No abstract available.
Humans ; Nitriles ; Pyrethrins ; Stomach Neoplasms

Short-term surgical results of gastric cancer improve with use of a laparoscopic approach compared to those after conventional laparotomy, particularly in patients with early gastric cancer (EGC). However, due to gastric resection and lymph node dissection, poor long-term quality of life (QOL) after gastric cancer surgery is equivalent between the approaches. Thus, gastric resection and lymph node dissection should be minimized to avoid injury to innervating nerves and the sphincter, to maintain gastric function, preserve gastric volume, and improve long-term QOL. Such a procedure should not impair the oncological outcome by removing the primary tumor and metastasis to lymph nodes. After analysis of the many single center feasibility studies, sentinel node biopsy (SNB) is useful for this purpose but sensitivity varies and is unsatisfactory. A large multicenter Japanese feasibility study showed promising results after clinical application of SNB in patients with EGC. Based on those results, a multicenter prospective randomized phase III trial of laparoscopic SNB conducted by the Korean surgical study group, the SENORITA (SEntinel Node ORIented Tailored Approach), is now ongoing. Prior to this phase III trial, a quality control study of participating institutions was completed in an effort to standardize and overcome the SNB learning curve. Laparoscopic SNB with gastric volume and function-preserving surgery to improve the long-term QOL without impairing the oncological outcome may be a surgical option after this trial in the subgroup of patients with EGC.
Asian Continental Ancestry Group ; Biopsy ; Feasibility Studies ; Humans ; Laparotomy ; Learning Curve ; Lymph Node Excision ; Lymph Nodes ; Neoplasm Metastasis ; Prospective Studies ; Quality Control ; Quality of Life ; Stomach Neoplasms*

Minimally invasive surgery (MIS) for gastric cancer was started from the early 1990s as laparoscopy-assisted distal gastrectomy (LADG). Currently, laparoscopic gastrectomy is the most popular surgical option in early gastric cancer (EGC) treatment. However, its application in advanced gastric cancer is still controversial and several clinical trials are ongoing. Another surgical tool for gastric cancer surgery is the robot. Robotic surgery is currently performed in a limited number of patients, primarily due to its high cost in Korea. Its safety is estimated to be equivalent to that of laparoscopic surgery, but its cost effectiveness is still controversial. To improve post-operative gastrointestinal function, modified gastrectomy procedures like pylorus-preserving gastrectomy (PPG) and proximal gastrectomy with double tract anastomosis have been tried but are still controversial. For minimizing gastric resection, wedge resection in EGC is proposed, applying the sentinel node (SN) concept, and this technique is now in clinical trials. Various approaches of MIS are now being trialed in gastric cancer patients in an attempt to identify strategies for improving surgical outcomes and patients' quality of life.
Cost-Benefit Analysis ; Gastrectomy ; Humans ; Korea ; Laparoscopy ; Quality of Life ; Stomach Neoplasms* ; Surgical Procedures, Minimally Invasive*

Minimally invasive surgery (MIS) for gastric cancer was started from the early 1990s as laparoscopy-assisted distal gastrectomy (LADG). Currently, laparoscopic gastrectomy is the most popular surgical option in early gastric cancer (EGC) treatment. However, its application in advanced gastric cancer is still controversial and several clinical trials are ongoing. Another surgical tool for gastric cancer surgery is the robot. Robotic surgery is currently performed in a limited number of patients, primarily due to its high cost in Korea. Its safety is estimated to be equivalent to that of laparoscopic surgery, but its cost effectiveness is still controversial. To improve post-operative gastrointestinal function, modified gastrectomy procedures like pylorus-preserving gastrectomy (PPG) and proximal gastrectomy with double tract anastomosis have been tried but are still controversial. For minimizing gastric resection, wedge resection in EGC is proposed, applying the sentinel node (SN) concept, and this technique is now in clinical trials. Various approaches of MIS are now being trialed in gastric cancer patients in an attempt to identify strategies for improving surgical outcomes and patients' quality of life.
Cost-Benefit Analysis ; Gastrectomy ; Humans ; Korea ; Laparoscopy ; Quality of Life ; Stomach Neoplasms* ; Surgical Procedures, Minimally Invasive*

PURPOSE: The carcinogenesis of gastric cancer has not been fully elucidated, but several molecular biologic alterations have been found to be related with it. TGF-betaRII mutation, which is one such alteration, has been well documented in gastric cancer, but its expression patterns in cancer and preneoplastic conditions are rarely reported. For that reason, we investigated the roles of TGF-betaI and TGF-betaRII in gastric carcinogenesis by comparing the difference of expression patterns in carcinomas and adenomas of the stomach and intestinal metaplasia by using immunohistochemical staining. METHODS: Twenty-six (26) cases of intestinal metaplasia with chronic atrophic gastritis, 21 cases of the gastric adenoma, and 51 cases of gastric cancers (28 cases of the intestinal type and 23 cases of the diffuse type) were enrolled in this study. All samples were paraffin-embedded and an immunohistochemical staining was performed using the polyclonal antibody to TGF-betaI and TGF-betaRII. Their clinicopathologic features were reviewed retrospectively. RESULTS: In normal gastric tissue and intestinal metaplasia, only the basal portion of the gastric foveola was strongly reactive to TGF-betaRII. In adenomas and well-differentiated intestinal type cancer, all tumor cells were strongly positive to TGF-betaRII, but the tumor cells of poorly differentiated intestinal-type and signet ring cell (diffuse type) cancer showed unresponsive to TGF-betaRII. The TGF-betaI expressions in normal and carcinomatous lesions were similar andshowed a weak positive reaction. TGF-betaI and TGF-betaRII responsive gastric cancer showed less invasive gastric-wall infiltration. In gastric cancer, a significant correlation was present between tumor depth and response to TGF-betaI & TGF-betaRII. CONCLUSION: It is presumed that TGF-betaRII plays an important role in cell differentiation and aggressiveness in gastric cancer and that it may be useful as a prognostic factor.
Adenoma* ; Carcinogenesis ; Cell Differentiation ; Gastritis, Atrophic ; Immunohistochemistry ; Metaplasia* ; Precancerous Conditions ; Receptors, Transforming Growth Factor beta* ; Retrospective Studies ; Stomach Neoplasms ; Stomach* ; Transforming Growth Factor beta* ; Transforming Growth Factors*

PURPOSE: Early gastric cancer is now considered to be a curable disease, and its traditional treatment is a D2 lymphadenectomy. However, the low rate of lymph node metastasis, the recent developments of endoscopic and laparoscopic surgery, and concerns for postoperative quality of life have led to less invasive therapeutic options. The D1 lymphadenectomy is one such option, so we investigated its adequacy as a substitute for a D2 lymphadenectomy as a treatment modality for early gastric cancer by comparing the prognoses of the two approaches. METHODS: A retrospective analysis of the case histories of 332 patients who had received an operation for early gastric cancer at Korea University Guro Hospital from 1984 to 1997 was performed. These cases were divided into D1 and D2 groups, and the groups were compared on the basis of clinicopathologic features, operative procedures, and 5-year survival rates. RESULTS: The D1 group included 160 cases, and the D2 group had 172 cases. The D2 group included more distal one-third cancer (66.3% vs 51.9%), more submucosal tumors (51.2% vs 38.7%), and more dissected lymph nodes (31.1+/-12.8 vs 23.0+/-11.3) than the D1 group (p<0.05). The overall 5-year survival rate for the early gastric-cancer patients was 95.5%. The 5-year survival rate of the D1 group was 96.6%, and that of the D2 group was 94.1%, but this difference was not significant (p>0.05). When the tumor depth was considered, the 5-year survival rates of the D1 and the D2 groups were not significantly different for mucosal and submucosal tumors (p>0.05). CONCLUSION: A D2 lymphadenec tomy for early gastric cancer can harvest more lymph nodes, but it has no survival benefit over a D1 lymphadenectomy. The result of this retrospective study suggests that a D1 lymphadenectomy may be used as a replacement for a D2 lymphadectomy in early gastric-cancer surgery, although prospective randomized studies are needed.
Humans ; Korea ; Laparoscopy ; Lymph Node Excision* ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis* ; Quality of Life ; Retrospective Studies ; Stomach Neoplasms* ; Surgical Procedures, Operative ; Survival Rate

No abstract available.
Angioplasty*