Purpose: Among patients with gastric cancer who underwent radical gastrectomy, the proportion of patients aged ≥80 years has increased. This study aimed to evaluate surgical outcomes and survival of patients aged ≥80 years who underwent curative resection for gastric cancer and identify independent factors that affect postoperative survival. Methods: This retrospective study enrolled 1,066 patients aged ≥65 years with gastric cancer who underwent curative resection between January 2014 and December 2018 at a single institution. They were divided into those aged ≥80 years (old-elderly group) and 65–79 years (young-elderly group). Their clinicopathological characteristics and surgical outcomes were compared. Results: Of the 1,066 patients, 136 (12.8%) were 80 years or older. Higher American Society of Anesthesiologists (ASA) physical status classification and more advanced cancers were observed in the old-elderly group than in the young-elderly group. No significant difference in postoperative complications was found between the groups. At a median follow-up of 49.1 months, the 5-year overall survival rate after surgery for the old-elderly group was lower than that for the youngelderly group (75.6% vs. 87.0%, P < 0.001). However, the 5-year disease-specific survival rate was comparable between the groups (90.1% vs. 92.2%, P = 0.324). ASA physical status classification, pathologic stage, and surgical approach were independent predictors of overall survival. Conclusion Old-elderly patients aged ≥80 years had comparable postoperative outcomes and disease-specific survival to the young-elderly group, suggesting that curative gastrectomy can be considered a viable option for octogenarian patients with gastric cancer.

PURPOSE: The inclusion criteria for laparoscopic gastrectomy have recently been expanded, and this has led to an increase in the number of publications describing the laparoscopic treatment of advanced gastric cancer. The aim of this study was to evaluate morbidity in advanced stage gastric cancer (ASGC; tumor, node, metastasis [TNM] stage II–III) compared with that in early stage gastric cancer (ESGC; TNM stage I) in patients undergoing laparoscopic assisted distal gastrectomy (LADG).METHODS: The clinical data of 448 consecutive patients who underwent LADG with R0 resection for gastric cancer at the Gyeongsang National University Hospital were retrospectively analyzed.RESULTS: The morbidity and mortality rates for radical distal gastrectomy were 20.3% (91/448) and 0.2% (1/448), respectively. Wound problems were the most common complication (4.7%, n=21), followed by leakage (4.5%, n=20), and postoperative bleeding (3.8%, n=17). We found ASGC had higher frequencies of postoperative ileus (0.8% vs. 5.4%), wound problems (3.1% vs. 10.9%), and pulmonary complications (4% vs. 7%) than ESGC in the LADG (P < 0.05).CONCLUSION: Among patients who underwent LADG, ASGC patients had higher rates of postoperative ileus and wound and pulmonary complications than ESGC patients. ASGC patients should be closely monitored for these complications after LADG.
Gastrectomy ; Hemorrhage ; Humans ; Ileus ; Laparoscopy ; Mortality ; Neoplasm Metastasis ; Postoperative Complications ; Retrospective Studies ; Stomach Neoplasms ; Wounds and Injuries

An 84-year-old man was diagnosed with two synchronous adenocarcinomas, a Borrmann type IV advanced gastric adenocarcinoma in his antrum and a well-differentiated Borrmann type I carcinoma on the anterior wall of the higher body of his stomach. Pre-operatively, computed tomography of the abdomen revealed the presence of advanced gastric cancer with peri-gastric and para-aortic lymph node (LN) metastasis. He planned for palliative total gastrectomy owing to the risk of obstruction by the antral lesion. We performed a frozen biopsy of a para-aortic LN during surgery and found that the origin of the para-aortic LN metastasis was from undiagnosed prostate cancer. Thus, we performed radical total gastrectomy and D2 LN dissection. Post-operatively, his total prostate-specific antigen levels were high (227 ng/mL) and he was discharged 8 days after surgery without any complications.
Abdomen ; Adenocarcinoma ; Aged, 80 and over ; Biopsy ; Gastrectomy ; Humans ; Lymph Nodes* ; Lymphatic Metastasis ; Neoplasm Metastasis* ; Prostate* ; Prostate-Specific Antigen ; Prostatic Neoplasms* ; Stomach ; Stomach Neoplasms*

PURPOSE: Enolase is a cytoplasmic enzyme that catalyzes the conversion of 2-phosphoglycerate to phosphoenolpyruvate in the glycolytic pathway. The aim of this study was to investigate whether the overexpression of neuron-specific enolase (NSE) can serve as a prognostic factor in patients with gastric cancer (GC). MATERIALS AND METHODS: To assess its prognostic value in GC, NSE expression was measured by immunohistochemistry in a clinically annotated tissue microarray comprising of 327 human GC specimens. Cytoplasmic NSE expression was scored from 0 to 4, reflecting the percentage of NSE-positive cells. RESULTS: In terms of histology as per the World Health Organization criteria (P=0.340), there were no differences between the NSE overexpression (NSE-OE) and NSE underexpression (NSE-UE) groups. The NSE-OE group showed a significantly lower rate of advanced GC (P<0.010), lymph node metastasis (P=0.010), advanced stage group (P<0.010), cancer-related death (P<0.010), and cancer recurrence (P<0.010). Additionally, a Kaplan-Meier survival analysis revealed that the NSE-OE group had longer cumulative survival times than the NSE-UE group (log-rank test, P<0.010). However, there were no significant differences in the serum levels of NSE expression in patients with GC and healthy volunteers (P=0.280). CONCLUSIONS: Patients with NSE overexpressing GC tissues showed better prognostic results, implying that NSE could be a candidate biomarker of GC.
Cytoplasm ; Healthy Volunteers ; Humans ; Immunohistochemistry ; Lymph Nodes ; Neoplasm Metastasis ; Phosphoenolpyruvate ; Phosphopyruvate Hydratase* ; Prognosis ; Recurrence ; Stomach Neoplasms* ; World Health Organization

INTRODUCTIONThe integration of reactive oxygen species is strongly associated with important pathophysiological mechanisms that mediate myocardial ischaemia/reperfusion (I/R) damage. Pyruvate is an efficacious scavenger of reactive oxygen species and a previous study has shown that ethyl pyruvate (EP) has a myocardial protective effect against regional I/R damage in an in vivo rat model. The purpose of this study was to determine whether the myocardial protective effect of EP is associated with anti-apoptosis.

METHODSRats were allocated to receive EP dissolved in lactated Ringer's solution or lactated Ringer's solution alone, via intraperitoneal infusion one hour before ischaemia. They were exposed to 30 minutes of ischaemia followed by reperfusion of the left coronary artery territory over two hours. Anti-apoptotic effects were checked using several biochemical parameters after two hours of reperfusion. Apoptosis was analysed using measured caspase-3 activity, Western blotting of B-cell lymphoma 2 (Bcl-2) family protein cleaved by caspase-3, and assessment of DNA laddering patterns and the terminal deoxynucleotidyl transferase dUTP nick end labelling (TUNEL) staining test.

RESULTSIn ischaemic myocardium, EP increased Bcl-2 expression, but reduced Bcl-2-associated X protein and cleaved caspase-3 expressions. EP reduced the expression of DNA laddering and the number of myocardial I/R-damaged TUNEL-positive cells.

CONCLUSIONThis study demonstrated that EP has an anti-apoptotic effect after regional I/R damage in an in vivo rat heart model. The myocardial protective effect of EP may be related to its anti-apoptotic effect.