No abstract available.
Education* ; Stomach Neoplasms*

Primary small-cell carcinomas of the stomach are rare and aggressive malignancies with poor survival rates. Preoperative diagnosis is difficult and a standard treatment is not yet established. We have recently experienced two cases of a primary small-cell carcinoma of the stomach. The first case was a 65-year-old man with epigastric soreness. Endoscopic biopsy showed an adenocarcinoma. He underwent a radical subtotal gastrectomy with D2 lymph-node dissection. Pathology revealed a collision tumor of a small- cell carcinoma and an adenocarcinoma with submucosal invasion and with metastasis in 20 out of 48 lymph nodes (T1N3M0). The second case was a 64-year-old man with epigastric soreness. Endoscopic biopsy revealed a small-cell carcinoma. There was no evidence of a primary tumor in the lung. A radical subtotal gastrectomy with D2 lymph-node dissection was performed. Pathology showed a pure small- cell carcinoma with proper muscle invasion and with metastasis in 1 out of 36 lymph nodes (T2aN1M0).
Adenocarcinoma ; Aged ; Biopsy ; Carcinoma, Small Cell* ; Diagnosis ; Gastrectomy ; Humans ; Lung ; Lymph Nodes ; Middle Aged ; Neoplasm Metastasis ; Pathology ; Stomach* ; Survival Rate

Recently, we experienced two advanced gastric cancer (AGC) patients younger than 17 years of age. The first case was a 15-year, 2-month-old male who had suffered from epigastric soreness for 5 weeks. His grandfather died of gastric cancer at 39 years of age. Under the diagnosis of AGC, he underwent a total gastrectomy with D2 lymph node dissection. There was no evidence of distant metastasis. Pathologic examination revealed a 4.5x4 cm, signet ring cell adenocarcinoma with subserosal invasion and with metastasis in 9 of 42 regional lymph nodes (T2bN2M0). The second case was a 17-year, 11-month-old male who had suffered from epigastric pain for 2 years without familial clustering. Under the diagnosis of AGC, he underwent a distal subtotal gastrectomy with D2 lymph node dissection. There was no evidence of distant metastasis. Pathologic examination revealed a 3x2 cm, signet ring cell adenocarcinoma with subserosal invasion and with metastasis in 9 of 45 regional lymph nodes (T2bN2M0). The two patients have been alive without recurrence for 27 months and 4 months, respectively. Even among teenagers, patients with abdominal complaints should be subjected to a thorough examination of the gastrointestinal tract.
Adenocarcinoma ; Adolescent ; Diagnosis ; Gastrectomy ; Gastrointestinal Tract ; Humans ; Infant ; Lymph Node Excision ; Lymph Nodes ; Male ; Neoplasm Metastasis ; Recurrence ; Stomach Neoplasms*

Surgical treatment for afferent loop syndrome (ALS) in patients with recurrent gastric cancer is usually not feasible because of the recurrent tumor mass at the anastomosis site and/or extensive carcinomatosis resulting in bowel loop fixation. Furthermore, ALS usually makes oral intake impossible, resulting in a rapid deterioration in general condition. In this situation, gastroscopic stenting at the anastomotic site and/or percutaneous external drainage may be a more feasible alternative for palliation. We herein report a recurrent gastric cancer whose ALS was successfully treated with internal and external drainage procedures.
Afferent Loop Syndrome* ; Carcinoma ; Drainage* ; Humans ; Stents* ; Stomach Neoplasms*

PURPOSE: The tumor suppressor gene p53 has been shown to be a factor in the carcinogenesis or progression of gastric cancer. The mutant p53 has been reported to cause a higher risk of lymph-node metastasis. Futhermore, mutation of the p53 has been linked to a poor prognosis for gastric cancer. The heat shock protein-27 (HSP27), a stress protein, has also been reported to be a poor prognostic factor in ovarian and breast cancers. However, in gastric-cancer patients, controversies exist as to its influence on the prognosis. In the present study, we used an immunohistochemical stain to observe the effects of p53 and HSP27 on the clinicopathological factors and on the prognosis for gastric-cancer patients. MATERIALS AND METHODS: To evaluate the significance of p53 and HSP27 in gastric cancer patients, we analyzed 212 cases of gastric cancer (stage I~IV). Tissue samples of 212 patients were stained immunohistochemically for the mutant p53 protein and for HSP27. The correlations between protein expression and the clinicopathological factors were investigated. RESULTS: The overall expression rates for p53 and HSP27 were 36.9% and 27.8%, respectively. p53 and HSP27 were correlated to each other because the HSP27 expression rate was higher in the p53-positive group (P=0.046). Statistically, the p53 and the HSP27 expression rates were significantly increased in the case of tumor invasiveness, lymphatic metastasis and vessel involvement. Therefore, they play a role in cancer progression. The 5-year survival rates of the p53-positive and the p53-negative groups were 62.8% and 60.1%, respectively (P=0.793) while the 5-year survival rates for the HSP27-positive and HSP27-negative groups were 54.2% and 63.1%, respectively (P=0.090). CONCLUSION: p53 and HSP27 were correlated to each other in our immunohistochemical study of gastric carcinomas and they were not independent prognostic factors in gastric- cancer patients. However, further studies are needed to determine their prognostic values for gastric-cancer patients.
Breast ; Carcinogenesis ; Genes, Tumor Suppressor ; Hot Temperature ; HSP27 Heat-Shock Proteins ; Humans ; Lymphatic Metastasis ; Neoplasm Metastasis ; Prognosis ; Shock ; Stomach Neoplasms ; Survival Rate

PURPOSE: The most feared complication of gastrointestinal tract operations is anastomotic leakage, not only because of the presumed individual surgeon's culpability but also because of the assumption that this event is often fatal. We have experienced 32 cases of anastomotic leakage after elective gastric resection during 8 years. The purpose of this study was to evaluate the result of their treatment. MATERIALS AND METHODS: We evaluated the records of 1335 patients who had undergone elective gastric resection for an adenocarcinoma of stomach from January 1995 to October 2003 and conducted a retrospective, multivariate analysis. RESULTS: Of the 1335 patients, 32 (2.4%) sustained an anastomotic leakage. Anastomotic leakages usually developed on mean postoperative day 9.1+/-3.2 (range:1~18 days). Overall, 31.3% (10/32) of patients who sustained an anastomotic leakage died. The anastomotic leakages were identifed by radiological study or by operative finding at the site of the duodenal stump (20 patients), the esophagojejunostomy (7), the gastroduodenostomy (4), and the gastrojejunostomy (1). Fourteen patients (43.8%) underwent a relaparotomy, a drainage procedure in the main, and 18 patients (56.3%) were treated conservatively. The mortality rates were 42.9% (6/14) and 22.2% (4/18), respectively, but this difference was not statistically significant. A cox's proportional hazard analysis showed that a body-mass Index < 24 kg/m2 (odds ratio 5.55, 95% CI: 0.69~44.82) and non-enteral feeding (odds ratio 18.27, 95% CI 2.22~150.69) were independent factors of mortality due to anastomotic leakage. CONCLUSION: Our observations show that anastomotic leakage after an elective gastric resection has a high risk of being fatal. Moreover, for a patient with a body-mass index lower than 24 kg/m2 and/or non-enteral feeding, an anastomotic leakage after an elective gastric resection has a higher risk of being fatal.
Adenocarcinoma* ; Anastomotic Leak* ; Drainage ; Enteral Nutrition ; Gastrectomy* ; Gastric Bypass ; Gastrointestinal Tract ; Humans ; Mortality ; Multivariate Analysis ; Retrospective Studies ; Stomach ; Stomach Neoplasms

PURPOSE: While E-cadherin in normal cells induces calcium-dependent cell-cell adhesion, in malignant cell, it plays a role in invasion and metastasis with a reduction of adhesion. Serum soluble E-cadherin is a result of the reduction of the cellular E-cadherin molecule and is found in the circulation of normal individuals, but it is particularly known to be increased in patients with malignancies. Accordingly, through checking the level of serum soluble E-cadherin in patients with gastric cancer and analyzing it in the view of clinicopathology, we investigated whether serum soluble E-cadherin could be translated into a clinicopathologic esult and used as a tumor marker. MATERIALS AND METHODS: The investigation targeted 88 patients who had been diagnosed as having gastric cancer by the Department of Surgery, St. Mary's Hospital, from October 1, 2002, to July 30, 2003, and who had under gone performed surgery. We measured the level of preoperative serum E-cadherin in the 88 patients by unsing ELISA. Among them, we collected gastric cancer tissues from 54 patients and executed immunohistochemistry for E-cadherin. The samples were compared with normal tissues in terms of both serum E-cadherin level and immunohistochemistry level, as well as with other clinicopathologic factors. RESULTS: The mean serum E-cadherin level of the 88 patients was 4368.7 ng/ml and was significantly higher than the level in 12 normal control patients, 3335.5 ng/ml (P=0.016). In terms of clinicopathology, the serum level of E-cadherin was significantly correlated with increasing age (P=0.0006) and was higher in positive venous invasion patients (P=0.0005). When the E-cadherin immunohistochemical stain was compared with the serum E-cadherin level in 54 patients, no significant statistically meaningful result was obtained (P=0.2881). However, 4 patients with serum E-cadherin levels about 6000 ng/ml were classified into the lower expression group (<80%) of E-cadherin immunohistochemicals stain. In the analysis for 36 patients who were early gastric cancer patients, the serum E-cadherin level in lymph-node-metastatic patients was higher than it was in the other patients (P=0.0442). CONCLUSION: The serum E-cadherin level in gastric cancer patients was higher than the level in normal control patients. In advanced gastric cancer patients, that the difference was increased. Also, since the E-cadherin level correlated with the serum E-cadherin level with venous invasion, it can be used as an effective tumor marker for gastric cancer. Particularly, in that the serum E-cadherin level correlated with lymph node metastasis in early gastic cancer, it can be used when a therapeutic method for early gastric cancer is selected.
Cadherins* ; Enzyme-Linked Immunosorbent Assay ; Humans ; Immunohistochemistry ; Lymph Nodes ; Neoplasm Metastasis ; Stomach Neoplasms*

PURPOSE: According to the recent studies, it is shown that the polymorphism of Interleukin 1beta gene is associated with the incidence of gastric cancer caused by the Helicobacter pylori infection. Interleukin 1beta is a cytokine markedly inhibiting gastric acid secretion. Interleukin 1beta production associated with Helicobacter pylori gastric infection may exacerbate mucosal damage including chronic gastritis and atrophic gastritis, may induce eventual neoplasia. Among these Interleukin 1beta gene polymorphisms, polymorphisms at -31 portion and -511 portion may associated with these processes, eventually increase the risk of gastric cancer. We investigated the risk of gastric cancer according to the Helicobacter pylori infection and genetic polymorphism of Interleukin 1beta in gastric cancer patients. MATERIALS AND METHODS: 176 individuals with gastric cancer and 40 healthy controls were analyzed. Each group was divided into two groups whether they infected with Helicobacter pylori or not. DNA was extracted from the peripheral blood in all groups. The PCR-RFLP method was used for investigating the distribution of genotype of C/C, C/T, T/T at -31 portion and -511 portion. RESULTS: T/T genotype at -511 portion was 19.3% in gastric cancer cases and 10% in controls, which was statistically significant. (P=0.0432) The risk of gastric cancer was increased 4.86 (1.26~18.77) in group which had T/T genotype. In gastric cancer cases, C/C genotype at 31 portion was 27.6% in group with Helicobacter pylori infection and 12.8% in group without infection, which was statistically significant. (P=0.0047) The risk of gastric cancer was increased 4.82 (1.81~12.81) in group which had C/C genotype. CONCLUSION: T genotype at -511 portion among the Interleukin 1beta genetic polymorphisms may be the risk factor of gastric cancer. And, with Helicobacter pylori infection, C genotype at -31 portion may be the risk factor of gastric cancer.
DNA ; Gastric Acid ; Gastritis ; Gastritis, Atrophic ; Genotype ; Helicobacter pylori* ; Helicobacter* ; Humans ; Incidence ; Interleukin-1beta* ; Interleukins* ; Polymorphism, Genetic ; Risk Factors ; Stomach Neoplasms*

PURPOSE: To determine the clinical value of the Siewert classification for gastic-cancer patients in Korea, we evaluated and compared the clinicopathologic factors of type II and type III cancer. MATERIALS AND METHODS: The medical records of 89 consecutive patients who had undergone surgery for an adenocarcinoma of the gastroesophageal junction (GEJ) at the Department of Surgery, Hanyang University Hospital, between Jun. 1992 and Dec. 2003 were reviewed retrospectively. RESULTS: There were one patient with type I, 12 pateints with type II and 77 patients with type III. During the same period, 1,341 patients underwent surgery for a gastric carcinoma, so proportion of GEJ cancer being 6.6%. The median follow- up duration was 31 months (range: 2~135 months), and the follow-up rate was 100%. Between type II and type III cancers, there were no significant differences in the clinicopathologic variables including age, sex, gross appearance, histologic type, depth of invasion, and pathologic stage. The longest diameter of the tumor was larger in type III (6.1+/-2.1 cm) than in type II (3.9+/-1.1 cm)(P=0.001). A total gastrectomy with Roux-en-Y esophagojejunostomy was done most frequently, while jejunal interposition was done in 3 cases of type II and 2 cases of type III. More than a D2 lymphadenectomy was done all cases. The numbers of dissected lymph nodes and metastatic lymph nodes in type II were 43.8 and 5.8 respectively, while they were 49.8 and 8.1 in type III, but the difference between the two groups were not statistically significant. The mean length of the proximal resection margin was 15+/-5 mm in type II and 21+/-13 mm in type III, but this difference was not statistically significanct. The time to recurrence after operation was 19.3 months in type II and 16.9 months in type III. The five-year survival rates of type II and III were 68.8% and 52.7% respectively, but difference was not significant. CONCLUSION: There were no significant differences in the clinicopathologic variables, including survival rate, between type II and type III cancers in Korean patients. According to these findings, it appears to be reasonable to classify type III cancer as a cardia cancer in a broad sense.
Adenocarcinoma* ; Cardia* ; Classification* ; Esophagogastric Junction ; Follow-Up Studies ; Gastrectomy ; Humans ; Korea ; Lymph Node Excision ; Lymph Nodes ; Medical Records ; Recurrence ; Retrospective Studies ; Survival Rate

PURPOSE: There have been some controversies over the therapeutic principles of advanced gastric cancer, and the results of treatment have been variable, especially for stage III disease. This study was conducted to define the prognostic factors of stage III gastric cancer. MATERIALS AND METHODS: This retrospective study was based on the medical records of 179 patients with stage III disease who received a gastrectomy from January 1990 to December 1994. The 5-year survival rate was analyzed according to the age, sex, tumor location, tumor size, Borrmann's type, depth of invasion, lymph-node metastasis, ratio of metastatic lymph nodes, type of surgical resection, extent of lymph- node dissection, curability of resection, postoperative chemotherapy, and pathological stage. The statistical analysis was done by using the Kaplan-Meier method, the log-rank test, and the Cox proportional hazards model. RESULTS: The overall 5-year survival rate was 61.6%. the 5-year survival rates according to subgroup were 69.7% for stage IIIa (100% for T2N2, 70.0% for T3N1, 68.6% for T4N0), and 54.1% for stage IIIb (T3N2) (P<0.05). Among various clinicopathologic factors of stage III gastric cancer, the age of the patient, the tumor location, the gross type of tumor, the type of gastric resection, the extent of lymph-node dissection, the curability of resection, and the subgroups of stage III were statistically significant in the univariate survival analysis. The multivariate analysis defined the curability of resection, the extent of lymph-node dissection, the type of operation, the stage of disease, and the age of the patient as independent prognostic factors. CONCLUSION: A curative surgical resection and an extended lymph-node dissection are thought to be most important for improving the survival rate in stage III gastric cancer patients.
Drug Therapy ; Gastrectomy* ; Humans ; Lymph Nodes ; Medical Records ; Multivariate Analysis ; Neoplasm Metastasis ; Proportional Hazards Models ; Retrospective Studies ; Stomach Neoplasms* ; Survival Rate*