Malignant gastrointestinal stromal tumors (GISTs) are rare non-epithelial, mesenchymal neoplasms of the gastrointestinal tract that metastasize or recur in 30% of patients who undergo surgical resection with curative intent. A 59-year-old man visited our hospital for an examination of a palpable mass in the left abdomen. Fourteen months prior to his visit, the patient underwent gastric wedge resection to remove a GIST of the gastric cardia. At the time of surgery, no evidence of metastatic disease was observed and the pathological interpretation was a high-risk GIST. A follow-up computed tomography scan of the abdomen revealed a partially necrotic solid mass (9.8 x 7.6 cm) and enhancing mass in the spleen (2.3 cm). On exploration, multiple masses were found in the liver, greater omentum, and mesentery. Here, we report a case of recurring GIST of the stomach that metastasized to the spleen. To the best of our knowledge, few reports of metastasis to the spleen exist.
Abdomen ; Cardia ; Follow-Up Studies ; Gastrointestinal Stromal Tumors ; Gastrointestinal Tract ; Humans ; Liver ; Mesentery ; Middle Aged ; Neoplasm Metastasis ; Omentum ; Spleen ; Stomach

PURPOSE: To compare the surgical outcomes of laparoscopic total gastrectomy between elderly and non-elderly patients. MATERIALS AND METHODS: Between 2008 and 2015, a total of 273 patients undergoing laparoscopic total gastrectomy for gastric carcinoma were divided into two age groups: elderly (> or =70 years, n=71) vs. non-elderly (<70 years, n=172). Postoperative outcomes, including length of hospital stay, morbidity, and mortality were compared between the groups. RESULTS: The elderly group showed a significantly higher rate of comorbidities and American Society of Anesthesiologists scores than those in the non-elderly group. No significant differences were found with respect to lymphadenectomy or combined organ resection between the groups. After surgery, the elderly group showed a significantly higher incidence of grade III and above complications than the non-elderly group (15.5% vs. 4.1%, P=0.003). Among the complications, anastomosis leakage was significantly more common in the elderly group (9.9% vs. 2.9%, P=0.044). Univariate and multivariate analyses showed that old age (> or =70 years) was an independent risk factor (odds ratio=4.42, 95% confidence interval=1.50~13.01) for postoperative complications of grade III and above. CONCLUSIONS: Elderly patients are more vulnerable to grade III and above complications after laparoscopic total gastrectomy than non-elderly patients. Great care should be taken to prevent and monitor the development of anastomosis leakage in elderly patients after laparoscopic total gastrectomy.
Aged* ; Comorbidity ; Gastrectomy* ; Humans ; Incidence ; Laparoscopy ; Length of Stay ; Lymph Node Excision ; Mortality ; Multivariate Analysis ; Postoperative Complications ; Retrospective Studies* ; Risk Factors ; Stomach Neoplasms

PURPOSE: Anal cancer is a relatively uncommon malignancy, representig only 1.8 to 3.4% of all colorectal cancers. In the past, an abdominoperineal resection (APR) was the treatment of choice for an anal cancer. Since the introduction of chemoradiation (radiation combined with 5-Fu and mitomycin) therapy which proved to enhance the responsiveness of the lesion, the limited resection with preservation of anal sphincter function became the gold standard treatment of the anal lesion. Few studies have examined the effectiveness of each modality due to the rarity of this disease. We compared the results of treatment in two groups, one treated with APR and the other with chemoradiation, and evaluated the prognosis of the anal cancer and the advantages and disadvantages of each method. METHODS: This study was performed from January 1992 to December 2001 in the Department of Surgery, Chonnam University Hospital. It considered many factors, including sex, age, chief complaint, location of the lesion, size of the lesion, histopathologic pattern, method of treatment, and metastasis, based on a retrospective review of clinical files and biopsy results. RESULTS: For the patients, the male to female ratio was 1.8:1.0; the mean age was 64.6 (47~90); the chief complaint was anal mass; with symptoms of anal bleeding and pain; and the mean prevalence rate of disease was 8.5 months. According to the staging, 4 patients were T1 (14%), 19 (67.8%) were T2 and 4 (14.3%) were T3. By histologic biopsy, there were 23 squamous cell and 5 cloacogenic carcinoma. Four patients were initially treated by an APR at a local clinic, while 22 underwent combined chemoradiation therapy. Of the four patients who underwent a chemoradiation after an APR, two died as a result of liver and bone metastasis. According to the TNM classification, the 5-year survival rates were 75, 67, 60, 83, and 55% for T1, T2, T3, M0, M1, respectively; the 5-year survival was 71% the for combined chemotherapy and radiation and 53% for the APR. CONCLUSIONS: In the anal cancer treatment, remission occured in over 50% of patients treated with combined chemoradiation therapy. Also, when the surgery had added, the prognosis was not worse than primary choice of APR. Therefore, combined chemoradiation therapy should be considered the treatment of choice, reducing the amount of resection and conserving the sphincter function.
Anal Canal ; Anus Neoplasms* ; Biopsy ; Classification ; Colorectal Neoplasms ; Drug Therapy ; Female ; Fluorouracil ; Hemorrhage ; Humans ; Jeollanam-do ; Liver ; Male ; Neoplasm Metastasis ; Prevalence ; Prognosis* ; Retrospective Studies ; Survival Rate

PURPOSE: Mucinous gastric carcinoma (MGC) is a histopathologic subtype of gastric adenocarcinoma with a poor prognosis. It comprises about 3~10% of gastric carcinomas. The purpose of this study was to compare the disease course of MGC with non-MGC (NMGC) and study the clinicopathologic features that influence the prognosis of MGC patients. METHODS: We reviewed the records of 2,383 patients with a confirmed histologic diagnosis of gastric carcinoma who underwent surgery at the Department of Surgery, Chonnam National University Hospital. There were 157 patients with MGC compared to 2,226 with NMGC. Patients were evaluated on the basis of gender, age, tumor size, tumor location, depth of invasion, region and number of lymph nodes with metastasis, hepatic or peritoneal metastasis, stage at presentation, estimate of surgical curability, and TNM stage based on the UICC classification. Multivariate analysis was performed to test the hypothesis that the histologic mucin contents themselves in MGC are an independent prognostic factor. RESULTS: There was no gender or age-at-diagnosis distinction between these two groups. The mean tumor size of MGC was larger than that of NMGC, but the difference was not statistically significant. Most carcinomas of both types were located in the antrum with no statistical difference in location between MGC and NMGC. However, a depth of invasion greater than T3 was more frequently found in MGC than in NMGC, not to a statistically significant degree. The mean number of lymph node with metastases was 2.78 in MGC and 2.28 in NMGC (P<0.001). There were more MGC patients with TNM stages II through IV(UICC classification). The overall survival rate was lower for the MGC group(46.5%) than for the NMGC group (64.0%). Depth of invasion, lymph node metastasis, and stage at diagnosis were significant factors affecting the outcome. Mucinous histologic type itself was not an independent predictive factor in survival. CONCLUSION: The factors that influence the poorer prognosis(lower 5-year survival rate) of MGC are advanced stage at the time of diagnosis, lymph node metastases, and a higher TNM status. The histologic subtype itself was not an independent prognostic factor.
Adenocarcinoma ; Classification ; Diagnosis ; Humans ; Jeollanam-do ; Lymph Nodes ; Mucins* ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis* ; Survival Rate

PURPOSE: Previous studies indicated conflicting results regarding the prognosis of gastric cancer with a family history (FHX). This study aimed to determine the clinicopathological features and survival of patients with gastric cancer with a FHX. MATERIALS AND METHODS: We reviewed 2,736 patients with gastric cancer who underwent surgery between 2003 and 2009. The prognostic value of a FHX was determined in the multivariate model after adjusting for variables in the Asian and internationally validated prognostic models. RESULTS: Of the patients, 413 (15.1%) had a FHX of gastric cancer. The patients with a FHX were younger (58.1 vs. 60.4 years; P<0.001) than the patients without a FHX. There were no significant differences in the histopathological characteristics between the 2 groups. A FHX was associated with a better overall survival (OS) rate only in the stage I group (5-year survival rate, 95% vs. 92%; P=0.006). However, the disease-specific survival (DSS) rate was not significantly different between the 2 groups in all stages. The multivariate model adjusted for the variables in the Asian and internationally validated prognostic models revealed that FHX has no significant prognostic value for OS and DSS. CONCLUSIONS: The clinicopathological features and survival of the patients with gastric cancer with a FHX did not significantly differ from those of the patients without a FHX.
Asian Continental Ancestry Group ; Humans ; Prognosis ; Stomach Neoplasms* ; Survival Rate

PURPOSE: Colorectal cancer is one of the most common gastrointestinal malignancies in Korea. However, there have been few studies concerning the prognosis of colorectal cancer in Korea. The purpose of this study is to elucidate the prognostic factors of colorectal cancer and identify those independent prognostic factors. METHODS: A total of 960 cases with colorectal cancer who received surgery at Chonnam University Hospital of Korea between Jan 1, 1980 and Dec 31, 2000 were analyzed retrospectively with respect to several prognostic factors including age, sex, location of tumor, histologic grade, stage, Borrmann type, depth of invasion, invasion of lymph node, tumor size, liver metastasis, peritoneal seeding, preoperative serum CEA level and DNA ploidy. Survival curves were estimated by the Kaplan-Meier method, and differences were analyzed by the Log-rank test. The Cox proportional hazard model was used for multivariate analysis. The data was considered to be significant when the p value was less than 0.05. RESULTS: The mean age was 57 years and median follow-up was 26.7 months. By univariate analysis, significant prognostic factors were stage by TNM, histologic grade, invasion of lymph node, liver metastasis, peritoneal seeding, depth of invasion, Borrmann type and preoperative serum CEA level. By multivariate analysis, TNM stage was the most obvious independent prognostic factor. Histologic grade and depth of invasion were also significant independent prognostic factors. CONCLUSION: In this study, TNM stage, histologic grade and depth of invasion were revealed independent prognostic factors.
Colorectal Neoplasms* ; DNA ; Follow-Up Studies ; Jeollanam-do ; Korea ; Liver ; Lymph Nodes ; Multivariate Analysis* ; Neoplasm Metastasis ; Ploidies ; Prognosis ; Proportional Hazards Models ; Retrospective Studies

PURPOSE: Little is known about the clinicopathological features of early mucinous gastric carcinoma (MGC). The purpose of this study was to compare the clinicopathological features and prognosis between patients with early MGC and those with early nonmucinous gastric carcinoma (NMGC). METHODS: We reviewed the records of 2,732 patients diagnosed with gastric carcinoma who were treated surgically. There were 14 patients (0.5%) with early MGC and 958 with early NMGC. RESULTS: Early MGC patients had a higher prevalence of elevated type (71.4%) compared with early NMGC patients (29.5%). More early MGC patients had submucosal carcinoma, compared with early NMGC patients (78.6% vs. 64.1%). The overall 5-year survival of the patients with early MGC was 97.2% as compared with 92.7% for the patients with early NMGC (P < 0.01). The statistically significant prognostic parameters influencing the 5-year survival rate according to Cox's proportional hazard regression model were: age (risk ratio, 2.22; 95% confidence interval [CI], 1.62-3.04; P < 0.01); sex (risk ratio, 1.97; 95% CI, 1.42-2.73; P < 0.01); and lymph node metastases (risk ratio, 1.88; 95% CI, 1.28-2.77; P < 0.01). CONCLUSION: Patients with early MGC had a better prognosis than those with early NMGC. Mucinous histology itself appears not to be an independent prognostic factor. Therefore, early detection is important for improving the prognosis for patients with gastric carcinoma regardless of tumor histology.
Humans ; Lymph Nodes ; Mucins* ; Neoplasm Metastasis ; Prevalence ; Prognosis* ; Stomach Neoplasms ; Survival Rate

The benefits of resection for gastric carcinoma patients with non-curative factors remain controversial. Thus, we evaluated the survival benefits of resection in these gastric carcinoma patients. We reviewed the hospital records of 467 gastric carcinoma patients with non-curative factors who had resection (n=305) and compared their clinicopathological findings with individuals (n=162) who underwent bypass or exploration from 1996 to 2010. The 3-year survival rate of patients who had resection was higher than was that of patients who did not (13.2 vs. 7.2%, respectively p < 0.001). Cox's proportional hazard regression analysis revealed that only one factor was an independent, statistically significant prognostic parameter: the presence of peritoneal dissemination (risk ratio, 1.37; 95% confidence interval, 1.04–1.79; p < 0.05). The 3-year survival rate of patients with peritoneal dissemination was higher in individuals who underwent resection compared with those who did not (9.5 vs. 4.7%, respectively; p < 0.001). The current results highlight the improved survival rates of gastric carcinoma patients with non-curative factors who underwent surgery compared with those who did not. Although resection is not curative in this group of patients, we still recommend performing the procedure.
Gastrectomy ; Hospital Records ; Humans ; Stomach Neoplasms ; Survival Rate

PURPOSE: With increasing life expectancy, the presence of comorbidities has become a major concern in elderly patients who require surgery. However, little is known about the impact of different comorbidities on the outcomes of laparoscopic total gastrectomy (LTG). In this study, we investigated the impact of comorbidities on postoperative complications in patients undergoing LTG for gastric carcinoma. MATERIALS AND METHODS: We retrospectively reviewed the cases of 303 consecutive patients who underwent LTG for gastric carcinoma between 2005 and 2016. The associations between each comorbidity and postoperative complications were assessed using univariate and multivariate analyses. RESULTS: A total of 189 patients (62.4%) had one or more comorbidities. Hypertension was the most common comorbidity (37.0%), followed by diabetes mellitus (17.8%), chronic viral hepatitis (2.6%), liver cirrhosis (2.6%), and pulmonary (27.1%), ischemic heart (3.3%), and cerebrovascular diseases (2.3%). The overall postoperative morbidity and mortality rates were 20.1% and 1.0%, respectively. Patients with pulmonary disease significantly showed higher complication rates than those without comorbidities (32.9% vs. 14.9%, respectively, P=0.003); patient with other comorbidities showed no significant difference in the incidence of LTG-related complications. During univariate and multivariate analyses, pulmonary disease was found to be an independent predictive factor for postoperative complications (odds ratio, 2.14; 95% confidence interval, 1.03–4.64), along with old age and intraoperative bleeding. CONCLUSIONS: Among the various comorbidities investigated, patients with pulmonary disease had a significantly higher risk of postoperative complications after LTG. Proper perioperative care for optimizing pulmonary function may be required for patients with pulmonary disease.
Aged ; Cerebrovascular Disorders ; Comorbidity* ; Diabetes Mellitus ; Gastrectomy* ; Heart ; Hemorrhage ; Hepatitis ; Humans ; Hypertension ; Incidence ; Laparoscopy ; Life Expectancy ; Liver Cirrhosis ; Lung Diseases ; Mortality ; Multivariate Analysis ; Perioperative Care ; Postoperative Complications ; Retrospective Studies ; Stomach Neoplasms

PURPOSE: Laparoscopic surgery is associated with lower surgical site infection (SSI) rates due to minimal skin incision and non-exposure of visceral organs. Most previous studies have analyzed the efficacy of prophylactic antibiotic use in open surgery. Here, we investigated the feasibility of total laparoscopic distal gastrectomy (TLDG) for gastric carcinoma without prophylactic antibiotic use.MATERIALS AND METHODS: Seventy-one patients who underwent TLDG without prophylactic antibiotic use were 1:1 propensity score matched with 393 patients who underwent TLDG with antibiotic prophylaxis. The short-term surgical outcomes, including SSI rates, were compared between the groups.RESULTS: After matching, 65 patients were selected in each group. The baseline clinicopathological characteristics were well balanced in the matched sample. In the matched group, there was no significant increase in postoperative morbidity in the non-prophylactic group compared with the prophylactic group (18.5% vs. 15.4%, P=0.640), and there were no grade 3≤ complications (1.4% vs. 0%, respectively; P=1.000). The SSI rates in the non-prophylactic and prophylactic groups were 3.1% and 1.5%, respectively (P=0.559). The time to gas passage, diet initiation, and mean hospital stay were not significantly different between the 2 groups. The SSI rate did not increase in the non-prophylactic group in the different subgroups based on different clinicopathological characteristics.CONCLUSIONS: Postoperative morbidity, including SSI rates, did not significantly increase in patients undergoing TLDG without prophylactic antibiotic use. A large prospective randomized trial is warranted to reappraise the efficacy of prophylactic antibiotic use in patients undergoing TLDG.
Anti-Bacterial Agents ; Antibiotic Prophylaxis ; Case-Control Studies ; Diet ; Gastrectomy ; Humans ; Laparoscopy ; Length of Stay ; Propensity Score ; Prospective Studies ; Research Design ; Skin ; Stomach Neoplasms ; Surgical Wound Infection