No abstract available.

This meta-analysis examined the surgical management of older patients (>80 years) with gastric cancer, who were often excluded from randomized controlled trials. We analyzed 23 retrospective cohort studies involving 18,372 patients and found that older patients had a higher in-hospital mortality rate (relative risk [RR], 3.23; 95% confidence interval [CI], 1.46–7.17; P<0.01) and more post-operative complications (RR, 1.36; 95% CI, 1.19–1.56;P<0.01) than did younger patients. However, the surgical complications were similar between the two groups. Older patients were more likely to undergo less extensive lymph node dissection and longer hospital stays. Although older patients had statistically significant post-operative medical complications, they were not deprived of surgery for gastric cancer.The comorbidities and potential risks of post-operative complications should be carefully evaluated in older patients, highlighting the importance of careful patient selection. Overall, this meta-analysis provides recommendations for the surgical management of older patients with gastric cancer. Careful patient selection and evaluation of comorbidities should be performed to minimize the risk of post-operative complications in older patients, while recognizing that they should not be deprived of surgery for gastric cancer.

PURPOSE: With the increase in the average life expectancy, the elderly population continues to increase rapidly. However, no consensus has been reached on the feasibility for surgical resection due to the high morbidity and mortality rate after surgical treatment in elderly patients caused by aging and underlying diseases. METHODS: This study was performed with patients aged 80 years and older. The subjects were classified into 2 groups as follows: the surgical resection group consisting of 61 patients, and the conservative treatment group consisting of 39 patients suitable for curative resection. RESULTS: Mean age and clinical stages in the conservative treatment group were higher than those in the surgical resection group. There was no significant difference in sex, location of the lesion, histological type, or underlying disease. The mean survival time of surgical resection group and conservative treatment group was respectively 52.1 ± 2.66 months and 37.1 ± 5.08 months (P < 0.05) for clinical stage 1 disease, 41.7 ± 5.16 months and 22.4 ± 6.07 months (P = 0.004) for stage 2 disease, and 31.7 ± 9.37 months and 10.6 ± 1.80 months (P = 0.049) for stage 3 disease. However, as for the extent of lymph node resection for the different stages, we observed no significant difference between the 2 groups. CONCLUSION: Surgical resection in all clinical stages, except stage 4, showed a higher survival rate than conservative treatment. To minimize postoperative surgery complications, limited lymph node dissection should also be considered.
Aged ; Aging ; Consensus ; Humans ; Life Expectancy ; Lymph Node Excision ; Lymph Nodes ; Mortality ; Stomach Neoplasms* ; Survival Rate

PURPOSE: To present the procedure and results of dorsal wedge osteotomy fixated by bioabsorbable polyglycolide pins for the treatment of symptomatic Freiberg's disease. MATERIALS AND METHODS: From January 1997 to December 2002, six patients with Freiberg's disease underwent dorsal wedge osteotomy of the metatarsal neck to bring the healthy plantar part of the metatarsal head into articulation. Bioabsorbable polyglycolide pins were used for the fixation and short-leg walking cast was applied for 4 weeks. RESULTS: All patients returned to full daily activities without pain in three months after the operation. Radiographically, solid healing of the osteotomy was observed at average ten weeks. The active range of motion of the metatarsophalangeal joint increased by a mean gain of 30 degrees, and no complication such as displacement, osteolysis or sinus formation was observed. CONCLUSION: Dorsal wedge osteotomy fixated by bioabsorbable pins for patients with symptomatic Freiberg's disease is effective procedure that provides relatively early range of motion exercise and avoids second procedure for implant removal.
Head ; Humans ; Metatarsal Bones ; Metatarsophalangeal Joint ; Neck ; Osteolysis ; Osteotomy* ; Polyglycolic Acid ; Range of Motion, Articular ; Walking

PURPOSE: To present the procedure and results of dorsal wedge osteotomy fixated by bioabsorbable polyglycolide pins for the treatment of symptomatic Freiberg's disease. MATERIALS AND METHODS: From January 1997 to December 2002, six patients with Freiberg's disease underwent dorsal wedge osteotomy of the metatarsal neck to bring the healthy plantar part of the metatarsal head into articulation. Bioabsorbable polyglycolide pins were used for the fixation and short-leg walking cast was applied for 4 weeks. RESULTS: All patients returned to full daily activities without pain in three months after the operation. Radiographically, solid healing of the osteotomy was observed at average ten weeks. The active range of motion of the metatarsophalangeal joint increased by a mean gain of 30 degrees, and no complication such as displacement, osteolysis or sinus formation was observed. CONCLUSION: Dorsal wedge osteotomy fixated by bioabsorbable pins for patients with symptomatic Freiberg's disease is effective procedure that provides relatively early range of motion exercise and avoids second procedure for implant removal.
Head ; Humans ; Metatarsal Bones ; Metatarsophalangeal Joint ; Neck ; Osteolysis ; Osteotomy* ; Polyglycolic Acid ; Range of Motion, Articular ; Walking

OBJECTIVES: The purpose of this study is to compare ultimate tensile load of newly designed loop suture technique, to those of Pulvertaft fishmouth suture technique and Kessler suture technique with core strands. MATERIALS AND METHODS: Eight week-old Habbard chickens were sacrificed to harvest flexor digitorum logus tendon of long toe. They were divided into four groups according to suture technique; interweave suture group, loop suture group, Kessler suture group, and normal control group. Twenty tendons were tested in each group. Comparison of cross-sectional areas between each technique was verified by statistical method and the difference was not statistically significant (p>0.05). Tensile load and deformed length were checked by Instron (Model 1000, Instron Corp, Canton, MA). ANOVA test was used for statistical analysis. RESULTS: Ultimate tensile loads were 22.83+/-7.89 N in interweave suture group, 30.58+/-5.96 N in loop suture group, and 10.83+/-4.47 N in Kessler suture group. These results showed statistically significant differences (p<0.001). The values were 33 % in interweave suture, 44% in loop suture, and 15 % in Kessler's suture respectively. Absorbed energy were 0.48+/-0.32 J in interweave suture group, 0.61+/-0.18 J in loop suture group, and 0.22+/-0.15 J in Kessler suture group, and 1.01+/-0.20 J in normal control group. There were statisti - cally significant differences between each groups (p<0.01). CONCLUSION: The loop suture technique showed better biomechanical properties than interweave or Kessler technique. We think the loop suture technique is a simple and useful method, especially for tendon transfer or tendon graft when tendon length is sufficiently long to make a good tendon overlap.
Chickens* ; Suture Techniques* ; Sutures* ; Tendon Transfer ; Tendons* ; Toes ; Transplants

PURPOSE: There is a growing concern that accumulated fatigue due to extended working hours may contribute to poor surgical outcomes. This study aimed to compare postoperative complications of gastric cancer patients according to operation chronology in a given day as a yardstick of a surgeon's fatigue.METHODS: The clinicopathologic data of gastric cancer patients who underwent a curative gastrectomy by one surgeon in Asan Medical Center from August 2012 to August 2014 were analyzed retrospectively. The patients were divided into 3 groups according to operation chronology in a given day. Perioperative data were collected by electronic medical records. Comorbidities were assessed using the Charlson comorbidity index. Postoperative complications were categorized according to the Clavien-Dindo classification.RESULTS: A total of 517 patients were divided into three groups according to chronological order of the surgery in one day. Each group exhibited similar characteristics except for operation time (P=0.001) and the America Society of Anesthesiologists score (P=0.01). Operations conducted late in the day tended to require more time and were associated with more comorbidities. However, no significant differences were detected between the chronological order of operation in a given day and postoperative complications.CONCLUSION: The chronological order of three gastrectomies performed by one surgeon in a day was not associated with postoperative complications rate.
Americas ; Chungcheongnam-do ; Classification ; Comorbidity ; Electronic Health Records ; Fatigue ; Gastrectomy ; Humans ; Postoperative Complications ; Retrospective Studies ; Stomach Neoplasms ; Work Schedule Tolerance

PURPOSE: We measured and compared the uPA, plasminogen activator inhibitor-1 (PAI-1) and uPA receptor (uPAR) levels in breast cancer tissues and blood of the patients to evaluate their clinical relevance for biotherapy. MATERIALS AND METHODS: uPA, PAI-1 (Monozyme, Netherland), uPAR (American Diagnostics, USA) levels were measured by ELISA assay in 192 breast cancer tissues, in 18 normal breast tissues and in 163 blood from breast cancer patients. RESULTS: There was a tendency of uPA increment from ductal carcinoma in situ while increment of PAI-1 and uPAR occurred from Ti. With the progression of cancer, uPA, PAI-1, uPAR tended to decrease; however, the uPA/uPAR, uPA/PAI-1 ratios remained unchanged. There was a correlation of uPA expression between normal and cancer tissues ( r(2)= 0.49). Correlation of uPA and PAI-1 was found in normal tissue and stage I cancer tissue while correlation of uPAR and PAI-1 was found with cancer progression. Between cancer tissue and blood significant correlations were found in uPA, PAI-1, uPAR levels. CONCLUSION: uPA, PAI-1, uPAR levels in cancer tissue elevated from the early stage maintaining correlative expressions with cancer progression. A positive correlation between cancer tissue and blood level suggested the applicability of the levels of uPA, PAI-1 or uPAR for detecting patients for biotherapy.
Biological Therapy* ; Breast Neoplasms* ; Breast* ; Carcinoma, Intraductal, Noninfiltrating ; Enzyme-Linked Immunosorbent Assay ; Humans ; Plasminogen Activator Inhibitor 1 ; Plasminogen Activators* ; Plasminogen* ; Urokinase-Type Plasminogen Activator*

PURPOSE: Cancer invasion is induced by several proteolytic enzyme systems associated with the destruction of basement membrane and extracellular matrix. Urokinase-type plasminogen activator (uPA) and plasminogen activator inhibitor-1 (PAI-1) have been reported as prognostic factors in breast cancer patients and plasminogen activation is regulated by various factor such as uPAR and growth factor. So we examined the tissue levels of urokinase-type plasminogen activator receptor (uPAR) in breast cancer patients. MATERIALS AND METHODS: Tissue uPAR levels were measured by ELISA assay in 268 breast cancer patients. RESULTS: The median and mean values of tissue uPAR level in breast cancer were 3.5 ng/mg and 4.8+-3.6 ng/mg cytosol protein, respectively. Tissue uPAR level was the highest in T1 stage, but there was no statistical significance between T stage (p >0.05). In nodal stage, there was also no difference in the value of uPAR according to progression. And the value of uPAR expression was not associated with estrogen and progesteron receptor status, number of involved node and percent of node involvement. In TNM stage, tissue uPAR levels were higher in patients with stage I-II than in patients with stage III-IV (p=0.027). In univariate analysis, nodal factor (p=0.0023) and TNM stage (p=0.0004) were significantly associated with overall survival. But, multivariate analysis showed that TNM stage was the only significant prognostic factor (p=0.0002). CONCLUSION: These results suggest that uPAR is mainly associated with initial tumor invasion and other factors might be involved in later stages of cancer progression.
Basement Membrane ; Breast Neoplasms* ; Breast* ; Cytosol ; Enzyme-Linked Immunosorbent Assay ; Estrogens ; Extracellular Matrix ; Humans ; Multivariate Analysis ; Plasminogen Activators* ; Plasminogen* ; Urokinase-Type Plasminogen Activator*

PURPOSE: This study compares the feasibility and safety of Totally Laparoscopic Total Gastrectomy (TLTG) with Open Total Gastrectomy (OTG) for Remnant Gastric Cancer (RGC) in patients who had previously undergone gastrectomy. METHODS: We retrospectively collected and analyzed the data of 139 consecutive patients who underwent OTG along with 21 patients who underwent TLTG for RGC between January 2008 and December 2016. One-to-two Propensity Score Matching (PSM) was performed to compare the age, gender, body mass index, American Society of Anesthesiologists score, clinical tumor stage, previous gastric disease, previous gastrectomy type, previous reconstruction type, history of previous upper abdominal surgery except gastrectomy, and combined major operations. A total of sixty patients (21 who underwent TLTG and 39 who underwent OTG) were matched, and surgical outcomes and survival rates were compared. RESULTS: The TLTG patients were found to recover bowel movements sooner than the OTG group (OTG 3.74±0.88 vs TLTG 3.19±0.81 days, p=0.02). Post-operative surgical outcomes, including pathological features, clinical courses, complications and survival rates did not differ between the two groups (p>0.05). CONCLUSION: Although TLTG was not found to have any definitive clinical advantage over OTG except for more rapid recovery of bowel movement, TLTG should be considered as safe and feasible surgical procedure as OTG for the treatment of RGC.
Body Mass Index ; Gastrectomy ; Humans ; Laparoscopy ; Propensity Score ; Retrospective Studies ; Stomach Diseases ; Stomach Neoplasms ; Survival Rate