PURPOSE: Borrmann type IV gastric cancer is often diagnosed only at an advanced stage, resulting in a prognosis poor. We performed a retrospective study of the clinical characteristics of Borrmann type IV gastric cancer and the prognostic factors affecting the survival rate in such patients. MATERIALS AND METHODS: Of 4, 063 patients with all gastric cancers, 370 (9%) with Borrmann type IV gastric cancer were analyzed. RESULTS: The clinical characteristics of these patients included a higher incidence rate in young females, and higher rates of serosa exposure, metastasis to lymph nodes and early peritoneal dissemination. Of patients presenting with peritoneal seeding, those resected had a higher survival rate than those that were not. A univariate analysis showed that the prognostic factors affecting the survival rate following a curative resection were the location, occupied area and depth of the primary tumor, as well as the presence of lymph node metastasis and the tumor stage. A multivariate analysis indicated that the tumor location and stage were significant independent prognostic factors after a curative resection for Borrmann type IV gastric cancer. CONCLUSION: In conclusion, the early diagnosis and treatment of patients with Borrmann type IV gastric cancer are essential for the better survival of these patients. Even in patients with advanced tumors, a noncurative palliative resection may improve the prognosis.
Early Diagnosis ; Female ; Humans ; Incidence ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Retrospective Studies ; Serous Membrane ; Stomach Neoplasms* ; Survival Rate

PURPOSE: Surgical site infection (SSI) is the most common nosocomial infection in surgical patients, and this accounts for approximately 17% of all hospital-acquired infections. Suture materials are possibly significant sources of SSI. This study aims to evaluate the in vitro antibacterial efficacy of Vicryl and PDS plus antibacterial suture coating with triclosan against bacteria. METHODS: Vicryl and PDS plus antibacterial suture coating with and without triclosan were tested for in vitro efficacy against methicillin-susceptible Staphylococcus aureus, methicillin-resistant S. aureus, methicillin-resistant Staphylococcus epidermidis, Escherichia coli by a zone of inhibition assay and test of bacterial adhesion and viability. RESULTS: Vicryl and PDS plus antibacterial suture coating with triclosan demonstrated activity against all tested bacteria in vitro. Evaluations by a zone of inhibition assay and test of bacterial adhesion and viability show the antibacterial activity compared with untreated sutures. Pretreatment of surgical sutures with fetal bovine serum did not diminish antibacterial activity of the triclosan-coated sutures compared with non-coated sutures (P<0.01). CONCLUSION: Vicryl and PDS plus antibacterial suture reduced in vitro colonization of several strains of bacteria compared with untreated control sutures.
Bacteria ; Bacterial Adhesion ; Colon ; Cross Infection ; Escherichia coli ; Humans ; Methicillin Resistance ; Polyglactin 910 ; Staphylococcus aureus ; Staphylococcus epidermidis ; Sutures ; Triclosan

The authors have experienced 9 cases of postgastrectomy efferent loop obstruction during the past 16 months' period and analyzed the clinical features, radiological findings, causes, and types of obstruction. The incidence of efferent loop obstruction was 1.3%(9/673). Among the 9 cases, eight patients were male and one patient was female. Median age was 60 years and more than half(5 out of 9 cases) of the patients were obese(defined by more than 110% of ideal body weight). None of the cases showed signs of strangulation, including persistent pain, fever, focal abdominal tenderness, and/or leukocytosis. Gastrointestinal anastomoses were done using a GIA stapler in 6 cases, and manually in 3 cases. The diagnoses were made on the basis of clinical symptoms and signs, further supported by radiologic contrast studies. All the patients were initially treated with conservative measures, including nasogastric drainage and fluid therapy for about 2 weeks in average. 7 cases underwent re-laparotomy using separate left subcostal incisions as conservative management had failed. Among the relaparotomy cases, adhesiolysis and side to side jejunojejunostomy were performed in 5 patients, Roux-en-Y gastrojejunostomy in 1 patient, and gastrojejunostomy revision in 1 patient. Causes of the obstruction in the seven re-opened cases were confirmed as postoperative adhesion. The authors have analyzed the pattern of obstruction and classified the patterns into 4 types. One of the remaining two patients underwent balloon dilatation successfully and the other was managed with prolonged nasogastric decompression. The average hospital stay was 32 days. Adequate omentectomy, gentle tissue handling during dissection, avoidance of ischemia along the suture line of anastomosis, and the use of biologically inert suture material would prevent this kind of postoperative adhesive obstruction.
Adhesives ; Decompression ; Diagnosis ; Dilatation ; Drainage ; Female ; Fever ; Fluid Therapy ; Gastric Bypass ; Humans ; Incidence ; Ischemia ; Length of Stay ; Leukocytosis ; Male ; Stomach Neoplasms ; Sutures

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: CEA, CA19-9, and CA72-4 are the most commonly used tumor markers in stomach cancer. This clinical study was performed to evaluate the diagnostic value of these tumor markers in stomach cancer patients. MATERIALS AND METHODS: A retrospective analysis of 170 stomach cancer patients who had undergone curative gastrectomy between January 1991 and December 1996 at the Department of Surgery was performed. The preoperative and postoperative serum levels of these tumor markers were measured in 170 patients. RESULTS: The preoperative positive cases were 28 cases (16%) in CEA, 15 (9%) in CA19-9, and 24 (14%) in CA72-4. The postoperative positive cases among 48 recurrences were 21 cases (44%) in CEA, 10 (21%) in CA19-9, and 10 (21%) in CA72-4. The combination of CEA with CA19-9 or CA72-4 had higher positivity rate (58%) than single tumor marker. The highest positivity rate was found in CEA at recurrences of anastomotic site, in CA19-9 at recurrences of lymph node, in CA72-4 at peritoneal seeding and distant metastasis. In multivariate analysis, these tumor markers were not independent prognostic factors. CONCLUSION: CEA, CA19-9, and CA72-4 have proved unhelpful in initial diagnosis of stomach cancer because of their low positivity rate. And the combination of 3 tumor markers was the useful method for raising positivity rate in diagnosis of recurrences.
Diagnosis ; Gastrectomy ; Humans ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Recurrence ; Retrospective Studies ; Stomach Neoplasms* ; Stomach* ; Biomarkers, Tumor*

PURPOSE: This study was designed to investigate the significance of preoperative serum CA 19-9 level as a prognostic factor and postoperative serum CA 19-9 level as an indicator for recurrence in gastric adenocarcinoma patients. MATERIALS AND METHODS: 328 patients, who received curative resection of stomach for gastric cancer from 1989 to 1996 and followed up successfully, were analyzed retrospec- tively. Median follow-up period was 24 months (range: 11-38 months). The cut off level of serum CA 19-9 was 37 U/ml. The relationships between preoperative serum CA 19-9 status and prognostic parameters, recurrence and survival rate were analyzed. Multivariate analysis using Cox proportional hazards regression analysis was performed to evaluate as an independent prognostic factor. The relationship between postoperative serum CA 19-9 level and recurrence was investigated. RESULTS: Out of 328 cases, 29 cases (8.8%) showed elevated preoperative serum CA 19-9 level. The preoperative serum CA 19-9 level was correlated with the degree of depth of invasion and the status of lymph node metastasis (p<0.05). Patients with positive pre- operative serum CA 19-9 status showed higher incidence of recurrence (p<0.05) and poorer survival rate (p=0.00003) than patients with negative status. Preoperative serum CA 19-9 status (risk ratio: 3.4464, p=0.0039) revealed as an independent prognostic factor in multivariate analysis. Postoperative serum CA 19-9 status revealed as a useful predictor for recurrence in patients with positive preoperative serum CA 19-9 status. CONCLUSION: Preoperative serum CA 19-9 determination in patients with gastric cancer was valuable for predicting tumor progression and prognosis. Preoperative serum CA 19-9 status may be helpful to predict recurrence earlier than other diagnostic tools, especially in the patients with positive preoperative serum CA 19-9 status.
Adenocarcinoma* ; Follow-Up Studies ; Humans ; Incidence ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Stomach ; Stomach Neoplasms ; Survival Rate

PURPOSE: With advancements in laparoscopic surgery, there have been efforts to expand the indication for laparoscopic surgery up to advanced gastric cancer. However, scant data are available regarding the feasibility and advantages of laparoscopy-assisted distal gastrectomy (LADG) with standard radical D2 lymph node dissection. MATERIALS AND METHODS: Twenty-two patients who were preoperatively diagnosed with cT1N0M0 gastric cancer underwent LADG with standard D2 lymphadenectomy between February and August 2007. They were compared with patients who underwent conventional open D2 lymphadenectomy with respect to clinicopathologic features, surgical outcomes, and postoperative course. RESULTS: The mean operative time was significantly longer in the LADG group than in the open group (160+/-25 min vs. 135+/-21 min, P<0.001). However, surgical outcomes, such as surgical margin and number of retrieved lymph nodes (25.7+/-11.1 vs. 26.9+/-9.2, P=ns) were comparable between the groups. The LADG group exhibited quicker postoperative recovery, and both groups exhibited similar postoperative morbidity and mortality. CONCLUSION: LADG with D2 lymphadenectomy is feasible and safe, with short-term surgical outcomes comparable to those seen in open D2 lymphadenectomy. Further prospective clinical investigation will be needed to better evaluate the advantages of LADG with D2 lymphadenectomy.
Gastrectomy ; Humans ; Laparoscopy ; Lymph Node Excision ; Lymph Nodes ; Operative Time ; Stomach Neoplasms

Various methods of gastrojejunostomy can be used in Billroth II gastrectomy. Two-layer sutures as Albert-Lembert type provide more secure anastomosis and one-layer sutures as Gambee type show better mucosal apposition. To take advantage of merits from the two suture types, we adopted stapling technique in gastrojejunostomy. We have performed 131 cases of stapling gastrojejunostomy and the results were compared with those of 313 conventional manual anastomoses. Stapling gastrojejunostomy consists of partial gastric resection, insertion of GIA stapler forks into jejunal and gastric openings at greater curvatures side, firing, closure of the stapler insertion site and placing reinforcing sutures to the apex of the anastomosis. This method shortened the operation time and did not worsen the postoperative recovery course. Gastrojejunostomy complications requiring laparotomy were occurred in 5 cases(3.8%) in stapling group. Complication cases showed adhesive ileus with efferent loop obstructions, which were resolved by bypass and adhesiolysis. In manual group, 5 cases(1.6%) were undertaken exploration due to adhesive bowel obstructions and anastomosis site bleeding. We concluded that stapling gastrojejunostomy is a safe and faster technique which can replace conventional manual anastomosis.
Adhesives ; Fires ; Gastrectomy* ; Gastric Bypass ; Gastroenterostomy* ; Hemorrhage ; Ileus ; Laparotomy ; Stomach Neoplasms ; Sutures

PURPOSE: A proximal gastrectomy is performed for gastric cancer in the upper part of the stomach to preserve the function of the stomach after surgery. An esophagogastrostomy is one of the common reconstruction methods for a proximal gastrectomy, but this method results in a high incidence of reflux esophagitis. This study was undertaken to compare subjective and functional results between esophagogastrostomy and jejunal interposition reconstructions. MATERIALS AND METHODS: From June 1998 to December 2002, proximal gastrectomies were perfomed in 33 patients with tumors in the upper third of the stomach; 8 had reconstruction using jejunal interposition between the esophagus and the remnant stomach (JI group) while 25 had reconstruction using esophagogastrostomy (EG group). The postroperative courses of the patients were reviewed in terms of symptoms, weight changes, and endoscopic findings. RESULTS: The mean age of the patients was 59 years; 26 were men and 7 were women. There were no significant differences in general complications, operating times, or histologic features between the two groups. Fifty-two percent (52%) of the EG group complained of dysphagia, and 16% them experienced heartburn and acid belching. Twelve percent (12%) of the JI group complained of dysphagia, but heartburn and acid belching did not occur. Incidences of reflux esphagitis (36%) and balloon dilatation for anastomotic stricture (16%) were more common in the EG group than in the JI group (0% and 12%). CONCLUSION: To prevent or minimize complications, such as reflux esophagitis and postoperative symptoms, a proximal gastrectomy with a jejunal interposition is an alternative method as an organ-preserving surgical strategy to improve quality of life for patients.
Constriction, Pathologic ; Deglutition Disorders ; Dilatation ; Eructation ; Esophagitis, Peptic ; Esophagus ; Female ; Gastrectomy* ; Gastric Stump ; Heartburn ; Humans ; Incidence ; Male ; Prospective Studies* ; Quality of Life ; Stomach ; Stomach Neoplasms

Isolated gastric IgG4-related disease (IgG4-RD) is a very rare tumefactive inflammatory condition, with only a few cases reported to date. A 48-year-old woman was incidentally found to have a subepithelial tumor in the stomach. Given a presumptive diagnosis of gastrointestinal stromal tumor or neuroendocrine tumor, she underwent wedge resection. The lesion was vaguely nodular and mainly involved the submucosa and proper muscle layer. Microscopically, all classical features of type I autoimmune pancreatitis including lymphoplasmacytic infiltration, storiform fibrosis, obliterative phlebitis, and numerous IgG4-positive plasma cells were seen. She had no evidence of IgG4-RD in other organs. Although very rare, IgG4-RD should be considered one of the differential diagnoses in the setting of gastric wall thickening or subepithelial mass-like lesion. Deep biopsy with awareness of this entity might avoid unnecessary surgical intervention.
Autoimmune Diseases ; Biopsy ; Diagnosis ; Diagnosis, Differential ; Female ; Fibrosis ; Gastrointestinal Stromal Tumors ; Granuloma, Plasma Cell ; Humans ; Middle Aged ; Neuroendocrine Tumors ; Pancreatitis ; Phlebitis ; Plasma Cells ; Stomach*