A gastroduodenostomy is the most physiological reconstruction after a distal gastrectomy. However, a gastroduodenostomy with either sutures or staples has many complications. These include bleeding, leakage and stenosis. A sutureless gastroduodenostomy with a biofragmentable anastomosis ring (BAR) in was used adenocarcinoma patients to prevent these complications from 1999. A BAR is composed of polyglycolic acid and Barium sulfate to allow for X-ray visualization. Hardy in first introduced the BAR in 1985. Since then, it has been used in an anastomosis of the colon or small bowel surgery but its use in a gastroduodenostomy is the first trial in the world. A 70 year male patient, old who received a subtotal gastrectomy (Billroth I), underwent a A sutureless gastroduodenostomy with a BAR. The gastroduodenostomy with the BAR was watertight and maintained the initial burst strength in the gastrografin X-ray study performed at the postoperative 1 week. The BAR began to fragment 3 weeks after the operation and disappeared from the digestive tract completely. The diameter of the anastomosis site was sufficient for passed foods. No other secondary changes from remained foreign bodies were found in the endoscopic examination. In a second operation to treat a primary hepatoma, there was no adhesive changes around the gastroduodenostomy site. In conclusion, a sutureless gastroduodenostomy with BAR is a safe, easy and efficient reconstructive method after a distal gastrectomy.
Adenocarcinoma ; Adhesives ; Barium Sulfate ; Carcinoma, Hepatocellular ; Colon ; Constriction, Pathologic ; Diatrizoate Meglumine ; Foreign Bodies ; Gastrectomy ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Male ; Polyglycolic Acid ; Stomach Neoplasms ; Sutures

Carcinomas of the stomach can spread to adjacent structure by local extension or metastasize to lymph nodes, peritoneum and distant organs. However, the incidence of metastatic bladder cancer originated at the stomach is very rare. A fifty-five year-old man admitted complaining of epigastric pain for 2 months. A large ulceroinfiltrative lesion was seen in the low body, which was confirmed poorly differentiated adenocarcinoma by histological examination. Abdomino- pelvic CT scan showed wall thickening at the greater curvature side of gastric body and urinary bladder. Urine cytology was negative. By transurethral resection of bladder, he was diagnosed as metastatic adenocarcinoma of the bladder. We report a case of stomach cancer with metastasis to urinry bladder.
Adenocarcinoma ; Incidence ; Lymph Nodes ; Neoplasm Metastasis* ; Peritoneum ; Stomach Neoplasms* ; Stomach* ; Tomography, X-Ray Computed ; Urinary Bladder Neoplasms ; Urinary Bladder*

PURPOSE: Chylous ascites is an accumulation of lymphatic fluid within the peritoneal cavity due to trauma or to an obstruction on the lymphatic system. Postoperative chylous ascites is a rare complication of abdominal surgery. It is frequently reported after retroperitoneal dissections and results in high morbidity and mortality. However, there have been few report of such a complication following a radical gastrectomy. Therefore, we review the clinical analysis and treatment of chylous ascites based on our experience. MATERIALS AND METHODS: From July 1992 to June 2001, we treated 13 cases of chylous ascites after operations for gastric cancer. We reviewed medical charts of those patients retrospectively. RESULTS: The incidence of chylous ascites after operations for gastric cancer was 0.83% (13/1552). The mean time from ingestion of a meal after the operation to the development of symptoms was 2 days (range: 1~6 days). Conservative treatment by fasting, total parenteral nutrition (TPN), and repeated paracentesis was successful in all patients. The mean time from diagnosis to complete resolution was 25 days (range: 2~105 days). CONCLUSION: Chylous ascites should be considered in any patient with a typical milky color of drainage who has recently undergone radical gastrectomy. Treatment with fasting, TPN, and repeated paracentesis usually is successful.
Chylous Ascites* ; Diagnosis ; Drainage ; Eating ; Fasting ; Gastrectomy ; Humans ; Incidence ; Lymphatic System ; Meals ; Mortality ; Paracentesis ; Parenteral Nutrition, Total ; Peritoneal Cavity ; Retrospective Studies ; Stomach Neoplasms*

PURPOSE: The H. pylori cagA gene, vacA gene and iceA gene are considered to be important virurence factors that have been implicated in the development of gastric adenocarcinoma. It was reported that the presence of IS605 elements may be responsible for rearrangements and lead to partial or total deletions of the cag pathogenicity island (PAI) and the virulence of cag PAI may be changed. However, different results regarding the association between these virulence factors and clinical disease have been reported from different geographic regions. This study evaluated the relationship between H. pylori virulence factors such as cagA, vacA, iceA, IS605 and gastric adenocarcinoma. MATERIALS AND METHODS: H. pylori isolates were obtained from 54 infected patients (24 cases of gastric adenocarcinoma, 30 cases of control). H. pylori isolates were identified by PCR with ureC gene and 16S rRNA. PCR was performed to examine cagA, vacA, iceA and IS605 genotypes. RESULTS: Significant difference was found in the negative rates of cagA between gastric adenocarcinoma group and control (62.5% vs. 33.3% P=0.033). No significant difference was found in the prevalence of iceA, vacA between gastric adenocar cinoma and control. The genotype of cagA+ vacA s1-m1 iceA1 was predominant in H. pylori isolates irrespective of the clinical outcome. IS605 in PAI was not found in gastric adenocarcinoma gruop and control. The positive rates of IS605 in genome were 33.3% in gastric adenocarcinoma group and 36.7% in control (P>0.05). In gastric carcinoma, the positive rate of cagA+/IS605- was lower than in control (12.5% vs. 40.0%, P=0.025) and the positive rate of cagA-/IS605- was higher than in control (54.2% vs. 23.3%, P=0.02). CONCLUSION: H. pylori virulence factors had not related significantly with gastric adenocarcinoma. Further study is needed to examine the specificity of H. pylori strains.
Adenocarcinoma* ; Genome ; Genomic Islands ; Genotype ; Helicobacter pylori* ; Helicobacter* ; Humans ; Polymerase Chain Reaction ; Prevalence ; Sensitivity and Specificity ; Virulence Factors ; Virulence*

PURPOSE: The purpose of this study is to identify immunohistochemical evidence of lymph-node micrometastasis in histologic node-negative gastric cancer patients and to evaluate the prognostic significance of lymph-node micrometastasis. MATERIALS AND METHODS: A retrospective study of 50 gastric cancer patients who underwent curative resections from October 1990 to November 1994 was performed. Two consecutive sections were prepared: one for ordinary hematoxylin and eosin staining, and the other for immunohistochemical staining with Pan cytokeratin antibody (Novocastra, UK). In the univariate analysis, the survival rate was calculated using the Life Table Method, and the multivariate analysis was determined using a Cox Proportional Hazards Model. The statistical analyses of the relationships between the clinicopathologic factors and micrometastases were performed by using a Chi-square test. RESULTS: Of 2522 harvested lymph nodes, 81 (4.1%) nodes and 19 (38%) of 50 patients were identified as having lymph- node micrometastases by using immunohistochemical staining for cytokeratin. The incidence of lymph-node micrometastases was significantly higher in diffuse type carcinomas (54%, P=0.024) and in patients with serosal invasion (52.2%, P=0.05). For patients with lymph-node micrometastases (n=19), the 5-year survival rate was significantly decreased (73.7%, P=0.015). The Lauren's classification (P= 0.021) and the depth of invasion (P=0.035) were shown by multivariate analysis to have a significant relationship with the presence of micrometastases. Multivariate analysis revealed that lymph-node micrometastasis was independently correlated with survival in histologic node-negative gastric cancer patients. CONCLUSION: The presence of cytokeratin detected lymph-node micrometastases correlates with the worse prognosis for patients with histologic node-negative gastric cancer.
Classification ; Eosine Yellowish-(YS) ; Hematoxylin ; Humans ; Incidence ; Keratins ; Life Tables ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Micrometastasis* ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Stomach Neoplasms* ; Survival Rate*

No abstract available.
Drug Therapy* ; Stomach Neoplasms*

Rhabdoid tumor has been considered to be a rare subtype of Wilm's tumor with Rhabdomyoma features. Since rhabdoid tumor that developed in the kidney was described for the first time in 1989, it has been reported in the gastrointestinal tract, although this is rare. The appropriate treatment is radical resection, and the effect of adjuvant chemotherapy has not yet been reported on. The outcome of extra-renal rhabdoid tumor is different from renal rhabdoid tumor and the former shows a poor prognosis. Among extra-renal rhabdoid tumors, undifferentiated gastric adenocarcinoma with rhabdoid features is very rare and its prognosis is poor. A 63 years old male patient underwent total gastrectomy for a tumor that developed in the greater curvature of the gastric body and this was diagnosed as undifferentiated gastric adenocarcinoma with rhabdoid features, according to the histopathology. We experienced an undifferentiated gastric adenocarcinoma with rhabdoid features that was diagnosed by immunohistochemical staining and we report here on this case.
Adenocarcinoma* ; Chemotherapy, Adjuvant ; Gastrectomy ; Gastrointestinal Tract ; Humans ; Kidney ; Male ; Middle Aged ; Prognosis ; Rhabdoid Tumor ; Rhabdomyoma ; Stomach Neoplasms ; Stomach* ; Wilms Tumor

Gastric carcinoid tumor is a neoplasm that arises from enterochromaffine-like (ECL) cells in the gastric fundus. It is a rare disease that comprises less than 2% of all gastric neoplasms; however its incidence has been recently increasing. We experienced one case of gastric carcinoid tumor that was revealed to be multiple polypoid lesions. A 29-year-old female patient visited a hospital three years ago due to syncope. The blood hemoglobin was measured as 6.0 g/dl. Gastroscopy revealed multiple polypoid lesions with bleeding; therefore endoscopic clipping was performed. The polyps were diagnosed as carcinoid tumor via endoscopic biopsy. She was transferred to our hospital because of persistent iron deficiency anemia that was caused by bleeding at the gastric polyps. Gastroscopy revealed more than twenty various-sized polypoid lesions from the mid-body to the antrum. The blood hemoglobin level was 9.0g/dl. Total gastrectomy was performed under the diagnosis of gastric carcinoid tumor with bleeding. All of the gastric polyps were diagnosed as carcinoid tumors, and any metastasis to the regional lymph nodes was not found. Eighteen months after operation, the blood hemoglobin was increased to 12.8g/dl with no evidence of recurrence. Surgical resection should be considered for treating gastric carcinoid tumor with continuous bleeding.
Adult ; Anemia ; Anemia, Iron-Deficiency ; Biopsy ; Carcinoid Tumor* ; Diagnosis ; Female ; Gastrectomy ; Gastric Fundus ; Gastroscopy ; Hemorrhage ; Humans ; Incidence ; Lymph Nodes ; Neoplasm Metastasis ; Polyps* ; Rare Diseases ; Recurrence ; Stomach Neoplasms ; Syncope

We report our experience with a case of performing laparoscopy-assisted total gastrectomy along with pancreas-preserving splenectomy for treating early gastric cancer. Laparoscopy-assisted total gastrectomy was planned for a 62-year-old male patient with a double early gastric cancer located in the upper and lower third of the stomach. Five trocars were placed and we used a harmonic scalpel to dissect the greater curvature. Enlarged splenic hilar lymph node was encountered and they were proved to be metastasis by frozen section biopsy. We then performed total gastrectomy with pancreas-preserving splenectomy for the purpose of completely dissecting the lymph nodes along the splenic artery and splenic hilum. We created a 4 cm sized longitudinal mini-laparotomy below the xiphoid process to remove the specimen, and anastomosis was done via the Roux-en-Y method. The patient was discharged on the 9th postoperative days after an uneventful recovery. Our experience shows that laparoscopy-assisted total gastrectomy with pancreas-preserving splenectomy is a relatively safe procedure for treating upper third early gastric cancer with metastatic splenic hilar lymph nodes.
Biopsy ; Frozen Sections ; Gastrectomy* ; Humans ; Lymph Nodes ; Male ; Middle Aged ; Neoplasm Metastasis ; Splenectomy* ; Splenic Artery ; Stomach ; Stomach Neoplasms* ; Surgical Instruments

PURPOSE: The only curative treatment for gastric carcinoma is surgery and it is still under debate which reconstruction method is better after performing gastrectomy for gastric carcinoma. The typical reconstruction methods after distal gastrectomy are Billroth I, Billroth II and Roux-en Y reconstruction. Yet it is difficult to compare these methods and not so much is known about which reconstruction is better in terms of the physiologic and nutritional function. With this background, we compared two reconstruction methods after distal gastrectomy (Billroth I versus Roux-en Y reconstruction) in terms of the long term physiologic function and nutritional status to create a reference for selecting reconstruction methods after distal gastrectomy. MATERIALS AND METHODS: Between 1999 and 2002, 663 patients who underwent distal gastrectomy for early gastric carcinoma filled out questionnaires every six months after operation, and these questionnaires evaluated the physiologic function. To evaluate their nutritional status, blood tests were performed every six months to check their albumin, protein and hemoglobin levels, and we checked the body weight every 6 months as well. RESULTS: The total score of the 15 questions on the questionnaire concerned with the physiologic function showed no difference between the two groups at every evaluation time, and both groups showed very low total scores, indicating tolerable physiologic function after operation. When comparing each question between two the groups, only symptoms of regurgitation and food passage showed a difference between the two groups, showing that the Roux-en Y group had better function in terms of these two symptoms. The Billroth I group showed a better nutrition status, indicating that the level of albumin, protein and hemoglobin were higher in the Billroth I group, with statistical significance. Body weight loss was severe in the Roux-en Y group. CONCLUSION: The physiologic function is slightly better in the Roux-en Y group in terms of some symptoms such as regurgitation and food passage. However, the nutritional status is better in the Billroth I group. In conclusion, because we cannot definitely ascertain which reconstruction is better when we consider both the physiologic and nutritional functions, it is reasonable that surgeon should choose reconstruction methods according to their experience and preference.
Body Weight ; Gastrectomy* ; Gastric Bypass* ; Gastroenterostomy* ; Hematologic Tests ; Humans ; Nutritional Status* ; Surveys and Questionnaires