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*

No abstract available.
Humans ; Nitriles ; Pyrethrins ; 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: Peritoneal carcinomatosis is a dismal prognostic factor and is frequently encountered during initial exploration in gastric-cancer patients, but there are no effective therapeutic modalities. Thus, we investigated the prognostic factors in gastric-cancer patients with peritoneal carcinomatosis and evaluated the usefulness of intraperitoneal (IP) chemotherapy as a treatment modality in such patients. METHODS: From 1992 to 1997 in Korea University Guro Hospital, 105 patients revealed at initial exploration peritoneal carcinomatosis due to gastric cancer. We excluded two patients who died due to postoperative complications and 10 patients who were lost during follow up. Prognostic factors, including IP che motherapy, were analyzed by using univariate and multivariate methods for the remaining 93 cases. RESULTS: The median survival time of the 93 patients was 7.86 months, and the frequency of peritoneal carcinomatosis at initial exploration was 11.6%. On univariate analysis, sex, tumor depth, degree of peritoneal seeding, presence of hepatic metastasis, operative method, and systemic chemotherapy were significant prognostic factors. However, IP chemotherapy was not a significant prognostic factor. On multivariate analysis, only the degree of peritoneal seeding and the presence of hepatic metastasis were significant prognostic factors (p<0.05). CONCLUSIONS: The most important prognostic factors in peritoneal carcinomatosis in gastric-cancer patients are the degree of peritoneal seeding and the presence of hepatic metastasis. However, operative resection of the primary tumor may prolong survival and improve the quality of life. Thus, a resection is recommended when possible.
Carcinoma* ; Drug Therapy ; Follow-Up Studies ; Humans ; Korea ; Multivariate Analysis ; Neoplasm Metastasis ; Postoperative Complications ; Quality of Life ; Stomach Neoplasms*

No abstract available.
Angioplasty*

PURPOSE: The gastrointestinal tract (GI) is the most common site of extranodal non-Hodgkin's lymphoma (NHL), which is increasing in incidence, but the staging and the histologic classification of GI-NHL are still in debate. Furthermore, there is no established optimal treatment modality. Thus, we investigated the clinicohistologic features, the therapeutic modalities, and the prognosis for GI-NHL, as well as the factors affecting it. We also give a review of the literature. METHODS: We retrospectively analyzed 67 patients who had been diagnosed as having GI-NHL and had been followed up from 1984 to 1999 at Korea University Medical Center Hospital. They were divided into groups according to the site of origin and to various other features, and the survivals of the various groups were compared. The modified Ann Arbor system and the international working formulation (IWF) were adopted for staging and histopathologic classification, respectively. RESULTS: GI-NHL of the stomach, the small bowel, and the colon and rectum occurred in 35 patients (52.2%), 20 patients (29.9%), and 10 patients (14.9%), respectively. In two patients, the entire gastrointestinal tract was diffusely involved. The mean age of patients was 49.7+/-16.2 years, and the male-to-female ratio was 4.2:1. There was an tendency for young and male to have GI-NHL involving the lower gastrointestinal tract. Twenty-three (34.3%) patients was in stage I, 28 (41.8%) in stage II, 7 (10.4%) in stage III, and 9 (13.4%) in stage IV. Eight (11.9%) patients had a low IWF grade, 47 (70.1%) an intermediate grade, and 12 (17.9%) a high grade. The stage and the histologic classification did not vary with the original site. Surgical resection was performed in 50 (74.6%) patients, and chemotherapy was performed in 53 (79.1%) patients. The overall 5-yearsurvival rate of 67 patients was 49.9%, and there was a significant survival difference between the stages (p=0.0023), but not between sites of origin (p=0.9043). The most important factors influencing the survival was the stage; other factors were not significant. CONCLUSION: The stomach was the most common site of GI-NHL. Most GI-NHLs were localized and of intermediate grade. Stage was the most important prognostic factor. However, prospective randomized studies are needed to approve the therapeutic modality.
Academic Medical Centers ; Classification ; Colon ; Drug Therapy ; Gastrointestinal Tract ; Humans ; Incidence ; Korea ; Lower Gastrointestinal Tract ; Lymphoma* ; Lymphoma, Non-Hodgkin ; Male ; Prognosis ; Rectum ; Retrospective Studies ; Stomach

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

PURPOSE: It is well known that the incidence of cholelithiasis and cholecystitis increases after a gastrectomy and vagotomy for peptic ulcer disease, but operations for ulcers have decreased due to improved medical therapy. However, there are not so many studies about cholelithiasis and cholecystitis after a gastric resection due to gastric cancer. Therefore, we investigated its incidence, the factors affecting it, and its natural course. METHODS: Six hundred eighty-four gastric patients who had received a gastric resection at the Korea University Guro Hospital from January 1992 to October 1999 and who had been followed regularly with abdominal ultrasonography or computed tomography were enrolled in this study. The incidence of gallstones and sludge was investigated according to age group (< OR =60 vs >60), sex, extent of gastric resection (subtotal vs total), anastomotic methods (duodenal bypass vs duodenal passage of food), and degree of lymph node dissection (< OR =D2 vs > or =D2+alpha). The clinical course of cholelithiasis was also followed up. RESULTS: Gallstones were discovered in 38 patients (5.6%) with a mean duration of 26.4+/-20.7 months, and sludge was found in 17 patients (2.5%) with a mean duration of 25.1+/-20.5 months. There were no significant differences of incidence of gallstones and sludge according to sex, age group, and other surgical options (p>0.05). Twenty- eight cases of gallstones (73.7%) were detected within 36 months, and 11 cases of sludge (64.7%) within 24 months. Among the 38 gallstones patient, only 7 patients (18.4%) developed acute cholecystitis; they received cholecystectomy during the follow-up period, and all removed stones were pigment stones. CONCLUSION: The incidences of cholelithiasis and chole-cystitis do not increased very much after a gastric resection with lymph-node dissection due to gastric cancer, and there are no specific factors affecting those incidences. A prophylactic cholecystectomy during the gastric cancer operation should be performed with caution.
Cholecystectomy ; Cholecystitis ; Cholecystitis, Acute ; Cholelithiasis* ; Follow-Up Studies ; Gallstones ; Gastrectomy ; Humans ; Incidence ; Korea ; Lymph Node Excision ; Peptic Ulcer ; Sewage ; Stomach Neoplasms* ; Ulcer ; Ultrasonography ; Vagotomy