Cardia ; pathology ; surgery ; China ; epidemiology ; Esophageal Neoplasms ; diagnosis ; epidemiology ; surgery ; Esophagectomy ; Esophagoscopy ; Gastroscopy ; Humans ; Mass Screening ; Minimally Invasive Surgical Procedures ; Precancerous Conditions ; diagnosis ; surgery ; Stomach Neoplasms ; diagnosis ; epidemiology ; surgery

Statistical analysis of 792 cases of gastric carcinoma is reported. Materials were collected from the medical record room during the 11 year period from Jan. 1955 to Dec. 1965. Diagnosis of gastric carcinoma was established by pathologic examination of the resected specimen, by lymph node biopsy, and by physical and X-ray findings. The age of peak incidence was in the 5th decade. The male to female ratio was 3:1. In the order of frequency, the symptoms and signs which were the most prominent and common were epigastric pain or discomfort, indigestion, anorexia, a palpable mass, weight loss, and epigastric tenderness. More than 50% of the patients had symptoms for less than 6 months. About 70% of the patients and hypochlorhydria on gastric analysis. More than 60% of the carcinomas were located in the prepyloric region. Regional lymph-node metastasis was present in 76% of the cases. In order of frequency this occurred in the omentum, celiac nodes, liver, pancreas, and mesocolon. There was a 56.4% operability and 58.8% resectability. The most common postoperative complication was wound infection. There were 9 operative deaths which made a 3.4% mortality for cases resected, and 2% mortality for all cases coming to surgery. The five year survival rate was 12.9% for all cases coming to surgery, but was increased to 22.2% for patient having a total gastrectomy and 24.2% for patients having a subtotal gastrectomy. 12.0% of patients having gastrectomy in which there were positive nodal metastases survived five years, but, when metastasis was not noted the patients who had had a gastrectomy survived at a rate of 45.5% for five years. The surgical result was influenced by several fastors other than the presence or absence of metastases to the lymph nodes. These factors included the grade of the tumor microscopically, the presence or absence of serosal involvement, and the pathologic type of the tumor. It is our opinion that our surgical results, which are poor when compared with those in the literature, are due mainly to the fact of a late diagnosis. Some of the patients were so far-advanced as to be questioned as to their being candidates for surgery. Most of the patients come to the surgeon simply because of their symptoms and signs which have developed beyond the point of tolerance, or because of family pressures to come for treatment. This study revealed that the resectability rate, and the surgical results improved year by year. This fact explains why the early diagnosis is so very important. It is felt keenly that education of the public and increased alertness on the part of both patients and physicians is needed. This is particularly true when the patient is over 40 years of age, complains of indigestion, epigastric pain or discomfort. Each of these patients should have a complete check-up. Once the chance for cure of the disease has passed it is difficult to do more than a palliative procedure.
Adult ; Aged ; Asian Continental Ancestry Group ; Female ; Human ; Korea ; Male ; Middle Aged ; Stomach Neoplasms/*diagnosis/epidemiology/*surgery

Postoperative complications are important outcome measurements for surgical quality and safety control. However, the complication registration has always been problematic due to the lack of definition consensus and the other practical difficulties. This narrative review summarizes the data registry system for single institutional registry, national data registry, international multi-center trial registries in the western world, aiming to share the experience of complication classification and data registration. We interviewed Dr. Koh from Royal Prince Alfred Hospital in Australia for single institutional experience, Dr. van der Wielen and Dr. Desideriofor, from two international multi-center trial(STOMACH) and registry (IMIGASTRIC) respectively, and Prof. Dr. Wijnhoven from the Dutch Upper GI Audit(DUCA). The major questions include which complications are obligated to report in the respective registry, what are the definitions of those complications, who perform the registration, and how are the complications evaluated or classified. Four telephone conferences were initiated to discuss the above-mentioned topics. The DUCA and IMGASTRIC provided the definition of the major complications. The consent definition provided by DUCA was based on the LOW classification which came out after a four-year discussion and consensus meeting among international experts in the according field. However, none of the four registries asked for an obligatory standardization of the diagnostic criteria among the participating centers or surgeons. Instead, all the registries required a detailed recording of the diagnostic strategy and classification of the complications with the Clavien-Dindo scoring system. Most data were registered by surgeons or data managers during or immediately after the hospitalization. The investigators or an independent third party conducted the auditing of the data quality. Standardization of complication diagnosis among different centers is a difficult task, consuming much effort and time. On top of that, standardization of the complication registration is of critical and practical importance. We encourage all centers to register complications with the diagnostic criteria and following intervention. Based on this, the Clavien-Dindo classification can be properly justified, which has been widely accepted by most centers and should be routinely used as the standard evaluation system for postoperative complications in gastric tumor surgery.
Australia ; epidemiology ; Data Collection ; standards ; statistics & numerical data ; Diagnostic Techniques and Procedures ; standards ; statistics & numerical data ; Digestive System Surgical Procedures ; adverse effects ; statistics & numerical data ; Health Care Surveys ; Humans ; Netherlands ; epidemiology ; Postoperative Complications ; classification ; diagnosis ; epidemiology ; Registries ; standards ; Risk Assessment ; methods ; standards ; Stomach Neoplasms ; complications ; surgery

BACKGROUND/AIMS: The well-organized study to support that increased cholelithiasis and bile duct dilatation can occur after gastrectomy has not been reported. The aim of this study was to determine the incidence of cholelithiasis and the degree of common bile duct (CBD) dilatation in patients undergoing subtotal gastrectomy, compared to those undergoing endoscopic treatment for gastric cancer. METHODS: Patients who diagnosed with gastric cancer and received treatment at six academic referral centers were investigated for the incidence and time of cholelithiasis and the degree of CBD dilatation after treatment by analysis of 5-year follow-up CTs. The operation group underwent subtotal gastrectomy without vagotomy, while in the control group endoscopic treatment was administered for gastric cancer. RESULTS: A total of 802 patients were enrolled in 5-year analysis (735 patients in the operation group and 67 patients in the control group). Cholelithiasis occurred in 47 patients (6.39%) in the operation group and 3 patients (4.48%) in the control group (p=0.7909). The incidences of cholelithiasis were 4.28% in Billoth-I and 7.89% in Billoth-II (p=0.0487). The diameter of proximal CBD and distal CBD increased by 1.11 mm and 1.41 mm, respectively, in the operation group, compared to 0.4 mm and 0.38 mm, respectively, in the control group (p<0.05). Patients with increased CBD dilatation more than 5 mm showed statistically significant increases in alkaline phosphatase and gamma-glutamyltransferase. CONCLUSIONS: The incidence of cholelithiasis was not increased due to subtotal gastrectomy without vagotomy, but the incidence was higher after Billoth-II compared to Billoth-I. In addition, significant change in the CBD diameter was observed after subtotal gastrectomy.
Aged ; Alanine Transaminase/analysis ; Aspartate Aminotransferases/analysis ; Bilirubin/analysis ; Case-Control Studies ; Cholelithiasis/*diagnosis/epidemiology ; Common Bile Duct/diagnostic imaging/*physiopathology ; Endoscopy, Gastrointestinal ; Female ; Follow-Up Studies ; Gastrectomy ; Humans ; Incidence ; Male ; Middle Aged ; Odds Ratio ; Stomach Neoplasms/*surgery ; Tertiary Care Centers ; Tomography, X-Ray Computed