5-year survival rates according to malignancy were 100% for benign and borderline GISTs and 78.1% for malignant GISTs, p=0.1119. The 5-year survival rates according to tumor size were 100% for tumor sizes smaller than 5 cm and 78.4% for tumor sizes larger than 5 cm, p=0.0453. The 5-year survival rate according to lymph node dissection during operative procedure of malignant GISTs was not significant statistically. CONCLUSION: GISTs of the stomach are infrequently encountered tumors. Tumor size was the most important factor for predicting survival in a clinical situation, and performing a complete resection of the tumor, especially tumors larger than 5 cm, will improve the outcome of treatment.
Gastrointestinal Stromal Tumors* ; Humans ; Korea ; Lymph Node Excision ; Retrospective Studies ; Stomach* ; Surgical Procedures, Operative ; Survival Rate

PURPOSE: Quality of life (QOL) assessment should be applied in surgical settings to compare treatment options. We compared QOL after a subtotal versus a total gastrectomy for gastric cancer to identify which resection would produce a better QOL for the patient. PATIENTS AND METHODS: We studied 362 patients with no evidence of recurrent disease after curative surgery for gastric cancer. The QOL was measured by assessing patient health perceptions according to the Spitzer index and Troidl score and by treatment-specific symptoms according to Korenaga and others with some modifications. High scores reflect a better QOL. RESULTS: The mean score of the Spitzer index was 8.87+/-1.36 after a subtotal gastrectomy and 8.80+/-1.23 after a total gastrectomy. More than 80% of the patients in both groups maintained good quality of life when measured by the Spitzer index. The mean Troidl score was 10.41+/-2.12 after a subtotal gastrectomy and 9.79+/-2.16 after a total gastrectomy (p=0.033). Swallowing difficulty was more frequent after a total gastrectomy (p=0.002). There was a statistically significant difference in the meal size (p=0.044). Other variables of the Troidl score revealed no statistically significant differences. Dizziness was significantly more frequent after a total gastrectomy than after a subtotal gastrec tomy (p=0.009). Conclusion: We conclude that in terms of postoperative quality of life, a subtotal gastrectomy has advantages over a total gastrectomy. In those cases where an adequate proximal safety margin can be achieved by a subtotal gastrectomy, that procedure is preferable to a total gastrectomy.
Deglutition ; Dizziness ; Gastrectomy* ; Humans ; Meals ; Quality of Life* ; Stomach Neoplasms*

PURPOSE: Roux stasis syndrome is the main complication of a Roux-en-Y gastrojejunostomy. The aim of this study was to compare the occurrence rate of Roux stasis syndrome with the passing of time in a conventional Roux-en-Y gastrojejunostomy and in an uncut Roux-en-Y gastrojejunostomy. MATENRIALS AND METHODS: 50 patients (31 men and 19 women) had a conventional Roux-en-Y reconstruction and 53 patients (35 men and 18 women) had an uncut Roux-en-Y reconstruction. The Roux stasis syndrome was defined by clinical criteria only. The criteria included one of the four following conditions at the time of follow-up: chronic upper abdominal pain, postprandial fullness, persistent nausea, and intermittent vomiting that are worsened by eating. Follow-up after surgery was done in all patients at 7~12, 13~18, 19~24, 25~30, and 31~36 months. RESULTS: According to the criteria, the Roux stasis syndrome occurred in 40.0% of the patients at 7~12 months, 33.3% at 13~18 months, 35.3% at 19~24 months, 32.0% at 25~30 months, and 33.3% at 31~36 months after a conventional Roux-en-Y operation. The syndrome occurred in 22.6% of the patients at 7~12 months, 15.2% at 13~18 months, 17.1% at 19~24 months, 19.2% at 25~30 months, and 20% at 31~36 months after an uncut Roux-en-Y reconstruction. Conclusion: In terms of occurrence pattern, only a little variance existed one year after both procedures. Comparing the Roux stasis syndrome in both procedures, the uncut Roux operation had better results than the conventional Roux operation.
Abdominal Pain ; Eating ; Follow-Up Studies ; Gastrectomy* ; Gastric Bypass* ; Humans ; Male ; Nausea ; Vomiting

PURPOSE: Three subgroups of stage II stomach cancer (T1N2M0, T2N1M0, T3N0M0) by UICC-TNM staging system show obvious survival difference to each other, which becomes the pitfall of the current staging system. We analyzed the survival and relapse pattern of stage II stomach cancer patients in three subgroups retrospectively to prove the need for change in staging system. MATENRIALS AND METHODS: From July 1989 to December 1995, curative gastric resection was performed in 1,037 patients with gastric adenocarcinoma, and among them 268 patients (26%) were in stage II. The number in each of subgroups (T1N2M0, T2N1M0, and T3N0M0) were 17, 139 and 112 respectively. Survival and relapse pattern were analyzed and median follow up period was 46 months. RESULTS: The 3-year cumulative survival rates of T1N2M0, T2N1M0, and T3N0M0 were 50%, 80%, and 76% respectively (p=0.001). And the 3-year cumulative survival rates of T1N2M0 was comparable to those of 2 subgroups of stage IIIa (T2N2M0, T3N1M0), 47% and 45% (p>0.05). Peritoneal recurrence was the most frequent in T3N0M0. And hematogenous spread was more frequent in T2N1M0 while nodal spread was more frequent in T1N2M0. Ten out of 17 cases of T1N2M0 died of recurrence. Most of them showed submucosal tumor with depressed lesion and mean tumor size was 3.3 cm. CONCLUSION: Up-staging of T1N2M0 should be considered because it has the lowest survival rate and the worst prognosis among the three subgroups of Stage II stomach cancer patients. In early gastric cancer patients with high-risk factors (large tumor size, invasion into the submucosal layer, and lymphatic vessel involvement), lymph node dissection and postoperative adjuvant therapy is recommended in an attempt to prevent recurrence in the form of lymph node metastasis.
Adenocarcinoma ; Follow-Up Studies ; Humans ; Lymph Node Excision ; Lymph Nodes ; Lymphatic Vessels ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Retrospective Studies ; Stomach Neoplasms* ; Stomach* ; Survival Rate

PURPOSE: Despite knowledge of the adverse effects of resection-line disease, surgeons continue to perform inadequate resections. This demonstrates the need for a more aggressive approach to assessment of resection margins at operation. MATENRIALS AND METHODS: Seven hundred fifteen gastric cancer patients who were operated on at our hospital from 1992 to 1998 were included in this analysis. Various clinico- pathological factors, including resection-line involvement, were ascertained from the surgical and histopathological records. RESULTS: Of the 715 evaluable patients, 27 patients (3.8%) had involvement of one or both resection lines; in 10 patients the proximal resection line only, in 16 the distal resection line only, and 1 both resection lines were involved. Presence of resection-line involvement was significantly associated with T3 and T4 stage, N (+) stage, M (+) stage, type of operation (total gastrectomy), tumor location (entire stomach), size > or =11 cm), and gross type of tumor (Borrmann 4 type). When performing a distal subtotal gastrectomy, no involvement was found when the cranial and caudal distances between the lesion and the line of transection was equal to or greater than 2 cm and 3 cm, respectively, for early cancer and 7 cm and 3 cm, respectively, for advanced cancer. When performing a total gastrectomy for upper 1/3 or middle 1/3 gastric cancer, no involvement was found when the cranial distances between the lesion and the line of transection were equal to or greater than 3 cm and 4cm, respectively, without distinction of the presence of serosal invasion. CONCLUSION: The difference in survival between positive and negative margin patients is limited to the group of patients with curative surgery. An important principle of treatment is that the entire tumor must be removed with a 3 cm distal margin and a 2- to 7 cm margin depending on the location and the depth of wall invasion of the tumor, to provide histologically negative margins.
Gastrectomy ; Humans ; Stomach Neoplasms*

PURPOSE: The purpose of this study is to analyze the clinicopathologic characteristics of gastric cancer patients and to evaluate the survival and prognostic factors and effect of immunochemosurgery for gastric cancer patients. MATENRIALS AND METHODS: The clinicopathologic characteristics were analyzed for 12,277 consecutive patients who underwent operation for gastric cancer from 1970 to 1999. We also evaluated the survival and prognostic factors for 9,262 consecutive patients from 1981 to 1996. The prognostic significance of treatment modality [surgery alone, surgery +chemotherapy, surgery+immunotherapy+chemotherapy (immunochemosurgery)] were evaluated in stage III gastric cancer. RESULTS: The 5-year survival rate (5-YSR) of overall patients was 55.8%, and that of patients who received curative resection was 64.8%. The 5-YSRs according to TNM stage were 92.9% for Ia, 84.2% for Ib, 69.3% for II, 45.8% for IIIa, 29.6% for IIIb and 9.2% for IV. Regarding adjuvant treatment modality, significant survival difference was observed in stage III patients. The 5-year survival rates were 44.8% for immunochemosurgery group, 36.8% for surgery+chemotherapy group and 27.2% for surgery alone group. Curative resection, depth of invasion and lymph node metastasis were the most significant prognostic factors in gastric cancer. CONCLUSION: Consequently, early detection and curative resection with radical lymph node dissection, followed by immunochemotherapy especially in patients with stage III gastric cancer should be recommended as a standard treatment principle for patients with gastric cancer.
Humans ; Lymph Node Excision ; Lymph Nodes ; Neoplasm Metastasis ; Stomach Neoplasms ; Survival Rate

PURPOSE: The p53 protein is a tumor supressor gene, and its mutation is associated with biologic aggressiveness. CD44v6, one of the CD44 family, is a cell surface glycoprotein that plays a role in cancer invasion and metastasis. Vascular endothelial growth factor (VEGF) is another recently identified growth factor with significant angiogenic properties. The purpose of this study was to investigate p53, CD44v6, and VEGF expressions to determine whether degree of expression was related to pathological parameters such as Lauren's classification, depth of invasion, and lymph node metastasis. MATENRIALS AND METHODS: Immunohistochemical stains of p53, CD44v6, and VEGF in formalin-fixed paraffin-embedded tissue sections of 125 gastric adenocarcinomas were done. RESULTS: The overall expression rates of p53, CD44v6, and VEGF were 54.4% (68/125), 36.8% (46/125), and 48.0% (60/ 125), respectively. The p53, not CD44v6 and VEGF was higher in intestinal-type gastric carcinomas by Lauren's classification. The expressions of p53, CD44v6, and VEGF were statistically correlated with depth of tumor invasion. The expression of CD44v6 was higher in the lymph node metastatic group than in the negative group. The p53 expression was significantly associated with VEGF expression. CONCLUSIONs: These data suggest that the expressions of p53, CD44v6, and VEGF are biologically related to malignancy. The p53 and CD44v6 expressions are independent; however, p53 gene mutation is one of the contributing factors to VEGF expression in gastric adenocarcinoma.
Adenocarcinoma* ; Classification ; Coloring Agents ; Genes, p53 ; Humans ; Immunohistochemistry ; Lymph Nodes ; Membrane Glycoproteins ; Neoplasm Metastasis ; Vascular Endothelial Growth Factor A*