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*

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*

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: Many epidemiological studies have revealed an increasing tendency for proximal gastric cancer. Furthermore, proximal gastric cancer has been known to have unique characteristics and a poor prognosis in contrast to middle and distal gastric cancer, but the reason have not yet been fully explained. For that reason, we investigated changes in the incidence of proximal gastric cancer, its clinicopathologic characteristics, and its prognosis, and we compared the results with those of other reports and tried to identify the reasons for such phenomena. METHODS: After excluding linitis platisca-type cancer, double primary cancer, and gastric cancer arising from the remnant stomach, we retrospectively analyzed the case histories of 836 patients who had undergone operations for gastric cancer from 1992 to 1997. The cases were divided into a proximal gastric-cancer (PGC) group and a middle and distal gastric-cancer (DGC) group based on the location of the primary tumor. RESULTS: The PGC group included 74 patients (8.9%); 762 patients (91.1%) were in the DGC group. The incidence of proximal gastric cancer was 5.0% in 1992 and 11.6% in 1997. The PGC group has more advanced tumor stages (p=0.001) and more positive lymph-node metastases (p=0.013). The resectability of PGC was 87.8%, and that of the DGC was 92.4%, but these were not significantly different (p=0.169). The overall 5-year survival rate for PGC was 48.4% and that of DGC was 59.0%, but these were also not significantly different (p=0.5776). Comparing the survival rates of two groups for various stages revealed no differences. CONCLUSION: The increasing tendency of proximal gastric cancer was similar those in other reports even though we observed for a shorter periods and the proximal gastric cancers were diagnosed in advanced stages, and probably that was the reason for the poor prognosis. Therefore, if early diagnosis is made and adequate therapy is performed, proximal gastric cancer, in contrast to distal gastric cancer, is not a unique disease entity.
Early Diagnosis ; Epidemiologic Studies ; Gastric Stump ; Humans ; Incidence ; Neoplasm Metastasis ; Prognosis* ; Retrospective Studies ; Stomach Neoplasms ; Survival Rate

PURPOSE: Retroperitoneal soft tissue sarcomas are frequently found in advanced state due to the abscent or nonspecific symptoms, and the only hope for cure is a radical resection. The differentiation between benign and malignant tumor is a prerequisite for preoperative preparation and deciding the extent of resection. for the purpose of determining the malignancy of retroperitoneal tumor, we evaluate the clinic oradiologic features of the patients. METHODS: Retrospective study was done on 37 eases who were oper ated Korea University Hospital from Jan. 1990 to Dec. 1998. Their clinicoradiologic characters were analyzed and compared between benign and malignant tumor pationts. RESULTS: Among the 37 cases, 27 cases (73%) were benign tumors and the remaining 10 cases (27%) were malignant tumors. There was no significant difference in age distribution between malignant and benigntumor group (p>0.05) Among 20 male patients, 10 eases had malignant tumor (50%) but all 17 female patients had benign tumor (p=0.001) Preoperative symptoms were present in 29 cases (78.4%). and mean duration of symp toms in malignant cases was 20 months and in benign cases was 18 months but had no significance in differentiating between malignant and benign tumors (p>0.05) All eases were porformed abdominal CT scanning and it had 100% of sensitivity and 74% of specificity. Among the radiologic characteristics, size of tumor, irregular margin, and abscence of calcification were correlated with malignancy (p<0.05). CONCLUSION: Preoperative clinical symptoms and duration are not helpful in differentiating the malig naney but CT scanning has a good results for such purpose. So when the retroperitoneal tumor shows large size, irregular margin and no visible calcification especially in male patients, the patient, we should prepare and treat the patients according to malignant tumor.
Age Distribution ; Diagnosis, Differential* ; Female ; Hope ; Humans ; Korea ; Male ; Retrospective Studies ; Sarcoma ; Sensitivity and Specificity ; Tomography, X-Ray Computed