PURPOSE: The purpose of this study is to evaluate the differences of the clinicopathological features and survival rates in gastric cancer according to the sex of the patients. MATERIALS AND METHODS: We reviewed 5,784 cases of gastric cancer patients who underwent laparotomy at the Department of Surgery, Seoul National University Hospital fmm Jan. 1986 to Dec. 1995. We have analyzed clinicopathologic features including tumor location, Bonmann type, depth of invasicm, lymph node metastasis, distant metastasis, TNM stage, histologic differentiation and survival rates according to the sex of the patients. RESULTS: The mean age of female patients was 52.4 years, which is lower than that of male, 54.8 years. There were no differences in tumor location, Borrmann type, depth of invasion, lymph node metastasis, distant metastasis, TNM stage of tumor between male and female. But there were some differences in histologic differentiation; well- and moderately differentiated cancers were more common in male and signet-ring cell cancers were more common in female. Female shows slightly better prognosis than male. But the prognosis of young female was poorer than that of young male. CONCLUSION: In gastric cancer patients, differences in histologic differentiation and more aggressive nature of the signet-ring cell cancer in female may affect the survival differences according to the sex.
Female* ; Humans ; Laparotomy ; Lymph Nodes ; Male ; Neoplasm Metastasis ; Prognosis ; Seoul ; Stomach Neoplasms* ; Survival Rate

BACKGROUND: The New Bethesda System terminology has opened a series of problems about the atypical squamous cells of undetermined significance and low grade squamous intraepithelial lesion categories, particularly on their follow up. METHODS: We observe 12300 Pap smear examination, from jan 1995 to Dec 1999, in the Health promotion Center in a university hospital. Subjects were defined a the Health Promotion Center in a university hospital by electrical record and chart review. RESULTS: We find 48 cases of ASCUS and 33 cases of LSIL. When it is followed up by Pap smear, 34 cases of ASCUS are confirmed normal 19 cases(55.9%), benign cellular change 6 cases(17.6%), ASCUS 5 cases(14.7%), HSIL 4 cases(11.8%) and 27 cases of LSIL are confirmed normal 11 cases(40.7%), benign cellular change 3 cases(11.1%), ASCUS 3 cases(11.1%), LSIL 8 cases(29.6%), HSIL 2 cases(7.4%). 14 cases of ASCUS and 23 cases of LSIL are diagnosed by biopsy. Hostologic results of 14 cases of ASCUS are confirmed cervicitis 10 cases(71.4%), Moderate dysplasia 2 cases(14.3%), carcinoma in sute 2 cases(14.3%) and histologic results of 23 cases of LSIL are confirmed cervicitis 15 cases(65.2%), mild dysplasia 3 cases(13%), moderated dysplasia 3 cases(13%), sever dysplasia 1 cases(4.3%), carcinoma in situ 1 case(4.3%). Pap smear only was used for follow-up at family medicine clinic and 14 cases(29.2%), 4 cases(12.1%) are follow-up loss. CONCLUSION: After it is diagnosed ASCUS or LSIL Lesion of Pap smear in healthy care visitors, Follw-up loss is high in only follow-up Pap smear examination and follow-up results are presented more we severe lesions. To reduce follow-up loss, aggressive diagnosis and managements may be needed more than Pap smear follow-up examination.
Biopsy ; Carcinoma in Situ ; Diagnosis ; Follow-Up Studies* ; Health Promotion ; Humans ; Uterine Cervicitis

PUPOSE: Anastomosis site stricture is a common complication after a total gastrectomy. End-to-end anastomosis (EEA) stapler devices are preferred to a hand-sewn esophagojejunostomy these days. However, stapling devices have been reported not to reduce the incidence of esophagojejunostomy site stricture considerably. MATERIALS AND METHODS: From Sep. 1998 to Dec. 2000, at Korea Gastic Cancer Center, Seoul Paik Hospital, Inje University, we experienced 228 total gastrectomies in which EEA stapling devices had been used. We investigated the correlation of the stricture with the size of the EEA stapling device, the type of esophagojejunal reconstruction, reflux esophagitis, and duration of stricture development. RESULTS: Among the 228 cases, as far as the patient's age was concerned, the 7th decade was the most common 64 cases, followed by the 5th decades. The Male-to-female ratio was 2.3 : 1. A loop esophagojejunostomy was used in 223 cases, and the Roux-en-Y method was used in 5 cases. The 32 patients with anastomosis site stricture were patients with loop esophagojejunal anastomosis. Anastomosis site stricture occurred in 14% (32/228) of the total gastrectomy cases, in15.9% (11/69) of the total gastrectomies involving stapler devices with a 25-mm diameter, and in 13.2% (21/159) of the total gastrectomies involving staper devices with a 28-mm diameter. There was no correlation between the incidence of stricture and EEA- stapling device size (P>0.05). Reflux esophagitis occurred in 56 of the 228 cases, with 7 of those 56 cases (12.5%) and 25 of the remaining 172 cases (14.5%) having strictures. There was no considerable difference in the stricture incidence rate according to the presence of reflux esophagitis (P>0.05). The onset of stricture development, occurred within 6 months in 16 cases, including 4 cases of reflux esophagitis, between 7 and 18 months in 14 cases, including 3 cases of reflux eshophagitis, and after 19 months in 2 cases. CONCLUSION: An esophagojejunostomy site stricture after a total gastrectomy was not correlated with the esophagojejunal reconstruction type, the size of the stapling device, or the presence of reflux esophagitis. General anastomosis technical factors (e.g., adequate blood supply, tension-free manner, adequate hemostasis) may be more important to prevent anastomosis site stricture after an esophagojejunostomy during a total gastrectomy.
Constriction, Pathologic* ; Esophagitis, Peptic ; Gastrectomy* ; Humans ; Incidence ; Korea ; Seoul

Leptomeningeal carcinomatosis occurs in approximately 5% of patients with cancer. The most common cancers involving the leptomeninges are breast, lung cancer and melanoma. However, gastric adenocarcinoma has been rarely reported with leptomeningeal carcinomatosis. The presenting manifestations are usually headache, visual disturbances and seizures. We report a case of leptomeningeal metastasis that presented as a gastric cancer. A 49-year-old woman was admitted to our hospital with the symptoms of headache and melena for 10 days. The endoscopy showed a thickening of the folds of the stomach compatible with the diagnosis of a Borrman type IV gastric cancer. The biopsy revealed a signet ring cell carcinoma. The MRI of brain showed no abnormal findings; however, the patient complained of an intractable persistent headache, nausea and vomiting on admission day 6. The cytology examination of the cerebrospinal fluid supported the diagnosis of metastatic signet ring cell carcinoma.
Adrenal Cortex Hormones ; Carcinoma, Signet Ring Cell/*diagnosis/pathology/surgery ; Female ; Humans ; Mannitol ; Meningeal Neoplasms/*diagnosis/pathology/surgery ; Middle Aged ; Stomach Neoplasms/*diagnosis/pathology/surgery

PURPOSE: With recent advances of diagnostic methods and precise histopathologic examination, the incidence of synchronous multiple gastric cancer has increased. The purpose of this study was to evaluate the clinicopathologic features of patients with synchronous multiple gastric cancer. MATERIALS AND METHODS: We reviewed the clinicopathologic features of 189 patients with synchronous multiple gastric cancer out of 8,101 patients who underwent gastric resections for gastric cancers during 20 years from January 1977 to December 1996 at the Department of Surgery, Seoul National University Hospital, and compared them with single gastric cancer patients. The clinicopathologic features evaluated were age, sex, diagnostic method and accuracy, location of lesions, tumor size, histologic differentiation, Lauren classification, macroscopic classification, depth of invasion, lymph node metastasis, TNM stage, and type of operation and prognosis. RESULTS: The overall incidence of multiple synchronous gastric cancer was 2.33%. The mean age was 57.2 years old (27~84) and peak incidence was sixth decade. Male was predominant, that the sex ratio was 3.9: 1. Multiple gastric cancer was more frequent in old age, male and early gastric cancer patients. The number of lesions ranged from 2 to 5. In most cases, the lesions were located in lower two-thirds of the stomach. However, in 13 cases, lesions were located in both upper one-third and lower one-third. Only 33.3% of multiple cancer was diagnosed preoperatively, with the diagnostic accuracy of GFS was 30.0% and that of UGIS 26.1%. The most frequently missed lesions at preoperative examination were located in upper third of stomach, posterior wall of middle third and anterior wall of lower third of stomach. The most common macroscopic type was Borrmann type III (54.5%) in advanced lesions and type IIc (47.0%) in early lesions. Regarding the histologic differentiation, 58.7% of the cases were of the same differentiation and the cases composed of well differentiated adenocarcinomas were most common. According to the Laurens classification, 66.7% of lesions were intestinal type. As to the progression of the lesions, all lesions were early cancers in 75 cases, advanced cancers in 39 cases and advanced cancers were coexist with early cancers in 75 cases. Lymph node metastasis was less frequent than in single gastric cancer. Total gastrectomy was performed more frequently in multiple cancer patients than in single gastric cancer patients. The 5-year survival rate of patients with multiple gastric cancer was 70.2%, which was not significantly different from that of patients with single gastric cancer. CONCLUSIONS: Surgeons must keep in mind the possibility of multiple gastric lesions. More careful preoperative and intraoperative examination is mandatory to detect the possible accessory lesions, and postoperative periodic follow-up is necessary to detect any missed lesions, especially in the old age, male and early gastric cancer patients.
Adenocarcinoma ; Classification ; Follow-Up Studies ; Gastrectomy ; Humans ; Incidence ; Lymph Nodes ; Male ; Neoplasm Metastasis ; Postoperative Period ; Prognosis ; Seoul ; Sex Ratio ; Stomach ; Stomach Neoplasms* ; Survival Rate

PURPOSE: The benefit of surgical resection for hepatic metastasis from gastric cancer still remains unclear. We planned this study to estimate the surgical outcome of hepatic metastasis from gastric cancer. METHODS: Sixteen patients underwent hepatic resections for metastasis from gastric cancer between December 1991 and May 2005. We analyzed 11 patients who had no gross residual tumor after their operations. The clinical and pathological factors were evaluated with the surgical outcomes. RESULTS: Six patients had synchronous metastasis and 5 had metachronous metastasis. The number of hepatic metastases was one in 9 patients, two in 1 patient and four in 1 patient. There was no bilobar metastasis. The extents of the hepatic resections were 3 lobectomies, 4 segmentectomies and 4 wedge resections. There was no operative mortality. There was one postoperative complication, an intra-abdominal abscess, which was cured with percutaneous drainage. The mean survival was 18 months, the median survival was 13 months and the 1-year survival rate was 52.0%. One female patient is still alive 80 months after resection for metachronous hepatic metastasis. There was no statistically significant prognostic factor except for the patients' gender. (p = 0.0378) CONCLUSION: We consider that hepatic resection is a safe and valuable option for the treatment of metastatic gastric cancer.
Abdominal Abscess ; Drainage ; Female ; Hepatectomy ; Humans ; Mastectomy, Segmental ; Mortality ; Neoplasm Metastasis* ; Neoplasm, Residual ; Postoperative Complications ; Prognosis ; Stomach Neoplasms* ; Survival Rate

PURPOSE: The transmembrane glycoprotein CD44 exists in a variety of isoforms generated by alternative splicing of the pre-mRNA. We studied the role of CD44-standard (CD44s) and CD44-variant6 (CD44v6) in gastric adenocarcinoma. MATERIALS AND METHODS: Immunohistochemical staining was performed in 101 patients with gastric adenocarcinoma who underwent radical gastrectomy at KGCC, Seoul Paik Hospital. The relationship of CD44s, CD44v6 expressions to the clinicopathologic parameters, p53 and Ki-67 were evaluated. RESULTS: CD44s and CD44-v6 expressions were found in 56.4% and 48.5%, respectively. CD44s expression was significantly correlated with lymph node metastasis, lymphatic invasion, and Borr mann type. CD44v6 expression was significantly correlated with sex, lymph node metastasis, lymphatic invasion, and perineural invasion and had a tendency toward p53 expression. In inte stinal type adenocarcinoma, CD44s expression had correlations with lymph node metastasis and CD44v6 had correlations with lymph node metastasis, lymphatic invasion. However, in diffuse type adenocarcinoma, CD44s and CD44v6 expressions had correlations with only Borrmann type. In multivariate analysis, lymph node metastasis was the most significant risk factor for CD44s and CD44v6 expressions in total cases and intestinal type adenocarcinoma. CONCLUSION: These data suggest that expression of CD44 v6 may play an important role in the regulation of lymph node metastasis in intestinal type adenocarcinoma of stomach.
Adenocarcinoma* ; Alternative Splicing ; Gastrectomy ; Glycoproteins ; Humans ; Lymph Nodes* ; Lymphatic Metastasis ; Multivariate Analysis ; Neoplasm Metastasis* ; Protein Isoforms ; Risk Factors ; RNA Precursors ; Seoul ; Stomach ; Stomach Neoplasms

The status of metastasis to the regional lymph nodes has been considered to be a major prognostic factor of gastric cancer along with the depth of invasion. So far, the extent of lymph node metastasis has mainly been described by the anatomic location of the involved lymph node, which is an artificial classification. Therefore, a quantitative system such as the number or the ratio of involved lymph nodes emerges as a simple and objective assessment tool. This retrospective study evaluated the prognostic significance of the ratio of involved lymph nodes to resected lymph nodes as an indicator of the status of lymph node metastasis compared to the number of involved lymph nodes in gastric cancer. Five thousand two hundred seventeen consecutive cases of resectable gastric cancer treated at the Department of Surgery, Seoul National University Hospital from 1986 to 1995, were reviewed. Among them, 170 cases with unreliable pathologic reports and 476 cases with less than 15 isolated lymph nodes were excluded to minimize the stage migration phenomenon and to increase the creditability of the ratio, so finally 4571 cases were evaluated. The distributions of the number of cases and the 5-year survival rates were analyzed in a two-dimensional matrix with the ratio of the number of involved to resected lymph nodes on one axis and either the number of involved lymph nodes or the number of resected lymph nodes on the other axis. The other clinicopathologic variables were also evaluated for their prognostic values. The overall 5-year survival rate was 62.4%. The mean number of resected lymph nodes was 4.1(15~168) and the mean number of involved lymph nodes was 5.7. The ratios of involved lymph nodes were evenly distributed in the two matrices and had significant prognostic value in both the involved lymph node matrix and resected lymph node matrix. Age, sex, type of operation, R-category, tumor location, Borrmann type, tumor size, histologic differentiation, Lauren`s classification, depth of invasion, number of involved lymph nodes, ratio of involved lymph nodes to resected lymph nodes, distant metastasis, perineural invasion, lymphatic invasion, and vascular invasion and prognostic significance in univariate analysis and multivariate analysis performed with the above factors revealed that R-category, depth of invasion, and ratio of involved lymph nodes to resected lymph nodes were the independent significant prognostic factors. In the situation where a radical lymph node dissection is performed as the standard operation for gastric cancer, the ratio of involved lymph nodes to resected lymph nodes has a more comprehensive and accurate prognostic value than the number of involved or resected lymph nodes, and it should be considered as an estimate of the nodal status in gastric cancer.
Axis, Cervical Vertebra ; Classification ; Lymph Node Excision ; Lymph Nodes* ; Multivariate Analysis ; Neoplasm Metastasis ; Retrospective Studies ; Seoul ; Stomach Neoplasms* ; Survival Rate

We report a case of advanced gastric cancer with Virchow's node and lung metastasis that responded remarkably to preoperative chemotherapy. A 47-year-old female patient was diagnosed as having incurable advanced gastric cancer with Virchow's node and multiple lung metastasis. Preoperative chemotherapy with Taxotere, CDDP and 5FU was carried out. After four courses of the regimen, the Virchow's node and the lung metastasis had disappeared, and a marked reduction of the gastric lesion was observed on the CT scan. Consequently, the patient underwent a total gastrectomy with D2 lymph node dissection. On histopathological examination, cancer cells were found to have infiltrated up to the muscle layer of the gastric wall, and 42 out of 60 resected lymph nodes were found to be metastatic. The patient received another two courses of chemotherapy after the operation
Drug Therapy* ; Female ; Fluorouracil* ; Gastrectomy ; Humans ; Lung* ; Lymph Node Excision ; Lymph Nodes ; Middle Aged ; Neoplasm Metastasis* ; Stomach Neoplasms* ; Tomography, X-Ray Computed

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