No abstract available.
Female ; Humans ; Male ; *Neoplasm Staging ; Stomach Neoplasms/*diagnosis/*mortality

BACKGROUND: Gastric cancer in elderly patients is one of the most important health issues in Korea, when considering its incidence and mortality rate. We have obtained the preliminary data concerning the diagnosis and treatment of gastric cancer in elderly people by analyzing the clinical and pathologic features. METHODS: We retrospectively analyzed 268 patients who were diagnosed with gastric cancer and who also underwent surgical procedures in Bundang Seoul National University Hospital from May 2003 to May 2005. The patients were divided into two groups: those aged<65 (n=162) and those aged> or =65 (n=106). We compared the clinical and pathological characteristics between the older and younger groups. RESULTS: The elderly group had more patients with well differentiated carcinoma (11.8% vs. 33.0%, respectively, p=0.001) and the intestinal type (34.0% vs. 59.4%, respectively, p<0.001). The frequency of microsatellite instability-high (MSI-H) was higher in the elderly group (5.6% vs. 17%, respectively, p=0.010). There was no significant difference in the postoperative recovery time (p=0.374) and the operation-related complication rate between the two groups. CONCLUSIONS: Gastric cancer in elderly patients demonstrated more pathologic types that have a known favorable outcome when compared to the younger patient group. We should more frequently consider surgery for the elderly patient with operable gastric cancer because of they have similar postoperative recovery compared to the younger patients.
Aged* ; Diagnosis ; Humans ; Incidence ; Korea* ; Microsatellite Repeats ; Mortality ; Pathology ; Retrospective Studies ; Seoul ; Stomach Neoplasms*

Stomach cancer is one of the major causes of cancer deaths in Korea. It has been well known, like other solid tumors, that cancer stage at diagnosis is the most important prognostic factor in gastric cancer. Previous studies from Japan have revealed that screen-detected gastric cancers showed an earlier stage distribution and had a lower mortality rate than symptom-diagnosed cases. Considering the high provalence and substantial mortality from gastric cancer in Korea, it seems necessary to establish a well organized nationwide screening program. In this regard, consensus meeting was held in January, 2002 in conjunction with The Koean Gastric Cancer Association and National Cancer Center in Korea. In this meeting, specialists from gastroenterology, surgery and radiology drew a conclusion as follows : biannual screening for people aged 40 years and over either by endoscopy or upper gastrointestinal series. During the screening endoscopy, biopsy can be performed if necessary, and specimens should be examined by pathologist. Screening test should be performed in authorized hospital or mobile unit by qualified doctors.
Biopsy ; Consensus ; Diagnosis ; Endoscopy ; Gastroenterology ; Japan ; Korea* ; Mass Screening* ; Mortality ; Specialization ; Stomach Neoplasms*

Gastric cancer is a major cause of cancer-related mortality. At the time of diagnosis, majority of the patients usually have unresectable or metastatic disease. The most common sites of metastases are the liver and the peritoneum, but in the advanced stages, there may be metastases to any region of the body. Bone marrow is an important metastatic site for solid tumors, and the prognosis in such cases is poor. In gastric cancer cases, bone marrow metastasis is usually observed in younger patients and in those with poorly differentiated tumors. Prognosis is worsened owing to the poor histomorphology as well as the occurrence of pancytopenia. The effect of standard chemotherapy is unknown, as survival is limited to a few weeks. This report aimed to evaluate 5 gastric cancer patients with bone marrow metastases to emphasize the importance of this condition.
Bone Marrow* ; Diagnosis ; Drug Therapy ; Humans ; Liver ; Mortality ; Neoplasm Metastasis* ; Pancytopenia ; Peritoneum ; Prognosis ; Stomach Neoplasms

BACKGROUNDS: Prognosis following surgery of gastric cancer has markedly improved as a result of early diagnosis, advances in operative techniques and perioperative managements. However, gastrointestinal surgery in patients with hepatic cirrhosis has continued to be associated with a high operative morbidity and mortality. The purpose of this retrospective study is to evaluate the prognostic factors on postoperative morbidity and survival in gastric cancer patients with hepatic cirrhosis. METHODS: We analysed 24 gastric cancer patients with hepatic cirrhosis between November 1994 and October 1999 (19 patients with Child A, 5 patients with Child B) to evaluate postoperative complications and survivals. RESULTS: There were no significant differences in age, sex, stage, operative types, and range of dissection between Child A and B. Postoperative complications occurred more commonly in the patients with more severe hepatic cirrhosis (Child A 5/19, Child B 4/5, p<0.05). There was no significant difference in 5-year survival rates between patients with Child A and B hepatic cirrhosis. Only the stage of cancer was proved to be the most significant prognostic factor. CONCLUSION: Patients with gastric cancer accompanied by hepatic cirrhosis can be successfully managed surgically on the basis of an appropriate preoperative assessment of hepatic conditions, proper selection of surgical procedures, and careful perioperative management.
Child ; Early Diagnosis ; Humans ; Liver Cirrhosis* ; Mortality ; Postoperative Complications ; Prognosis ; Retrospective Studies ; Stomach Neoplasms* ; Survival Rate

OBJECTIVETo discuss the present status and progress of clinical research on recurrence of gastric cancer after surgery, including patterns, clinicopathologic factors, prognosis, detection, diagnosis, prevention, and treatment strategies.

DATA SOURCESThe data used in this review were mainly from PubMed articles published in English from 2000 to August 2011. The search terms were "gastric cancer" and "recurrence".

STUDY SELECTIONArticles were selected if they involved clinicopathologic factors, detection methods, and treatment strategies of recurrence of gastric cancer.

RESULTSPeritoneal recurrence is the most common pattern in recurrence of gastric cancer. The main risk factors for recurrence of gastric cancer are tumor stage, including depth of tumor invasion and lymph node metastasis, and Borrmann classification. The prognosis of patients with recurrence is very poor, especially patients with peritoneal recurrence. Systemic chemotherapy is still the main treatment method for patients with recurrent cancer. If complete resection can be accomplished, some benefits may be obtained from surgery for recurrence. However, standard treatment for patients with recurrence has not yet been established.

CONCLUSIONSEarly detection and diagnosis of recurrence is quite crucial for treatment and prognosis. The optimal therapeutic strategy for recurrence should be based on a multidisciplinary assessment and the patient's individual state and should involve combined therapy.

Biomarkers, Tumor ; analysis ; Humans ; Neoplasm Recurrence, Local ; diagnosis ; rehabilitation ; surgery ; therapy ; Neoplasm Staging ; Prognosis ; Stomach Neoplasms ; diagnosis ; mortality ; pathology ; surgery

Gastric intestinal metaplasia (GIM) is a known premalignant condition of the human stomach along the pathway to gastric cancer (GC). Histologically, GIM represents the replacement of normal gastric mucosa by mucin-secreting intestinal mucosa. Helicobacter pylori infection is the most common etiologic agent of GIM development worldwide. The prevalence of GIM is heterogeneous among different regions of the world and correlates with the population endemicity of H. pylori carriage, among other environmental factors. GC remains the third leading cause of cancer-related mortality globally. GIM is usually diagnosed by upper endoscopy with biopsy, and histologic scoring systems have been developed to risk-stratify patients at highest risk for progression to GC. Several recent endoscopic imaging modalities may improve the optical detection of GIM and early GC. Appropriate surveillance of GIM may be cost effective and represents an opportunity for the early diagnosis and therapy of GC. Certain East Asian nations have established population-level programs for the screening and surveillance of GIM; guidelines regarding GIM surveillance have also recently been published in Europe. By contrast, few data exist regarding the appropriateness of surveillance of GIM in the United States. In this review, we discuss the pathogenesis, epidemiology, diagnosis, and management of GIM with an emphasis on the role of appropriate endoscopic surveillance.
Asian Continental Ancestry Group ; Biopsy ; Diagnosis ; Early Diagnosis ; Endoscopy ; Epidemiology ; Europe ; Gastric Mucosa ; Helicobacter pylori ; Humans ; Intestinal Mucosa ; Mass Screening ; Metaplasia ; Mortality ; Prevalence ; Stomach ; Stomach Neoplasms ; United States

PURPOSE: The purpose of this study is to suggest a treatment strategy for stage IV gastric cancer by investigating the behavioral difference between initially and recurrent metastatic disease. METHODS: We reviewed the medical records of the patients who underwent chemotherapy alone for metastatic gastric cancer between January 2006 and September 2013. Patients were divided into those who underwent chemotherapy for metastatic disease since initial diagnosis (IM group) and for metastatic recurrence after curative surgery (RM group). Survival and causes of death were compared between the 2 groups, and significant prognostic factors were also investigated. RESULTS: A total of 170 patients were enrolled in this study. Of these patients, 104 were included in the IM group and 66 in the RM group. Overall survival of the IM group did not differ from that of RM (P = 0.569). In the comparison of the causes of death, the IM group had a greater tendency to die from bleeding (P = 0.054) and pneumonia (P = 0.055). In multivariate analysis, bone metastasis (P < 0.001; HR = 2.847), carcinoma peritonei (P = 0.047; HR = 1.766), and the frequency of chemotherapy (P < 0.001; HR = 0.777) were significantly associated with overall survival of IM group. CONCLUSION: Disease-burden mainly contributes to the prognosis of metastatic gastric cancer, although noncurative gastrectomy may be helpful in reducing the mortality of initially metastatic disease. Therefore, disease-burden should be also prioritized in determining the treatment strategies for stage IV gastric cancer.
Cause of Death ; Diagnosis ; Drug Therapy ; Gastrectomy* ; Hemorrhage ; Humans ; Medical Records ; Mortality ; Multivariate Analysis ; Neoplasm Metastasis ; Pneumonia ; Prognosis ; Recurrence ; Stomach Neoplasms*

BACKGROUND: The prognosis following surgery for gastric cancer has been markedly improved as a result of early diagnosis and advancements both in operative techniques and perioperative management. However, gastrointestinal surgery in the presence of hepatic cirrhosis has shown high operative morbidity and mortality due to severe perioperative complications, such as bleeding, lymphorrhea, anastomosis leakage, hepatic failure, fluid retention, acute renal failure and multiple organ failure. Recently, the frequency of gastric cancer involving liver cirrhosis has been increasing, especially early gastric cancer cases. METHODS: From June 1995 to December 1997, a total of 410 patients with gastric cancer were treated surgically. Among them, 9 cases with liver cirrhosis underwent gastric resection. RESULTS: Three major postoperative complications occurred in 2 patient, anastomosis leakage in one, and bleeding in both. CONCLUSIONS: The purposes of this study were to assess the causes of complications and to decide the appropriate operation type for improving the prognosis for these patients with liver cirrhosis.
Acute Kidney Injury ; Early Diagnosis ; Hemorrhage ; Humans ; Liver Cirrhosis* ; Liver Failure ; Mortality ; Multiple Organ Failure ; Postoperative Complications ; Prognosis ; Stomach Neoplasms*

Atrophic gastritis (AG) and intestinal metaplasia (IM) are the main precursor lesions of gastric cancer as the incidence of gastric cancer increases in the gastric mucosa involved with AG and IM. The prevalence of AG and IM vary depending on countries, even it represents diverse results in the same nation. Usually AG is antecedent of IM but the etiologies of AG and IM are not always the same. The sensitivity and specificity of diagnostic methods to detect AG and IM are different. Furthermore, the management strategy of AG and IM has not been established, yet. Helicobacter pylori infection has been proved as the most important cause of AG and IM. Thus the eradication of H. pylori is very important to prevent the progression to gastric cancer which is still placed in the high rank in morbidity and mortality among cancers. However, the reversibility of AG and IM by eradication of H. pylori which was assumed to be certain by meta-analysis is; however, controversial now. Therefore, the understanding and early diagnosis of AG and IM are very important, especially, in high incidence area of gastric cancer such as Republic of Korea.
Early Diagnosis ; Gastric Mucosa ; Gastritis, Atrophic* ; Helicobacter pylori ; Incidence ; Metaplasia* ; Mortality ; Prevalence ; Republic of Korea ; Sensitivity and Specificity ; Stomach Neoplasms*