PURPOSE: A gastroduodenostomy after a distal subtotal gastrectomy is known to have several advantage over a gastrojejunostomy. However, recently, anastomotic methods using an EEA stapler during a gastro duodenostomy have been developed and have been reported to be superior to manual anastomosis with respect to operative time and complications. Thus, we investigated the differences between a manual and a stapled gastroduodenostomy by comparing the clinicopatholoic features and clinical course. METHODS: From January to October 1999 at Korea University Guro Hospital, a gastroduodenostomy using an EEA stapler was performed on 30 gastric cancer patients after a distal subtotal gastrectomy. From January 1996 to December 1998, a manual anastomosis had been used on 40 patients at the same hospital. A retrospective analysis of these two groups was made with respect to patients, tumor, operation, post operative complications and clinical course. RESULTS: The mean age of the stapled group was older than that of manual group (62.3+/-8.4 vs 53.0+/-10.7 years), and most of the tumors were located at the antrum and the body. In the stapled group, the operative time was significantly shorter than I was in the manual group (205.0+/-20.0 vs 239.6+/-37.3 minutes, p<0.001), and there was no significant difference in the resection margin between the two groups. The time of nasogastric (NG) tube removal was earlier in the stapled group (4.8+/-0.8 vs 5.9+/-2.2 days, p=0.007), but no significant differences were observed with respect to the oral intake and the complication rate between the two groups. Anastomotic stenosis was observed in one case of manual group, but it was not significant. CONCLUSIONS: A gastroduodeno stomy using an EEA stapler has an advantage over conventional manual anastomosis with respect to operation time and NG tube removal, so this method can be employed safely in aged and generally morbid patients to improve the postoperative course.
Constriction, Pathologic ; Duodenostomy ; Gastrectomy* ; Gastric Bypass ; Humans ; Korea ; Operative Time ; Retrospective Studies ; Stomach Neoplasms*

PURPOSE: Peritoneal carcinomatosis is a dismal prognostic factor and is frequently encountered during initial exploration in gastric-cancer patients, but there are no effective therapeutic modalities. Thus, we investigated the prognostic factors in gastric-cancer patients with peritoneal carcinomatosis and evaluated the usefulness of intraperitoneal (IP) chemotherapy as a treatment modality in such patients. METHODS: From 1992 to 1997 in Korea University Guro Hospital, 105 patients revealed at initial exploration peritoneal carcinomatosis due to gastric cancer. We excluded two patients who died due to postoperative complications and 10 patients who were lost during follow up. Prognostic factors, including IP che motherapy, were analyzed by using univariate and multivariate methods for the remaining 93 cases. RESULTS: The median survival time of the 93 patients was 7.86 months, and the frequency of peritoneal carcinomatosis at initial exploration was 11.6%. On univariate analysis, sex, tumor depth, degree of peritoneal seeding, presence of hepatic metastasis, operative method, and systemic chemotherapy were significant prognostic factors. However, IP chemotherapy was not a significant prognostic factor. On multivariate analysis, only the degree of peritoneal seeding and the presence of hepatic metastasis were significant prognostic factors (p<0.05). CONCLUSIONS: The most important prognostic factors in peritoneal carcinomatosis in gastric-cancer patients are the degree of peritoneal seeding and the presence of hepatic metastasis. However, operative resection of the primary tumor may prolong survival and improve the quality of life. Thus, a resection is recommended when possible.
Carcinoma* ; Drug Therapy ; Follow-Up Studies ; Humans ; Korea ; Multivariate Analysis ; Neoplasm Metastasis ; Postoperative Complications ; Quality of Life ; Stomach Neoplasms*

PURPOSE: The carcinogenesis of gastric cancer has not been fully elucidated, but several molecular biologic alterations have been found to be related with it. TGF-betaRII mutation, which is one such alteration, has been well documented in gastric cancer, but its expression patterns in cancer and preneoplastic conditions are rarely reported. For that reason, we investigated the roles of TGF-betaI and TGF-betaRII in gastric carcinogenesis by comparing the difference of expression patterns in carcinomas and adenomas of the stomach and intestinal metaplasia by using immunohistochemical staining. METHODS: Twenty-six (26) cases of intestinal metaplasia with chronic atrophic gastritis, 21 cases of the gastric adenoma, and 51 cases of gastric cancers (28 cases of the intestinal type and 23 cases of the diffuse type) were enrolled in this study. All samples were paraffin-embedded and an immunohistochemical staining was performed using the polyclonal antibody to TGF-betaI and TGF-betaRII. Their clinicopathologic features were reviewed retrospectively. RESULTS: In normal gastric tissue and intestinal metaplasia, only the basal portion of the gastric foveola was strongly reactive to TGF-betaRII. In adenomas and well-differentiated intestinal type cancer, all tumor cells were strongly positive to TGF-betaRII, but the tumor cells of poorly differentiated intestinal-type and signet ring cell (diffuse type) cancer showed unresponsive to TGF-betaRII. The TGF-betaI expressions in normal and carcinomatous lesions were similar andshowed a weak positive reaction. TGF-betaI and TGF-betaRII responsive gastric cancer showed less invasive gastric-wall infiltration. In gastric cancer, a significant correlation was present between tumor depth and response to TGF-betaI & TGF-betaRII. CONCLUSION: It is presumed that TGF-betaRII plays an important role in cell differentiation and aggressiveness in gastric cancer and that it may be useful as a prognostic factor.
Adenoma* ; Carcinogenesis ; Cell Differentiation ; Gastritis, Atrophic ; Immunohistochemistry ; Metaplasia* ; Precancerous Conditions ; Receptors, Transforming Growth Factor beta* ; Retrospective Studies ; Stomach Neoplasms ; Stomach* ; Transforming Growth Factor beta* ; Transforming Growth Factors*

PURPOSE: Many epidemiological studies have revealed an increasing tendency for proximal gastric cancer. Furthermore, proximal gastric cancer has been known to have unique characteristics and a poor prognosis in contrast to middle and distal gastric cancer, but the reason have not yet been fully explained. For that reason, we investigated changes in the incidence of proximal gastric cancer, its clinicopathologic characteristics, and its prognosis, and we compared the results with those of other reports and tried to identify the reasons for such phenomena. METHODS: After excluding linitis platisca-type cancer, double primary cancer, and gastric cancer arising from the remnant stomach, we retrospectively analyzed the case histories of 836 patients who had undergone operations for gastric cancer from 1992 to 1997. The cases were divided into a proximal gastric-cancer (PGC) group and a middle and distal gastric-cancer (DGC) group based on the location of the primary tumor. RESULTS: The PGC group included 74 patients (8.9%); 762 patients (91.1%) were in the DGC group. The incidence of proximal gastric cancer was 5.0% in 1992 and 11.6% in 1997. The PGC group has more advanced tumor stages (p=0.001) and more positive lymph-node metastases (p=0.013). The resectability of PGC was 87.8%, and that of the DGC was 92.4%, but these were not significantly different (p=0.169). The overall 5-year survival rate for PGC was 48.4% and that of DGC was 59.0%, but these were also not significantly different (p=0.5776). Comparing the survival rates of two groups for various stages revealed no differences. CONCLUSION: The increasing tendency of proximal gastric cancer was similar those in other reports even though we observed for a shorter periods and the proximal gastric cancers were diagnosed in advanced stages, and probably that was the reason for the poor prognosis. Therefore, if early diagnosis is made and adequate therapy is performed, proximal gastric cancer, in contrast to distal gastric cancer, is not a unique disease entity.
Early Diagnosis ; Epidemiologic Studies ; Gastric Stump ; Humans ; Incidence ; Neoplasm Metastasis ; Prognosis* ; Retrospective Studies ; Stomach Neoplasms ; Survival Rate

PURPOSE: The gastrointestinal tract (GI) is the most common site of extranodal non-Hodgkin's lymphoma (NHL), which is increasing in incidence, but the staging and the histologic classification of GI-NHL are still in debate. Furthermore, there is no established optimal treatment modality. Thus, we investigated the clinicohistologic features, the therapeutic modalities, and the prognosis for GI-NHL, as well as the factors affecting it. We also give a review of the literature. METHODS: We retrospectively analyzed 67 patients who had been diagnosed as having GI-NHL and had been followed up from 1984 to 1999 at Korea University Medical Center Hospital. They were divided into groups according to the site of origin and to various other features, and the survivals of the various groups were compared. The modified Ann Arbor system and the international working formulation (IWF) were adopted for staging and histopathologic classification, respectively. RESULTS: GI-NHL of the stomach, the small bowel, and the colon and rectum occurred in 35 patients (52.2%), 20 patients (29.9%), and 10 patients (14.9%), respectively. In two patients, the entire gastrointestinal tract was diffusely involved. The mean age of patients was 49.7+/-16.2 years, and the male-to-female ratio was 4.2:1. There was an tendency for young and male to have GI-NHL involving the lower gastrointestinal tract. Twenty-three (34.3%) patients was in stage I, 28 (41.8%) in stage II, 7 (10.4%) in stage III, and 9 (13.4%) in stage IV. Eight (11.9%) patients had a low IWF grade, 47 (70.1%) an intermediate grade, and 12 (17.9%) a high grade. The stage and the histologic classification did not vary with the original site. Surgical resection was performed in 50 (74.6%) patients, and chemotherapy was performed in 53 (79.1%) patients. The overall 5-yearsurvival rate of 67 patients was 49.9%, and there was a significant survival difference between the stages (p=0.0023), but not between sites of origin (p=0.9043). The most important factors influencing the survival was the stage; other factors were not significant. CONCLUSION: The stomach was the most common site of GI-NHL. Most GI-NHLs were localized and of intermediate grade. Stage was the most important prognostic factor. However, prospective randomized studies are needed to approve the therapeutic modality.
Academic Medical Centers ; Classification ; Colon ; Drug Therapy ; Gastrointestinal Tract ; Humans ; Incidence ; Korea ; Lower Gastrointestinal Tract ; Lymphoma* ; Lymphoma, Non-Hodgkin ; Male ; Prognosis ; Rectum ; Retrospective Studies ; Stomach

PURPOSE: Early gastric cancer is now considered to be a curable disease, and its traditional treatment is a D2 lymphadenectomy. However, the low rate of lymph node metastasis, the recent developments of endoscopic and laparoscopic surgery, and concerns for postoperative quality of life have led to less invasive therapeutic options. The D1 lymphadenectomy is one such option, so we investigated its adequacy as a substitute for a D2 lymphadenectomy as a treatment modality for early gastric cancer by comparing the prognoses of the two approaches. METHODS: A retrospective analysis of the case histories of 332 patients who had received an operation for early gastric cancer at Korea University Guro Hospital from 1984 to 1997 was performed. These cases were divided into D1 and D2 groups, and the groups were compared on the basis of clinicopathologic features, operative procedures, and 5-year survival rates. RESULTS: The D1 group included 160 cases, and the D2 group had 172 cases. The D2 group included more distal one-third cancer (66.3% vs 51.9%), more submucosal tumors (51.2% vs 38.7%), and more dissected lymph nodes (31.1+/-12.8 vs 23.0+/-11.3) than the D1 group (p<0.05). The overall 5-year survival rate for the early gastric-cancer patients was 95.5%. The 5-year survival rate of the D1 group was 96.6%, and that of the D2 group was 94.1%, but this difference was not significant (p>0.05). When the tumor depth was considered, the 5-year survival rates of the D1 and the D2 groups were not significantly different for mucosal and submucosal tumors (p>0.05). CONCLUSION: A D2 lymphadenec tomy for early gastric cancer can harvest more lymph nodes, but it has no survival benefit over a D1 lymphadenectomy. The result of this retrospective study suggests that a D1 lymphadenectomy may be used as a replacement for a D2 lymphadectomy in early gastric-cancer surgery, although prospective randomized studies are needed.
Humans ; Korea ; Laparoscopy ; Lymph Node Excision* ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis* ; Quality of Life ; Retrospective Studies ; Stomach Neoplasms* ; Surgical Procedures, Operative ; Survival Rate

PURPOSE: It is well known that the incidence of cholelithiasis and cholecystitis increases after a gastrectomy and vagotomy for peptic ulcer disease, but operations for ulcers have decreased due to improved medical therapy. However, there are not so many studies about cholelithiasis and cholecystitis after a gastric resection due to gastric cancer. Therefore, we investigated its incidence, the factors affecting it, and its natural course. METHODS: Six hundred eighty-four gastric patients who had received a gastric resection at the Korea University Guro Hospital from January 1992 to October 1999 and who had been followed regularly with abdominal ultrasonography or computed tomography were enrolled in this study. The incidence of gallstones and sludge was investigated according to age group (< OR =60 vs >60), sex, extent of gastric resection (subtotal vs total), anastomotic methods (duodenal bypass vs duodenal passage of food), and degree of lymph node dissection (< OR =D2 vs > or =D2+alpha). The clinical course of cholelithiasis was also followed up. RESULTS: Gallstones were discovered in 38 patients (5.6%) with a mean duration of 26.4+/-20.7 months, and sludge was found in 17 patients (2.5%) with a mean duration of 25.1+/-20.5 months. There were no significant differences of incidence of gallstones and sludge according to sex, age group, and other surgical options (p>0.05). Twenty- eight cases of gallstones (73.7%) were detected within 36 months, and 11 cases of sludge (64.7%) within 24 months. Among the 38 gallstones patient, only 7 patients (18.4%) developed acute cholecystitis; they received cholecystectomy during the follow-up period, and all removed stones were pigment stones. CONCLUSION: The incidences of cholelithiasis and chole-cystitis do not increased very much after a gastric resection with lymph-node dissection due to gastric cancer, and there are no specific factors affecting those incidences. A prophylactic cholecystectomy during the gastric cancer operation should be performed with caution.
Cholecystectomy ; Cholecystitis ; Cholecystitis, Acute ; Cholelithiasis* ; Follow-Up Studies ; Gallstones ; Gastrectomy ; Humans ; Incidence ; Korea ; Lymph Node Excision ; Peptic Ulcer ; Sewage ; Stomach Neoplasms* ; Ulcer ; Ultrasonography ; Vagotomy

PURPOSE: Recently, the bispectral index monitor has been promoted as an objective measure of sedation depth during pediatric procedural sedation in the emergency department (ED). However, rectal administration of thiopental sodium for pediatric procedural sedation has not been validated. METHODS: Patients aged one to seven years and undergoing primary closure procedures for simple facial and hand laceration in the ED were enrolled. Procedural sedation was performed by rectal administration of thiopental sodium. The bispectral index score and the Ramsay Sedation Scale were recorded every 10 minutes during sedation. The investigator and treating physician were blinded to bispectral index scores, which were later correlated with the Ramsay Sedation Scales values. Receiver operator characteristic (ROC) curves were conducted to determine the ability of the bispectral index score to discriminate various thresholds of sedation depth. RESULTS: One hundred thirty paired measurements were obtained from 12 patients. The Spearman's correlation coefficient for paired measurements, was -0.906 (95% confidence interval: [-9.8] ~ [-8.1], p<0.001). ROC curve analysis demonstrated a high discriminatory power for bi-spectral index scores in predicting the level of sedation, with areas under the curve at least 0.95 for all Ramsay Sedation Scale thresholds. CONCLUSION: Bispectral index monitoring can serve as a useful, objective measure of sedation depth in pediatric procedural sedation with rectal administration of thiopental sodium in the ED.
Administration, Rectal ; Consciousness Monitors* ; Emergencies* ; Emergency Service, Hospital* ; Hand ; Humans ; Lacerations ; Research Personnel ; ROC Curve ; Thiopental* ; Weights and Measures

PURPOSE: Although obstructive jaundice is a rare presentation, it is an ominous sign of poor prognosis in patients with gastric cancer. Thus, we investigated the incidence, the clinical features, the pathologic characteristics, the treatment modality, and the prognosis for obstructive jaundice in patients with gastric cancer. METHODS: A retrospective analysis was done for patients with gastric cancer who had presented with obstructive jaundice at Korea University Guro Hospital from January 1988 to December 1998. RESULTS: During that period, 2546 patients were diagnosed with gastric cancer, and obstructive jaundice was revealed in 20 (0.78%). The mean age was 58 13 years, and the sex ratio (male:female) was 5.7:1. Jaundice was the first presentation in two patients, and it developed in the other 18 patients during the follow-up period after the initial operation or chemotherapy. The level of total bilirubin was 16.7 8.1 mg/dl, and the cause of the jaundice was lymph-node enlargement at the porta hepatis. A percutaneous transhepatic biliary drainage (PTBD) was done in 17 patients, and improvement was seen in 13 (76%). The most common site of the obstruction was common hepatic duct (CHD) (60%). Antrally located, moderately differentiated and Borrmann type-III gastric cancers were commonly associated with obstructive jaundice. The mean duration from jaundice to death was 4.6 6.2 month. CONCLUSION: Obstructive jaundice is very rare in patients with gastric cancer and is associated with poor survival. Although the bilirubin level was decreased by a PTBD, the survival was not improved. An extended lymphadenectomy along the hepatoduodenal ligament is necessary to prevent obstructive jaundice due to recurrence particularly, in patients with antrally located, moderately differentiated and Borrmann type-III carcinomas.
Bilirubin ; Drainage ; Drug Therapy ; Follow-Up Studies ; Hepatic Duct, Common ; Humans ; Incidence ; Jaundice ; Jaundice, Obstructive* ; Korea ; Ligaments ; Lymph Node Excision ; Prognosis ; Recurrence ; Retrospective Studies ; Sex Ratio ; Stomach Neoplasms*

PURPOSE: Multiple early gastric cancers were found in 6.9~11.7% of patients with early gastric cancer. The goal of this study was to clarify the clinicopathologic features of and to investigate treatment strategy for multiple early gastric cancer. MATENRIALS AND METHODS: Of 967 patients with an gastric adenocarcinoma who were treated by surgical resection during the period of 1993~1998 at the Department of Surgery, Korea University College of Medicine, 267 patients had early gastric cancer. A retrospective analysis of the clinicopathologic differences between the main and the accessory lesions in multiple early gastric cancer was carried out. A comparative analysis was also conducted between solitary early gastric cancer and multiple early gastric cancer. RESULTS: Of 267 patients with early gastric cancer, multiple early gastric cancers were found in 12 patients (4.5%), including 10 men and 2 women. Eleven patients with multiple early gastric cancer had one accessory lesion and 1 patient had 2 accessory lesions. Of the 13 accessory lesions, 7 (53.8%) were located in the same region as the main lesion. The most frequent combination of macroscopic types for the main lesion and the accessory lesion were depressed and depressed types (6 cases, 46.1%). The most frequent histologic type of main lesion was a well differentiated adenocarcinoma in 7 (58.3%) of the 12 cases; the accessory lesion was also well differentiated in 4 of those 7 cases. Of the 13 accessory lesions, 4 (30.8%) had been overlooked preoperatively; most of them were located in the lower third of the stomach and were IIb or IIc type and measured less than 1 cm in diameter. Lymph node metastasis was detected in 1 patient (8.3%). The clinicopathologic features of multiple early gastric cancer were not different from those of solitary early gastric cancer. CONCLUSION: In multiple early gastric cancer, the main and the accessory lesions showed similar differentiation, and lymph node metastasis was less frequent than in solitary early gastric cancer. Therefore, limited procedures, including endoscopic mucosal resection, may be indicated if each lesion of the multiple early gastric cancer fits the criteria for treatment strategy.
Adenocarcinoma ; Female ; Humans ; Korea ; Lymph Nodes ; Male ; Neoplasm Metastasis ; Retrospective Studies ; Stomach ; Stomach Neoplasms*