PURPOSE: After the excision of a choledochal cyst, late complications seldom develop. Herein, we propose a modified surgical classification, which allows surgeons to select an appropriate operation and minimize late postoperative complications. METHODS: A total of 90 Todani type I and IV cases were reviewed to examine the morphologic characteristics of choledochal cysts and to evaluate the clinical outcomes after cyst excision. The cysts were then reclassified based on factors determining the postoperative outcomes. RESULTS: There were 8 intrahepatic complications (4 cholangitis, 4 IHD stones) and 3 intrapancreatic complications (2 pancreatitis, 1 symptomatic remnant distal cyst). Seven of the 8 intrahepatic complications (87.5%) occurred in cases with IHD dilatation, 6 of which were associated with a ductal stricture or isolated intrahepatic cyst. Using the above factors as classification criteria, a modified surgical classification is proposed. Cases were classified as types I or IV cysts according to the presence of IHD dilatation. The type I cysts were further divided into types Ia and Ib according to the cyst multiplicity, and type IV cysts according to the pattern of continuity between the extra- and intrahepatic cyst: IHD dilatation without stricture, IVa; IHD dilatation with ductal stricture, IVb; isolated intrahepatic cyst, IVc. CONCLUSION: According to our classification, the extrahepatic approach is enough for types I, IVa and IVb to improve long-term outcome. For type IVc and some of type IVb with a stricture, where an extrahepatic approach is difficult, and hepatectomy should be combined.
Cholangitis ; Choledochal Cyst* ; Classification* ; Constriction, Pathologic ; Dilatation ; Hepatectomy ; Pancreatitis ; Postoperative Complications

PURPOSE: Recent decreases in operative mortality haves made pancreaticoduodenectomy (PD) a routine surgical procedure for malignant and even benign diseases of the periampullary region. However, as But the procedure requires resection of multiple organs and reconstruction of the digestive tract and, therefore, it may lead to a variety of problems after operation. In the present study, the long-term outcomes of gastrointestinal (GI) function and quality of life (QOL) after PD were assessed. METHODS: The subjects were 78 patients who underwent PD during the period from 1996 to 2000 and survived more than 3 years without clinical evidence of recurrence. General nutritional status, the exocrine and endocrine function of the pancreas, GI symptoms and QOL were assessed. The mean follow-up duration was 58.8 months. RESULTS: There were 45 men and 33 women, with athe mean age of 54.8 years. The indications for PD were ampulla of Vater cancer in 35 patients (44.9%), common bile duct cancer in 20 patients (25.6%), pancreatic head cancer in 4 patients (5.1%), duodenal cancer in 3 patients (3.8%), gallbladder cancer in 1 patients (1.3%) and benign diseases in 15 patients (19.2%). Pylorus preserving pancreatoduodenectomy (PPPD) was performed in 63 cases (80.8%) and Whipple"s operation in the other 15 cases (19.2%). After PD, overall body weight decreased significantly compared to preoperative body weight (p< 0.05) but remained above the ideal body weight. Steatorrhea adversely affected postoperative body weight recovery adversely. The serum protein and albumin recovered to more than their preoperative levels after 6 months postoperatively. Excluding 15 patients with preexisting impaired fasting glucose (IFG) or diabetes mellitus (DM), IFG or DM newly developed in 18 of 63 (28.5%) patients after operation and steatorrhea was significantly related. Steatorrhea developed in 20 cases (25.6%) and associated factors were the development of DM, pancreaticogastrostomy and being aged ages under 60 (p< 0.05). The most troubling GI symptoms were increased flatus (28.8%), hard stools (16.7%) and sucking sensation (11.9%). The score for the global health status / QOL was 73.7% and was not very so much different from the reference value of the general population (75.3%). CONCLUSION: Long-term outcomes of GI functions and QOL after PD were generally favorable. However, But DM and steatorrhea due to pancreas atrophy has developed not rather infrequently and so, early detection and careful management of these are required after PD.
Ampulla of Vater ; Atrophy ; Body Weight ; Common Bile Duct ; Diabetes Mellitus ; Duodenal Neoplasms ; Fasting ; Female ; Flatulence ; Follow-Up Studies ; Gallbladder Neoplasms ; Gastrointestinal Tract ; Glucose ; Head and Neck Neoplasms ; Humans ; Ideal Body Weight ; Male ; Mortality ; Nutritional Status ; Pancreas ; Pancreaticoduodenectomy* ; Pylorus ; Quality of Life ; Recurrence ; Reference Values ; Sensation ; Steatorrhea

PURPOSE: The prognosis of a ductal adenocarcinoma of the body and tail of the pancreas is poor because it is usually diagnosed at an advanced stage and is rarely resectable. The aim of this study was to evaluate the clinical outcomes after a surgical resection of an adenocarcinoma of the distal pancreas. METHODS: A total of 311 patients with an adenocarcinoma of the distal pancreas were admitted between 1985 and 2001, and of these, 54 patients were surgically treated; 29 patients underwent a distal pancreatectomy (extended resection in 12 cases), 9 underwent a palliative bypass, and 16 underwent a open biopsy. The clinical outcome of the 29 patients who underwent a surgical resection for the adenocarcinoma of the distal pancreas was retrospectively analyzed. RESULTS: The resectability rate was 9.3% (29/311). In the resected cases, the cumulative 3-year survival rate was 14.9%, whereas it was 0% (p=0.013) in the non-resected cases. Moreover, a significant survival difference was found between the curatively resected cases (n=16, 28.1%) and the palliatively resected cases (n=13, 0%)(p=0.003). After the curative resection, 11 patients (68.8%) developed a recurrence. Three patients survived more than 3 years (46, 74, 56 months), of whom only one had no recurrent disease. The size of the tumor and the residual tumor were identified as independent significant prognostic factors by multivariate analysis. CONCLUSION: Only a curative resection can offer long-term survival as well as a survival benefit in patients with a ductal adenocarcinoma of the body and tail of the pancreas. Therefore, a surgical resection should be preferably performed and efforts for a curative resection should be made. However, adjuvant therapy, local and systemic, needs to be further developed because most patients develop a recurrence after the resection.
Adenocarcinoma* ; Biopsy ; Carcinoma, Pancreatic Ductal ; Humans ; Multivariate Analysis ; Neoplasm, Residual ; Pancreas* ; Pancreatectomy ; Prognosis ; Recurrence ; Retrospective Studies ; Survival Rate

The incidence of heterotopic gastric mucosa located in the submucosa in resected stomach specimens has been reported to be 3.0 to 20.1%. Heterotopic gastric mucosa is thought to be a benign disease, which rarely becomes malignant. Heterotopic gastric mucosa exists in the gastric submucosa, and gastric cancer rarely occurs in heterotopic gastric mucosa. Since tumors are located in the normal submucosa, they appear as submucosal tumors during endoscopy, and are diagnosed through endoscopic biopsies with some difficulty. For such reasons, heterotopic gastric mucosa is mistaken as gastric submucosal tumor. Recently, two cases of early gastric cancer arising from heterotopic gastric mucosa in the gastric submucosa were treated. Both cases were diagnosed as submucosal tumors based on upper gastrointestinal endoscopy, endoscopic ultrasound, and computed tomography findings, and in both cases, laparoscopic wedge resections were performed, the surgical findings of which also suggested submucosal tumors. However, pathologic assessment of the surgical specimens led to the diagnosis of well-differentiated intramucosal adenocarcinoma arising from heterotopic gastric mucosa in the gastric submucosa.
Adenocarcinoma ; Biopsy ; Endoscopy ; Endoscopy, Gastrointestinal ; Gastric Mucosa ; Incidence ; Stomach ; Stomach Neoplasms

PURPOSE: Adequate health-related information provided by health professionals may help cancer patients overcome their uncertain situation and manage their healthcare. To provide information effectively, there is a need to understand the content of the patients' essential information. The purpose of this study was to identify recent informational needs of postoperative gastric cancer patients. MATERIALS AND METHODS: Data were collected from 190 postoperative gastric cancer patients who attended the Stomach Cancer Patients' Day ceremony (18 November 2008) held by the Stomach Cancer Center of Samsung Medical Center with the use of a questionnaire which measured informational needs. A questionnaire with 37 items was comprised of domains of diagnostic tests, cancer therapy, prognosis, follow-up, sexual activity, stomach cancer-related information, and 7 single items. RESULTS: The priorities of informational needs were the domains of prognosis, ways of healthcare during treatment (a single item), follow-up, stomach cancer-related information, cancer therapy, and diagnostic tests (in descending order). Items related to prognosis, diet, and management of their healthcare ranked in the top 10 informational need scores. As age decreased, the degree of informational needs about diagnostic tests, cancer therapy, sexual activity, and stomach cancer-related information increased. CONCLUSION: We suggest that prognosis-related information based on the accumulated institutional therapeutic outcomes and objective prognosis data should be incorporated in the current education program. Health professionals should provide comprehensible information content to cancer patients and caregivers and encourage patients to participate in their therapy with a more positive attitude.
Caregivers ; Delivery of Health Care ; Diagnostic Tests, Routine ; Diet ; Follow-Up Studies ; Health Occupations ; Humans ; Prognosis ; Surveys and Questionnaires ; Sexual Behavior ; Stomach ; Stomach Neoplasms

PURPOSE: This study aimed to investigate the correlation between multiple early gastric cancer (MEGC) and multiple primary malignancies during the follow-up of patients with gastrectomy. MATERIALS AND METHODS: The number of primary tumors detected in other organs after gastrectomy for early gastric cancer (EGC) has been increasing because of improved survival and surveillance programs. A total of 3,129 patients underwent radical gastrectomy for treatment of EGC at Samsung Medical Center from January 2000 to December 2005. Of these, 3,057 patients were selected and their medical records were retrospectively analyzed. RESULTS: Among the 3,057 patients, 148 (4.8%) had MEGC, 84.5% were male, 57.4% were over 60 years old, 42.6% had a macroscopic type EGC IIb main lesion, and 68.9% had well-differentiated tumors with a significantly high incidence of MEGC. There were no differences between patients with solitary early gastric cancer (SEGC) and those with MEGC with regard to overall survival or recurrence-free survival, but MEGC was an independent risk factor for metachronous primary malignancies in other organs (P=0.004, hazard ratio [HR]=2.444). CONCLUSIONS: MEGC is not a risk factor for poor prognosis after curative gastrectomy, but it is a risk factor for metachronous primary malignancies in other organs during postoperative follow-up; therefore, careful surveillance is needed.
Follow-Up Studies ; Gastrectomy ; Humans ; Incidence ; Male ; Medical Records ; Neoplasms, Multiple Primary ; Neoplasms, Second Primary ; Prognosis ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms*

Objectives: This study aimed to examine the characteristics of patients according to their nutritional status as assessed by five nutritional screening tools: Patient-Generated Subjective Global Assessment (PG-SGA), NUTRISCORE, Nutritional Risk Index (NRI), Prognostic Nutritional Index (PNI), and Controlling Nutritional Status (CONUT) and to compare the agreement, sensitivity, and specificity of these tools. Methods: A total of 952 gastric cancer patients who underwent gastrectomy and chemotherapy from January 2009 to December 2012 at the Samsung Medical Center were included. We categorized patients into malnourished and normal according to the five nutritional screening tools 1 month after surgery and compared their characteristics. We also calculated the Spearman partial correlation, Cohen’s Kappa coefficient, the area under the curve (AUC), sensitivity, and specificity of each pair of screening tools. Results: We observed 86.24% malnutrition based on the PG-SGA and 85.82% based on the NUTRISCORE among gastric cancer patients in our study. When we applied NRI or CONUT, however, the malnutrition levels were less than 30%. Patients with malnutrition as assessed by the PG-SGA, NUTRISCORE, or NRI had lower intakes of energy and protein compared to normal patients. When NRI, PNI, or CONUT were used to identify malnutrition, lower levels of albumin, hemoglobin, total lymphocyte count, total cholesterol, and longer postoperative hospital stays were observed among patients with malnutrition compared to those without malnutrition. We found relatively high agreement between PG-SGA and NUTRISCORE; sensitivity was 90.86% and AUC was 0.78. When we compared NRI and PNI, sensitivity was 99.64% and AUC was 0.97. AUC ranged from 0.50 to 0.67 for comparisons between CONUT and each of the other nutritional screening tools. Conclusions Our study suggests that PG-SGA and NRI have a relatively high agreement with the NUTRISCORE and PNI, respectively. Further cohort studies are needed to examine whether the nutritional status assessed by PG-SGA, NUTRISCORE, NRI, PNI, and CONUT predicts the gastric cancer prognosis.

Objectives: This study examined the characteristics of patients according to nutritional status assessed by five nutritional screening tools: Patient-Generated Subjective Global Assessment (PG-SGA), NUTRISCORE, Nutritional Risk Index (NRI), Prognostic Nutritional Index (PNI), and Controlling Nutritional Status (CONUT) and to compare the agreement, sensitivity, and specificity of these tools. Methods: A total of 952 gastric cancer patients who underwent gastrectomy and chemotherapy from January 2009 to December 2012 were included. The patients were categorized into malnutrition and normal status according to five nutritional screening tools one month after surgery. The Spearman partial correlation, Cohen’s Kappa coefficient, the area under the curve (AUC), sensitivity, and specificity of each two screening tools were calculated. Results: Malnutrition was observed in 86.24% of patients based on the PG-SGA and 85.82% based on the NUTRISCORE. When NRI or CONUT were applied, the proportions of malnutrition were < 30%. Patients with malnutrition had lower intakes of energy and protein than normal patients when assessed using the PG-SGA, NUTRISCORE, or NRI. Lower levels of albumin, hemoglobin, total lymphocyte count, and total cholesterol and longer postoperative hospital stays were observed among patients with malnutrition compared to normal patients when NRI, PNI, or CONUT were applied. Relatively high agreement for NUTRISCORE relative to PG-SGA was found; the sensitivity was 90.86%, and the AUC was 0.78. When NRI, PNI, and CONUT were compared, the sensitivities were 23.72% for PNI relative to NRI, 44.53% for CONUT relative to NRI, and 90.91% for CONUT relative to PNI. The AUCs were 0.95 for NRI relative to PNI and 0.91 for CONUT relative to PNI. Conclusions NUTRISCORE had a high sensitivity compared to PG-SGA, and CONUT had a high sensitivity compared to PNI. NRI had a high specificity compared to PNI. This relatively high sensitivity and specificity resulted in 77.00% agreement between PNI and CONUT and 77.94% agreement between NRI and PNI. Further cohort studies will be needed to determine if the nutritional status assessed by PG-SGA, NUTRISCORE, NRI, PNI, and CONUT predicts the gastric cancer prognosis.

Objectives: This study aimed to examine the characteristics of patients according to their nutritional status as assessed by five nutritional screening tools: Patient-Generated Subjective Global Assessment (PG-SGA), NUTRISCORE, Nutritional Risk Index (NRI), Prognostic Nutritional Index (PNI), and Controlling Nutritional Status (CONUT) and to compare the agreement, sensitivity, and specificity of these tools. Methods: A total of 952 gastric cancer patients who underwent gastrectomy and chemotherapy from January 2009 to December 2012 at the Samsung Medical Center were included. We categorized patients into malnourished and normal according to the five nutritional screening tools 1 month after surgery and compared their characteristics. We also calculated the Spearman partial correlation, Cohen’s Kappa coefficient, the area under the curve (AUC), sensitivity, and specificity of each pair of screening tools. Results: We observed 86.24% malnutrition based on the PG-SGA and 85.82% based on the NUTRISCORE among gastric cancer patients in our study. When we applied NRI or CONUT, however, the malnutrition levels were less than 30%. Patients with malnutrition as assessed by the PG-SGA, NUTRISCORE, or NRI had lower intakes of energy and protein compared to normal patients. When NRI, PNI, or CONUT were used to identify malnutrition, lower levels of albumin, hemoglobin, total lymphocyte count, total cholesterol, and longer postoperative hospital stays were observed among patients with malnutrition compared to those without malnutrition. We found relatively high agreement between PG-SGA and NUTRISCORE; sensitivity was 90.86% and AUC was 0.78. When we compared NRI and PNI, sensitivity was 99.64% and AUC was 0.97. AUC ranged from 0.50 to 0.67 for comparisons between CONUT and each of the other nutritional screening tools. Conclusions Our study suggests that PG-SGA and NRI have a relatively high agreement with the NUTRISCORE and PNI, respectively. Further cohort studies are needed to examine whether the nutritional status assessed by PG-SGA, NUTRISCORE, NRI, PNI, and CONUT predicts the gastric cancer prognosis.

no abstract available.